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Effects of dichloromethylene diphosphonate on the osteolytic and osteoplastic effects of rat prostate adenocarcinoma cells.

A model system of prostate adenocarcinoma (PA) in Lobund-Wistar rats is described in which the transplanted tumor cells (PA-III) were inoculated sc over the calvaria. A local tumor developed that, when attached to the bone, caused erosion and fragmentation of the bone, with adjacent osteoplastic changes and metastases to the lungs. The attachment of the tumor to the bone was enhanced if the periosteum was scratched during the inoculation of tumor cells. The destructive effect on bone structure was also induced by in vivo transplanted PA-I and PA-IV cells, but not by PA-II cells. In rats that were pretreated with dichloromethylene diphosphonate, the local PA-III tumors developed with metastases to the lungs, but the calvariae were intact.

Adenocarcinoma↗

99MTc-metyhlene diphosphonate concentration in soft tissue malignant fibrous histiocytoma.

Four cases of non-calcifying soft tissue malignant fibrous histiocytoma are presented which showed concentration of 99mTc-methylene diphosphonate. Angiography was performed in one of the patients and it featured hypervascularity, tumor staining and early draining veins indicative of arteriovenous shunting. As with other extraskeletal non-calcifying entities which exhibit enhanced uptake of 99mTc-phosphate complex, the mechanism of concentration is largely conjectural. Malignant fibrous histiocytoma can be added to the expanding list of conditions which may portray in avidity for 99mTc-phosphate complex.

Aged↗

Splenic visualization using 99mTc-methylene diphosphonate in a patient with sickle cell disease.

Splenic visualization with a bone-seeking agent 99mTc-methylene diphosphonate (99mTc-MDP) with absence of splenic uptake using sulfur colloid was seen in a 15-year-old boy in sickle cell crisis. Uptake of 99mTc-MDP is probably due to splenic infarction and calcification. This represents a potentially sensitive method for following the functional auto-splenectomy process in sickle cell disease and may also detect the presence of splenic tissue when it is not visualized in a sulfur colloid liver/spleen scan. Splenic visualization by bone-seeking agents should not be confused with skeletal lesions or indicate the presence of an abnormal left upper quadrant mass lesion.

Adolescent↗

Metastatic abdominal implants of endometrial carcinoma demonstrated on 99mtc-methylene diphosphonate bone scan.

Metastatic serosal and omental implants from a primary papillary endometrial carcinoma were well demonstrated by radionuclide uptake on a bone scan utilizing 99mTc-methylene diphosphonate. Imaging of an endometrial malignancy by a 99mTc-labeled phosphate compound has not previously been reported. While the exact mechanism of accumulation in such soft-tissue neoplastic foci is not known, several possibilities have been suggested. In this particular case, the mechanism appears related in some way to the presence of dystrophic calcifications within the metastatic deposits.

Abdominal Neoplasms↗

Tc-99m diphosphonate imaging in the differential diagnosis of thyroid nodules.

Early Tc-99m diphosphonate (DP) imaging was performed in 122 patients with cold thyroid nodules in an effort to differentiate benign nodules from malignant. Immediately upon completion of the routine 24-hour I-123 uptake and multiview pinhole imaging, Tc-99m DP was injected intravenously and three serial 3-minute anterior images of the thyroid gland were obtained. Follow-up information was available in 85 patients. All cystic lesions had less Tc-99m uptake as compared with the uptake in the normal parts of the thyroid. However, 48 of 50 solid nodules had Tc-99m DP uptake to the same or greater degree than did the normal gland. The other two had mixed pattern on ultrasound examination. Most of the carcinomas (8 of 10) and benign adenomas (15 of 22) had identical appearance on Tc-99m scans, i.e., uptake in the lesion being the same as in the normal thyroid. It appears that by using this technique it is possible to separate solid nodules from cystic, but not benign from malignant.

Diagnosis, Differential↗

Transient loss of femoral head Tc-99m diphosphonate uptake with prolonged maintenance of femoral head architecture.

