PMC4861892_01
A 75-year-old female was referred to the nuclear medicine department for cardiac evaluation with Tc99m-Sestamibi MPS as part of cardiac clearance before a diverting end sigmoid colostomy. The patient was found to have abnormal focal uptake adjacent to the anterior wall of the left ventricle (A, B, C). Additional SPECT images in the axial, sagittal, and coronal projections were acquired during the same visit. These images localized this focus to the left fifth rib. Additional foci of sestamibi accumulation within the left upper lung field (D), left hilum (E), and right lateral aspect of the T5 vertebra (F) were demonstrated. Correlation with prior CT and FDG18-PET/CT studies confirmed these foci to be aggressive osteolytic bone metastases and lung metastasis.
gr1.jpg
PMC4861892_01_gr1.jpg
fig1
Additional foci were noted within the spine, left upper lung, and hilum (Fig. 1).
Tc99m-MDP bone scan of the same patient four months before the MPS demonstrated a photopenic focus in the T5 vertebral body (arrow) consistent with local bone destruction. A bone scan failed to demonstrate any bone findings in the left anterior chest.
gr2.jpg
PMC4861892_01_gr2.jpg
fig2
A review of medical records from another institution, in addition to correlation with outside F18-fluorodeoxyglucose (FDG) positron-emission tomography (PET/CT), MRI, and bone scans performed earlier the same year, indicated that these foci most likely represented metastases from recurrent thyroid cancer (Figure 2, Figure 3, Figure 4).
F18-FDG PET/CT study 4 months before the MPS demonstrating the left upper lung (A), left 5th rib (B) and right T5 vertebral lesions (C) with subtle increase in F18-FDG uptake.
gr3.jpg
PMC4861892_01_gr3.jpg
fig3
A review of medical records from another institution, in addition to correlation with outside F18-fluorodeoxyglucose (FDG) positron-emission tomography (PET/CT), MRI, and bone scans performed earlier the same year, indicated that these foci most likely represented metastases from recurrent thyroid cancer (Figure 2, Figure 3, Figure 4).
T2-weighted MRI demonstrates the T5 vertebral metastasis with destruction of the body and posterior elements and spinal cord impingement (A, B).
gr4.jpg
PMC4861892_01_gr4.jpg
fig4
A review of medical records from another institution, in addition to correlation with outside F18-fluorodeoxyglucose (FDG) positron-emission tomography (PET/CT), MRI, and bone scans performed earlier the same year, indicated that these foci most likely represented metastases from recurrent thyroid cancer (Figure 2, Figure 3, Figure 4).