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Lymphoma of the skeleton: scintigraphic evaluation
J A Orzel1, N W Sawaf, M L Richardson
1Department of Radiology, University of Washington, Seattle 98195.
AJR. American Journal of Roentgenology
|May 1, 1988
Summary
Technetium-99m diphosphonate scans reveal common, subtle skeletal lesions in lymphoma patients, often asymptomatic and involving extremities. These scans are more sensitive than Gallium-67 citrate imaging for detecting bone involvement.
Area of Science:
- Nuclear Medicine
- Oncology
- Skeletal Imaging
Background:
- Skeletal involvement is a known complication of lymphoma.
- Accurate detection of bone lesions is crucial for staging and management.
Purpose of the Study:
- To characterize the typical appearance and distribution of skeletal lesions in lymphoma patients using 99mTc-diphosphonate scintigraphy.
- To compare the sensitivity of 99mTc-diphosphonate and 67Ga-citrate scintigraphy in detecting osseous involvement.
- To correlate scintigraphic findings with skeletal symptoms.
Main Methods:
- Retrospective review of 99mTc-diphosphonate scans from 980 patients with Hodgkin or non-Hodgkin lymphoma.
- Comparison of findings with skeletal symptoms and 67Ga-citrate scintigraphy when available.
Main Results:
- Osseous involvement was detected in 4% of patients (77 scans), averaging 3.5 lesions per study.
- Hodgkin disease patients had fewer axial lesions (44%) but more extremity involvement compared to non-Hodgkin lymphoma patients (82%).
- 99mTc-diphosphonate imaging detected 95% of lesions, significantly more than 67Ga-citrate (44%). Skeletal pain was specific but insensitive.
Conclusions:
- Skeletal scintigraphy with 99mTc-diphosphonate typically shows multiple, subtle, and often asymptomatic bone lesions in lymphoma patients, frequently affecting the extremities.
- Diffuse calvarial activity is common and may persist even in remission.
- Increased juxtaarticular activity is a specific indicator of malignant skeletal involvement.