Nine pediatric patients presented with synovitis and suspected Legg-Perthes disease, hemarthrosis, acute slipped capital femoral epiphysis, prolonged traumatic hip dislocation, or transcervical femoral fracture. All had hip scintigraphs that showed loss of Tc-99m diphosphonate uptake in the affected femoral head. Radiographic changes associated with aseptic necrosis failed to appear during the initial follow-up period of three to 14 months. Repeat scintigraphy showed complete revascularization in six cases and partial revascularization in two. Reambulation at 1.5 to eight months after presentation was accomplished without recurrence of pain in seven cases, without development of x-ray changes in 5 cases. Three children developed x-ray changes associated with avascular necrosis after reambulation, while one child had minimal x-ray changes. Some children with loss of uptake in the femoral head do not develop x-ray changes associated with aseptic necrosis.

Adolescent↗

Early diagnosis of myositis ossificans with Tc-99m diphosphonate imaging.

Myositis ossificans is primarily a disorder of young adults, whereby an area of muscle mass undergoes progressive ossification. The authors review a case in which the patient's presentation was somewhat atypical, and where the course of disease was unusually prolonged. Examination of the soft tissue lesion using Tc-99m diphosphonate bone scans was helpful in establishing the diagnosis and in determining the full extent of the process early in its evolution.

Adult↗

Comparison of technetium-99m pyrophosphate and technetium-99m methylene diphosphonate with variable amounts of stannous chloride in the detection of acute myocardial infarction.

The authors prospectively compared the ability of Tc-99m pyrophosphate (PYP) and Tc-99m methylene diphosphonate (MDP) to detect acute myocardial infarctions. The agents used were PYP (12 mg) with 3.4 mg of stannous chloride, MDP (10 mg) with 1.0 mg of stannous chloride, and MDP (10 mg) with 3.4 mg of stannous chloride. Imaging was performed on three consecutive days on 34 patients with proven myocardial infarctions, using the same agent on the first and third days of the study and an alternate agent on the second day. Agents were assigned randomly to each of six groups of patients. First images were obtained an average of 3.7 days (range, one to six days) following myocardial infarction. Seventeen of 23 patients (75%) had images positive for acute myocardial infarction with Tc-99m PYP, whereas only two of 21 patients (9.5%) had positive studies with Tc-99m MDP with 3.4 mg of stannous chloride and one of 24 patients (4.2%) had positive studies with Tc-99m MDP and 1.0 mg of stannous chloride. All three myocardial infarctions detected by Tc-99m MDP were extensive and transmural. When MDP and PYP were both positive in the same patient, the apparent size of the myocardial infarction was much smaller with the MDP. It is concluded that MDP can detect only large myocardial infarctions, has poor localization in the infarcted tissue, and varying the stannous chloride content of the preparation does not improve the ability of MDP to detect acute myocardial infarctions.

Adult↗

Technetium-99m MDP vs technetium-99m dicarboxypropane diphosphonate. A clinical comparison in various pathologic conditions.

The performance of Tc-99m MDP vs Tc-99m dicarboxypropane diphosphonate (DPD) was evaluated in 20 patients with various skeletal bone diseases. Each patient was investigated twice, with an interval of three days between studies and using the same protocol, hence each case served as its own control. The results were: In a subjective interpretation by five independent and experienced investigators, the difference between agents was small, yet in favor of MDP. Region of interest (ROI) analysis of the pooled results in 74.4% of all cases shows a higher bone lesion to normal bone ratio (BL/NB), and in 79.3% of all cases, a better bone lesion to soft tissue ratio (BL/ST) with Tc-99m MDP. When considering pathology types separately, the BL/NB ratio of Tc-99m MDP was 17.7% higher than the one of Tc-99m DPD in metastases, 9.5% higher in rheumatoid arthritis, 2.8% higher in metabolic diseases, and 24% higher in bone fractures. Student's paired t test on the pooled BL/NB ratios shows a difference of 15.5% for Tc-99m MDP, significant at P = 0.00155. The overall results of our study favor Tc-99m MDP.

Adult↗

Hepatic uptake of technetium-99m diphosphonate in thalassemia major.

Two cases of thalassemia major are presented in which bone scintigraphy demonstrated diffuse hepatic uptake of Tc-99m diphosphonate. Although abnormal splenic and renal uptake of Tc-99m phosphates has been reported in patients with thalassemia major, hepatic uptake has not been reported previously. This scintigraphic finding is presumably due to increased iron deposition in the liver, resulting from increased iron turnover and retention in these patients and from multiple previous blood transfusions.

