n.58 – HEART UP-TAKE OF 99mTc-HDP IN BONE SCAN



Abstract

BACKGROUND-AIM
To clear meaning of 99mTc-HDP myocardial uptake in bone scan and to verify if it may give important clinical and diagnostic informations.
METHODS
In a period of 5 years (from January 2009 to October 2014) we enrolled and submitted to bone scintigraphy 4869 patients (PTs).
Bone scan images revealed in 13 PTs 99mTc-HDP intense homogeneous heart up-take. 12 of these PTs were male and have prostate cancer; 1 was a woman with painful hip prosthesis and was submitted to three phase bone scintigraphy.
Other PTs who were performed to bone scan in the same days of those 13 PTs enrolled showed lack of heart up-take.
Bone scans of all these PTs were negative for bone metastases or other findings, except for a male examined in 2012 who had vertebral metastases.
Clinical situation of these 13 PTs was studied at the moment of bone scan and they were submitted to a follow-up until October 2014. During follow-up we observed presence of heart diseases, therapy changing of and other clinical setting modifications.
RESULTS
During follow-up we discovered that a man who was submitted to bone scan in January 2010, died suddenly 2 months later for a diffuse myocardial infarction. He used bicalutamide [Casodex] after
prostatectomy, previously he wasn’t an heart PT and, after bone scan, he did electrocardiogram and echocardiography with evidence of pericardial pouring, so he was treated with diuretic therapy (furosemide and ramipril).
Another PT caring only with bicalutamide showed pericardial pouring in echocardiography, so he was submitted to furosemide therapy. 2 years before discovering prostate cancer, he was submitted to dissection of a basal-cell carcinoma of the skin of his head and then a metastasis localized in the neck.
Other PTs hadn’t hearth diseases or other important clinical events during follow-up.
PT with bone metastases was performed to radiotherapy.
Pathological calcifications may be classified mainly into three types:
1. Dystrophic calcifications of dying or dead tissue due to increased calcium-binding capacity of the exposed denatured proteins of the injured cells with phosphate ions that react with calcium and form calcium deposits.
2. Metastatic calcifications in undamaged tissue as results of hypercalcemia due to renal failure, hypervitaminosis D and hyperparathyroidism or increased bone demineralization from bone tumors or disseminated metastases.
3. Heterotopic bone formation with the presence of bone in soft tissue where it doesn’t normally exist secondary to transformation of pluripotent mesenchymal cells of the connective tissue into the osteogenic cell line.
We verified that 99mTc-HDP heart up-take in the PTs enrolled may be result of heart metastatic calcifications due to renal failure in 10 PTs, hyperparathyroidism in 2 PTs and hypervitaminosis D in a male.
CONCLUSION
We think that heart activity in bone scintigraphy must be underlined in the report because it allows to study unknown heart disease due to renal failure, hyperparathyroidism or to hypervitaminosis D.

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