Diffuse liver and spleen accumulation on Tc-99m methylene diphosphonate bone scan

Diffuse Liver and Spleen Accumulation on Tc-99m Methylene Diphosphonate Bone Scan Shung-Shung Sun, Shih-Chuan Tsai, Che-Chun Su, and Chia-Hung Kao the patient was off the herbs for 6 months, a follow-up bone scan showed that the liver and spleen uptake was no longer present (Fig 1C). The cause of the abnormal liver and spleen uptake while the patient was on herb therapy is unknown. In a review of previous publications, the causes of diffuse uptake by the liver and spleen on bone scan are listed in the following section.

HE EXTRASKELETAL accumulation of boneseeking radiotracers is noted in a variety of conditions that have been previously described. The combination of diffuse liver and spleen accumulation of bone-seeking radiopharmaceuticals is, however, uncommon. We have identified a case in which diffusely increased Tc-99m methylene diphosphonate (MDP) uptake in the liver and spleen was noted in a patient with juvenile rheumatoid arthritis after treatment with herbs. A 7-year-old boy with multiple arthralgias for 6 months was referred for a bone scan with a clinical impression of possible juvenile rheumatoid arthritis. The initial bone scan showed possible increased radioactivity in the hips (Fig 1A). The follow-up bone scan after treatment with herbs for 1 year showed no apparent change in the hip region. However, significant diffuse increased tracer uptake was observed in the liver and spleen (Fig 1B). No prior radiopharmaceutical had been administered. After

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From the Department of Nuclear Medicine and the Division of Rheumatology-lmmunolog~; China Medical College Hospital Taichung: the Department of Nuclear Medicine, ShowChwan Memorial Hospital Chunghua; and the Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung. Taiwan. Address reprint requests to Chia-Hung Kao. MD, Department of Nuclear Medicine, Taichung Veterans General Hospital 160 Taichung Harbor Road, Section 3. Taichung, 40705, Taiwan. Copyright 9 2001 by W.B. Saunders Company 0001-2998/01/3103-0009535.00/0 doi: l O.1053/snuc.2001.24647

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Fig 1. (A) The pretreatment whole-body bone scan showed no definite Tc-99m MDP uptake in the liver and spleen. (B) The follow-up bone scan after treat-

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ment with herbs showed significantly diffuse Tc-99m MDP uptake in the liver and spleen. (C) After the patient was off the herbs

for

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months, the showed no significantly diffuse increased tracer uptake in the liver and spleen.

follow-up bone scan

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1. Previous Tc-99m sulfur colloid liver scan simulating uptake 1 2. Radiopharmaceutical preparation causing microcolloid formation 2 3. Metastatic disease from colon cancer 3 UNCOMMON AND RARE 1. Thalassimia major 4'5 2. Metastatic disease from breast, 6'7 lung, 8 and esophageal cancer 9 3. Amyloidosis (primarily liver) 1~ 4. Treatment with herb* *Our case reported here. REFERENCES 1. Hansen S, Stadalnik RC: Liver uptake of Tc-99m pyrophosphate. Semin Nucl Med 12:89-91, 1982 2. Poulose KP, Reba RC, Eckelman WC, et al: Extraosseous localization of Tc-99m-Sn pyrophosphate. Br J Radiol 48:724726, 1975

3. Guiberteau MI, Postsaid MS, McKusick KA: Accumulation of 99mTc diphosphonate in four patients with hepatic neoplasm: Case report. J Nuc Med 17:1060-1061, 1976 4. Valdez VA, Jacobstein JG: Visualization of the liver with Tc-99m-EHDP in thalassemia major. Gastrointest Radiol 6:175176, 1981 5. Howman-Giles RB, Gilday DL, Ash JM, et al: Splenic accumulation of Tc-99m diphosphonate in thalassemia major. J Nucl Med 19:976-977, 1978 6. Costello P, Gramm HF, Steinberg D: Simultaneous occurrence of functional asplenia and splenic accumulation of diphosphonate in metastatic breast carcinoma. J Nucl Med 18:1237-1238, 1977 7. Baumert JE, Lantieri RL, Homing S, et al: Liver metastases of breast carcinoma detected on Tc-99m methylene diphosphonate bone scan. AJR A m J Roentgenol 134:389-391, 1980 8. Oren VO, Uszler JM: Liver metastases of oat cell carcinoma of lung detected on 99mTc-diphosphonate bone scan. Clin Nucl Med 3:355-358, 1978 9. Wilkinson RH, Gaedo JT: Concentration of Tc-99m methylene diphosphonate in hepatic metastases from squamous cell carcinoma. J Nucl Med 20:303-305, 1979 10. Van Antwerp JD, O'Mara RE, Pitt MJ, et al: Technetium 99m-diphosphonate accumulation in amyloid. J Nucl Med 16:238-240, 1975