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

Document Type : Case report

Authors

Department of Nuclear Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan

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


  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.