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Potential of ^99mTc-MIBI for Detecting Bone Marrow Metastases

¹ Department of Nuclear Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

View larger version (65K): [in a new window]   FIGURE 1. Classification of 99mTc-MIBI activity patterns. (A) No detectable activity in patient with breast cancer was confirmed by lack of abnormal MRI findings. (B) Homogeneous mild activity in patient with lung cancer was confirmed by lack of abnormal MRI findings. (C) Clearly visualized focal activity in patient with malignant lymphoma (non-Hodgkin’s) was confirmed by abnormal MRI findings and bone marrow cytology from puncture sites on each anterior iliac crest. Clearly visualized activity of 99mTc-MIBI was interpreted as abnormal.

View larger version (52K): [in a new window]   FIGURE 2. Normal 99mTc-MIBI skeletal images of woman with hypertension with no evidence of cancer. Homogeneous mild activity was found in thoracic spine, ribs, and lumbar spine; no detectable activity was evident in femur.

View larger version (103K): [in a new window]   FIGURE 3. Patient with breast cancer. (A) Initial 99mTc-HMDP scans show no bone metastases. (B) 99mTc-MIBI scans show multiple lesions in thoracic spine, bilateral proximal femur, and right pubic bone. Findings were confirmed 1 mo later by MRI. (C) Multiple intense accumulations of 99mTc-HMDP appeared 4 mo later on whole-body scans. (D) Further 99mTc-MIBI scans (second set) show increased accumulations in thoracic spine, bilateral proximal femur, and left lung metastatic lesion. 99mTc-HMDP accumulations in more extensive sites, including bilateral proximal femur, appeared 2 mo after obtaining second set of 99mTc-HMDP scans.

View larger version (105K): [in a new window]   FIGURE 4. Patient with lung cancer. (A) 99mTc-HMDP scans show no definite bone metastases, although anterior pelvis image could not be obtained. (B) 99mTc-MIBI scans show increased uptake in multiple regions of ribs, in thoracic and lumbar spine, and in right lung tumor and also show irregular-shaped uptake in bilateral proximal femur in anterior pelvis image. MRI showed multiple metastases in thoracic spine, and bone marrow cytology from puncture sites on sternum showed many lung cancer cells.

View larger version (73K): [in a new window]   FIGURE 5. Patient with colon cancer. (A) 99mTc-HMDP scans show no metastases in thoracic spine. (B) Corresponding 99mTc-MIBI scans reveal diffuse intense uptake in thoracic spine. Bone marrow cytology from puncture sites on each anterior iliac crest indicated positive findings.

View larger version (92K): [in a new window]   FIGURE 6. Patient with prostate cancer. (A) 99mTc-HMDP scans show multiple intense accumulations in cervical spine, thoracic spine, lumbar spine, skull, and ribs. (B) In contrast, 99mTc-MIBI scans do not show any abnormalities.