False Negativity of Tc-99m Labeled Sodium Phytate Bone Marrow Imaging Under the Effect of G-CSF Prescription in Aplastic Anemia: A Case Report

Document Type : Case report


Department of Radiology and Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, PR China


Granulocyte colony-stimulating factor (G-CSF) is a hematopoietic cytokine which controls the differentiation and growth of hematopoietic cells in the bone marrow. We report a severe aplastic anemia (SAA) patient with false-negative 99mTc sodium phytate bone marrow imaging findings under concurrent G-CSF therapy. The first bone marrow imaging showed a normal bone marrow activity. However, the bone marrow biopsy pathology report revealed a lack of hematopoietic cells. Furthermore, the complete blood count indicated severe pancytopenia resulting in the diagnosis of aplastic anemia (AA). A second marrow scan implemented after the stoppage of G-CSF showed an abnormal bone marrow activity, which matched the pathology reports. Accordingly, the concurrent administration of G-CSF was considered as the cause of false-negative bone marrow imaging findings obtained in the first scan. Consequently, it should be kept in mind that a 99mTc sodium phytate bone marrow scintigraphy during the concurrent administration of G-CSF may lead to the achievement of false negative results because it induces changes in bone marrow mimicking a normal marrow scan in patients with AA.


Main Subjects

1. Mehta HM, Malandra M, Corey SJ. G-CSF and GM-CSF in neutropenia. J Immunol. 2015;195(4):1341-9.
2. Hanna SL, Fletcher BD, Fairclough DL, Jenkins JH 3rd, Le AH. Magnetic resonance imaging of disseminated bone marrow disease in patients treated for malignancy. Skeletal Radiol. 1991;20(2):79-84.
3. Ricci C, Cova M, Kang YS, Yang A, Rahmouni A, Scott WW Jr, et al. Normal age-related patterns of cellular and fatty bone marrow distribution in the axial skeleton: MR imaging study. Radiology. 1990;177(1):83-8.
4. Kojima S. Use of granulocyte colony-stimulating factor for treatment of aplastic anemia. Nagoya J Med Sci. 1999;62(3-4):77-82.
5. Hanrahan CJ, Christensen CR, Crim JR. Current concepts in the evaluation of multiple myeloma with MR imaging and FDG PET/CT. Radiographic. 2010;30(1):127-42.
6. Mabuchi S, Morimoto A, Fujita M, Isohashi K, Kimura T. G-CSF induces focal intense bone marrow FDG uptake mimicking multiple bone metastases from uterine cervical cancer: a case report and review of the literature. Eur J Gynaecol Oncol. 2012;33(3):316-7.
7. Zampa V, Cosottini M, Michelassi C, Ortori S, Bruschini L, Bartolozzi C. Value of opposed-phase gradient-echo technique in distinguishing between benign and malignant vertebral lesions. Eur Radiol. 2002;12(7):1811-8.
8. Cakir FB, Baysal B, Dogan O. False positivity of magnetic resonance imaging under the effect of granulocyte-colony stimulating factor in a child with leukemia. Contemp Oncol. 2013;17(3):334-6.
9. Liang C. Hematic and lymphatic system. In: Zhang Y, Kuang A, Huang G, editors. Nuclear Medicine. 1st ed. Beijing, China: People’s Health Publishing House; 2005. P. 305-15