Asia Oceania Journal of Nuclear Medicine and Biology

Asia Oceania Journal of Nuclear Medicine and Biology

Usefulness of three-phase bone scintigraphy and SPECT/CT for the diagnosis of bone lesions of systemic sarcoidosis

Document Type : Case report

Authors
Shigeaki Higashiyama
Joji Kawabe
Atsushi Yoshida
Kohei Kotani
Susumu Shiomi
Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
10.7508/aojnmb.2014.01.010
Abstract
We report a three-phase bone scintigraphy for the diagnosis of a peripheral bone lesion caused by systemic sarcoidosis. A 32-year-old man with suspected osteomyelitis of the right forefinger underwent three-phase bone scintigraphy with Tc-99m hydroxymethylene diphosphonate (HMDP) and single-photon emission computed tomography/computed tomography (SPECT/CT). The lesion was rich in blood flow according to flow study and blood pool study on bone scintigraphy, and was associated with an osteolytic change on SPECT/CT imaging performed 3 hours after injection of a radioisotope (RI). Whole-body bone scintigraphy indicated multiple high levels of abnormal RI accumulation.
The findings of the three-phase bone scintigraphy and SPECT/CT suggested the presence of systemic sarcoidosis; however, a subsequent 18Ffluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) could not exclude the possibility of multiple metastases from testicular tumors. Therefore, testicular enucleation was performed, and the pathological examination confirmed the presence of sarcoidosis.
Keywords
Sarcoidosis SPECT/CT Tc
99m HMDP Three
phase bone scintigraphy
  1. Sohn HS, Kim EN, Park JM, Chng YA. Muscular sarcoidosis: Ga-67 scintigraphy and magnetic re-sonance imaging. Clin Nucl Med. 2001;26:29-32.
  2. Hoshi H, Dadparvar S, Slizofski WJ, Brown S, Glab LB, Brady LW. Bone and gallium scintigraphy in a patient with bone sarcoidosis. Radiat Med. 1989; 7: 178-80.
  3. Ortapamuk H, Naldoken S. Multisystemic sarco-idosis with uncommon osseous involvement demonstrated by Ga-67 citrate and Tc-99m MDP. Clin Nucl Med. 2004; 29: 60-2.
  4. Aoki J, Watanabe H, Shinozaki T, Takagishi K, Ishijima H, Oya N, et al. FDG PET of primary benign and malignant bone tumors: standardized uptake value in 52 lesions. Radiology. 2001; 219: 774-7.
  5. Mostard RL, Prompers L, Weijers RE, van Kroonenburgh MJ, Wijnen PA, Geusens PP, et al. F-18 FDG PET/CT for detecting bone and bone marrow involvement in sarcoidosis patients. Clin Nucl Med. 2011; 37: 21-5.
  6. Neville E, Carstairs LS, James DJ. Sarcoidosis of bone. Quarterly J Med. 1977; 182: 215-27.
  7. Haas GP, Badalament R, Wonnell DM, Miles BJ. Testicular sarcoidosis: case report and review of literature. J Urol. 1986; 135: 1254-6.
  8. Silverstein A, Siltzbach LE. Muscle involvement in sarcoidosis. Asymptomatic, myositis, and myopathy. Arch Neurol. 1969; 21: 235-41.
  9. Wallace SL, Lattes R, Malia JP, Ragan C. Muscle involvement in Boeck's sarcoid. Ann Intern Med. 1958; 48: 497-511.
  10. Ortapamuk H, Naldoken S. Multisystemic sarco-idosis with uncommon osseous involvement demonstrated by Ga-67 citrate and Tc-99m MDP. Clin Nucl Med. 2003; 29: 60-2.
  11. Horger M, Eschmann SM, Pfannenberg C, Storek D, Vonthein R, Claussen CD, et al. Added value of SPECT/CT in patients suspected of having bone infection: preliminary results. Arch Orthop Trauma Surg. 2007; 127: 211-21.
  12. Krubsack AJ. Three-phase bone scan in muscular sarcoidosis. J Nucl Med. 1991; 32: 1829-30.
  13. Morris MJ, Akhurst T, Osman I, Nunez R, Macapinlac H, Siedlecki K, et al. Fluorinated deoxyglucose positron emission tomography imaging in progressive metastatic prostate cancer. Urology. 2002; 59: 913-8.