Diphosphonate intestinal activity seen on two bone images in neuroblastoma

Neuroblastoma is well recognized as a cause of soft tissue uptake of Tc-99m MDP. Two cases of neuroblastoma arising in the midline from the celiac axis are reported. Bone imaging performed on two separate days showed not only typical soft tissue uptake, but also the appearance of the radiopharmaceutical in the bowel. At surgery, a midline upper abdominal neuroblastoma was found in both patients without evidence of involvement of the liver, kidneys, bowel, gallbladder or mesentery. It became apparent with delayed images in the second patient that this activity was in the bowel and moving around the abdomen in a typical large bowel pattern. Bowel activity was not seen in other patients having bone scans at this time. Follow-up bone imaging on the first patient after resection of the tumor did not demonstrate diphosphonate activity in the bowel. These authors have never seen or read of this finding previously in this condition, and report it in these two patients.