PMC3312464_01
Tc-99m MDP WBBS of the first admission found multiple lesions with intensive radioactive accumulation in skull, mandible, left humerus, scapulas, ribs, vertebras, pelvis, femurs, and tibias.
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fig1
All of images of Tc-99m MDP WBBS (Figure 1), left shoulder joint MRI (Figure 2), and thoracic CT (Figure 3) indicated bone metastases. Another Tc-99m MDP WBBS (Figure 4) was performed, and similar findings (except for deterioration of right femur site) were observed as shown in the previous one (Figure 1).
MRI of left shoulder demonstrated isointensity and mild-hypo-intensity signal on T1-weighted images (A), hyperintensity signal on T2-weighted images (B), and inhomogenily enhanced after Gd-DTPA administration (C) in humeral midshaft and surrounding soft tissues. These abnormal signals prompted bone malignancy and pathologic fracture.
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fig2
All of images of Tc-99m MDP WBBS (Figure 1), left shoulder joint MRI (Figure 2), and thoracic CT (Figure 3) indicated bone metastases.
Chest CT of bone window showed eroded bone destruction with sclerotic edge in scapulas and ribs ((A): right scapula; (B): left scapula and the left 5th posterior rib) and patchy high density in thoracic vertebrae (C) However, the amount of the lesions was greater than that in Tc-99m MDP WBBS within the corresponding thoracic area. The bone lesions on CT with intensive Tc-99m MDP accumulation prompted multiple bone metastases.
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fig3
All of images of Tc-99m MDP WBBS (Figure 1), left shoulder joint MRI (Figure 2), and thoracic CT (Figure 3) indicated bone metastases.
Tc-99m MDP WBBS of the second admission 2 years later showed multiple bone involvement observed as similar to those found in the previous Tc-99m MDP WBBS except the increased radioactive accumulation in fractured right femur.
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fig4
Another Tc-99m MDP WBBS (Figure 4) was performed, and similar findings (except for deterioration of right femur site) were observed as shown in the previous one (Figure 1).
PMC3312464_02
Tc-99m MDP WBBS before chemotherapy found a wide range of abnormal radioactive accumulation in ribs, thoracic and lumbar vertebra, sacrum, and pelvis.
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fig5
Tc-99m MDP WBBS (Figure 5) was performed before chemotherapy and found multiple bones accumulated the agent abnormally.
PMC3312464_03
Tc-99m MDP WBBS showed ribs, spine, and pelvis intensively accumulated the agent and was very similar to the changes of multiple bone metastasis.
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fig6
Tc-99m MDP WBBS (Figure 6) demonstrated high uptake in multiple bones.
PMC3312464_04
Tc-99m MDP WBBS found abnormal intensive accumulation in right femur, tibia, and cotyle suggesting tumor, and decreased accumulation in upper right femur due to the previous operation.
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fig7
WBBS (Figure 7) before operation found abnormal accumulation in right femur, tibia, and cotyle.
PMC3312464_05
Tc-99m MDP WBBS before operation demonstrated intensive radioactive accumulation in multiple metacarpophalangeal and interphalangeal joints of left hand, left ulna, left radius, and right femur.
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fig8
Tc-99m MDP WBBS (Figure 8) found additional bones involvement. This patient received sectional resection of multiple lesions in left hand and allograft the next day.