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Pathologic hepatic Tc-99m-MDP uptake in polyostotic fibrous dysplasia
Ersoy Kekilli1, Cengiz Yagmur, Akin Kuzucu
1Department of Nuclear Medicine, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey. ekekilli@inonu.edu.tr
Abstract:
Fibrous dysplasia of bone is a congenital, sporadic developmental disorder characterized by immature fibrous connective tissue and bone deformities. Hepatic Tc-99m-MDP uptake is a rare, serendipitous finding during bone scanning studies. The present patient was a 25-year-old male who had severe polyostotic fibrous dysplasia. On Tc-99m-MDP (methylene diphosphonate) bone scintigraphy, increased activity accumulations were seen on multiple ribs, vertebrae and base of the cranium. In addition, diffuse increased pathologic uptake of Tc-99m-MDP in the liver was shown. Intravenous pamidronate was administered monthly for two months. In the third week of the last administration Tc-99m-MDP bone scintigraphy was performed again, but despite sustained bone involvement, pathologic hepatic uptake was not seen on the scan. We thought that pathologic hepatic Tc-99m-MDP accumulation, may be related to the formation and aggregation of calcium oxalate and phosphate crystals which improved with pamidromat treatment.
Insights
This study reports a rare case of liver uptake of Tc-99m-MDP in polyostotic fibrous dysplasia. Pamidronate treatment resolved the hepatic uptake, suggesting a link to crystal deposition.
Area of Science:
- Nuclear Medicine
- Radiopharmaceuticals
- Skeletal Dysplasias
Background:
- Fibrous dysplasia of bone is a rare congenital disorder causing bone deformities.
- Hepatic technetium-99m-methylene diphosphonate (Tc-99m-MDP) uptake is an uncommon finding in bone scans.
Observation:
- A 25-year-old male with severe polyostotic fibrous dysplasia showed increased Tc-99m-MDP uptake in bones and liver.
- The patient received monthly intravenous pamidronate for two months.
Findings:
- Follow-up bone scintigraphy revealed resolution of hepatic Tc-99m-MDP uptake despite persistent bone involvement.
- This suggests pamidronate treatment may improve or resolve abnormal hepatic accumulation.
Implications:
- Pathologic hepatic Tc-99m-MDP uptake in fibrous dysplasia might be associated with calcium oxalate and phosphate crystal formation.
- Pamidronate therapy may be effective in managing this rare scintigraphic finding.
