Bone scintigraphic imaging using Tc-99m-methylene diphosphonate (MDP) is one of the most common nuclear medicine procedures. Although MDP can accumulate not only in osseous but also in soft tissue, increased MDP activity in the spleen is relatively uncommon. A 3-year-old girl with recurrent meduloblastoma underwent bone scintigraphy to evaluate for potential osteomyelitis and bone metastases. The images demonstrated increased MDP activity in the spleen in both early blood pool and 3-hour delayed images, which was due to Candida albicans infection.

Elevated MDP activity in the spleen due to fungal infection.

Earlier studies indicate that abnormal liver and spleen uptake on bone scan has been observed in association with intravenous injection of Gd-DTPA contrast for MRI. All of these patients, however, received Gd-DTPA injection prior to (99m)Tc MDP administration. We report herein 3 patients with hepatic and splenic uptake on bone scan; all were administered (99m)Tc MDP before Gd-DTPA. Thus, we can conclude that Gd-DTPA after (99m)Tc MDP administration may also induce increased hepatic and splenic radioactivity on bone scan.

Hepatic and splenic uptake on bone scintigraphy in patients with intravenous administration of 99mTc methylene diphosphonate prior to gadolinium-containing contrast.

A 47-year-old woman with a history of subtotal gastrectomy due to gastric cancer underwent bone scintigraphy to evaluate possible recurrent disease. The whole-body images revealed a single focus of elevated 99mTc-MDP activity in the right pubic region, which was located in the intrapelvic soft tissue on subsequent SPECT/CT images. Pathological examination after needle biopsy demonstrated that the soft tissue was an implantation metastasis from gastric cancer.

99mTc-MDP uptake in implantation metastasis of gastric cancer: the additional value of SPECT/CT.

A 74-year-old male patient with a newly diagnosed prostate cancer had whole-body bone scintigraphy for staging. The images did not demonstrate osseous metastasis. However, there was a large ring-shaped, relatively photopenic region with peripherally increased MDP activity in the left back, which was caused by a large lipoma.

A large soft-tissue lipoma shown on bone scintigraphy.

Purpose There are various etiologies, which can result in nonosseous, nonurologic uptake in bone scintigraphy. This study aimed to evaluate the influence of the interval between gadolinium (Gd)-containing contrast of MRI and Tc-99m DPD (Tc-99m 3,3-diphosphono-1,2-propanedicarboxylic acid) on bone scintigraphy. Materials and methods We retrospectively analyzed 1028 patients with bone scintigraphy performed between January 2010 and February 2011. All these 1028 patients had MRI contrast administration prior to bone scintigraphy. Fifty patients (8 women, 42 men) showed hepatic uptake on bone scintigraphy. The patients were subdivided into 2 groups (group A: MRI performed on the same day with bone scintigraphy, group B: MRI performed 1 or 2 days before bone scintigraphy). Results Among 1028 subjects, hepatic uptake in patients with MRI and bone scintigraphy on the same day was shown in 39 of the 585 bone scintigraphies (6.67%), while hepatic uptake with interval of 1 and 2 days was visualized in 8 of the 186 (4.30%) and 3 of the 87 (3.45%) subjects. No patients with interval more than 2 days showed hepatic uptake of bone scintigraphy. Conclusion The interval between MRI with Gd-contrast and bone scintigraphy has an influence on hepatic uptake. Gd-containing contrast injection before bone scintigraphy within 2 days might affect the nonosseous uptake of Tc-99m DPD. At least 2 days of interval between MRI and bone scintigraphy might be needed to avoid hepatic uptake of bone scintigraphy.

Hepatic uptake of Tc-99m DPD on bone scintigraphy: the influence of the interval with gadolinium-containing contrast of MRI.

Several conditions that can cause diffuse hepatic or splenic uptake of Tc-99m methylene diphosphonate (Tc-99m MDP) have been previously reported. Nevertheless, diffuse abnormal liver and spleen uptake of Tc-99m MDP associated with intravenous injection of magnetic resonance imaging contrast gadolinium-diethylenetriaminepentaacetic acid is not previously known. In our series, we reported diffuse increased Tc-99m MDP activity in the liver and spleen in bone scans in patients who received Tc-99m MDP injection shortly after contrast-enhanced magnetic resonance imaging.

Increased liver and spleen accumulation of Tc-99m methylene diphosphonate associated with intravenous injection of MRI contrast gadolinium-diethylenetriaminepentaacetic acid.

Primary extragastrointestinal stromal tumor is very rare. We report a case of cervical paravertebral extragastrointestinal stromal tumor involving adjacent bones revealed by FDG PET/CT in a 66-year-old man without any gastrointestinal involvement.

Primary Extragastrointestinal Stromal Tumor on FDG PET/CT.

A 55-year-old woman complaining of discomfort and tenderness on the right inferior thorax for 2 weeks underwent thoracic CT scan on which a well-defined expansile lesion with fat and calcification density was demonstrated in the right ninth rib. The lesion showed marked radiotracer uptake on bone scintigraphy. Histology confirmed intraosseous lipoma with inflammatory infiltration.

Intraosseous lipoma of rib with intense radiotracer uptake on bone scintigraphy.

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Increased liver and spleen accumulation of Tc-99m methylene diphosphonate associated with intravenous injection of MRI contrast gadolinium-diethylenetriaminepentaacetic acid.

Primary Extragastrointestinal Stromal Tumor on FDG PET/CT.

Intraosseous lipoma of rib with intense radiotracer uptake on bone scintigraphy.