Adult↗

Tc-99m dicarboxypropane diphosphonate uptake in ovarian fibrothecoma.

A 76-year-old woman had a palpable mass in the lower abdomen. Computed tomography showed an abnormal pelvic mass with necrotic areas, probably of ovarian origin. A Tc-99m dicarboxypropane diphosphonate whole-body scan performed to evaluate the extent of the disease (i.e., the presence of bone metastases) revealed only diffuse uptake of the tracer in the pelvis. Histopathologic analysis after surgical excision of the mass revealed a fibrothecoma of the right ovary, which is a benign tumor composed of cells derived from the ovarian stroma and, in some instances, resembles the thecal element of the follicle.

Aged↗

Removal of strontium by the chelating agent acetylamino propylidene diphosphonic acid in rats.

Studies of the effects of the chelating agent, calcium acetylamino propylidene diphosphonic acid (Ca-APDA), on the removal of radioactive strontium with two administration modalities were carried out in rats. The parenteral (intraperitoneal) administration of 150, 300, or 600 mg kg(-1) Ca-APDA was carried out for 3 d, 10 min after exposure of the animals to the strontium injection. On the first day post-treatment, the retention of strontium in the whole body decreased to 90.1%, 83.9%, and 35.1% that of the control level, respectively. The strontium deposited in femur of 600 mg kg(-1) Ca-APDA group was lowered to 28.4% of the control value. A single oral dose of 600 mg kg(-1) Ca-APDA administered simultaneously with, or 10 min after, oral administration of strontium, radionuclide retention in the whole body was reduced after 1 d to 42.9% and 31.9% of the control, respectively; meanwhile the strontium deposited in the femur was reduced to 16.9% and 29.3% of the control. In conclusion, the results indicate the efficacy of the new agent, Ca-APDA, to remove radioactive strontium from the body, or to inhibit the strontium intestinal absorption, in radio-strontium contaminated individuals.

Administration, Oral↗

Clinical evaluation of a technetium-99m bone imaging agent based on the vicinal diphosphonate 1,2-diphosphonoethyleneglycol (DPEG).

From a series of technetium-99m labelled agents based on a vicinal diphosphonic acid structure, the ligand 1,2-diphosphonoethyleneglycol (DPEG) was selected for clinical study on the basis of a biodistribution in rats which compared well with that of methylene disphonphonate (MDP). The 99Tcm-DPEG agent was assessed in ten patients in whom bone metastases had been demonstrated by 99Tcm-MDP imaging two to seven days previously. Visual comparison of the skeletal images obtained with the two agents revealed the same number of bone metastases at the same locations. Statistical analysis of the data revealed no significant differences between the two radiopharmaceuticals on the basis of lesion to soft tissue ratio and lesion to normal bone ratio, although a slightly higher lesion to soft tissue ratio was found for MDP than for DPEG (p less than 0.03). At least for the formulation tested, it is concluded that this new radiopharmaceutical based on the P-C-C-P structure does not possess diagnostic advantages over 99Tcm-MDP for the detection of bone metastases.

Aged↗

A simple method for estimating the skeletal uptake of diphosphonates.

It is possible to obtain an estimate of the bone uptake of diphosphonates after 3 h (BU) on the basis of the difference between the dose administered and the sum of the component eliminated in the urine plus the component present in the extra-osseous volume of distribution. The results of this simple method have been compared in 15 patients using whole body retention at 24 h (determined by means of a complete urine collection) and the ratio of plasma concentrations of 51Cr-EDTA/99Tcm-HMDP after 3 h (DPS). Both DPS and BU can be used on a practical basis, and therefore be used routinely with scintigraphy. The added advantage is that, for BU, the use of a second radiopharmaceutical is avoided.

Adult↗

Skeletal scintigraphy with technetium diphosphonate in multiple myeloma--a comparison with skeletal x-ray.

Twenty-one patients with multiple myeloma were examined in close time relation with skeletal X-ray survey and bone scanning using technetium diphosphonate. Results indicate that X-ray is superior to bone scan in detecting myelomatous bone lesions. Approximately twice as many lesions were detected by X-ray as by bone scan. An exception to this general finding is the lumbar spine and rib cage, in which the two methods are equally reliable. Thus, a negative bone scan does not exclude the possibility of a myelomatous bone lesion.

Bone Neoplasms↗