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Metastatic Bone Disease from
Prostate Carcinoma -
Case Study Compiled by Christy Barnosky, student technologist
Jason Freeman, CNMT, St. Joseph's Hospital, Augusta, Georgia
NM Technologists' Concerns -
Radiopharmacy: 20 mCi 99mTc-MDP
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Pt. Prep: IV injection, force fluids, 3 hour delay for best
- T/Bkg ratio, remove prostheses and pocket change
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Instrumentation: 20% Window at 140 keV, LEHR Collimator,
- WB scan speed at 12 cm/min
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Positioning: Anterior/Posterior with planar views as need for specific patient pathology, comfort for minimizing pt. motion.
Processing: Manipulate image to highlight both long bones on appropriate images, and veterbral bodies and rib pathology on others.
Current Study Findings:
A dose of 19.6 mCi of Tc99m-MDP was administered to the patient, and delayed whole body anterior and posterior images were taken at a rate of four minutes per frame. Some soft tissue uptake and visualization of the kidneys occurs. Areas of increased radiopharmaceutical uptake are seen in the cervical, thoracic, and lumbar spin. All of the ribs, the sternum, clavicles, pelvis, femurs, and epiphysis of the left humerus also show areas of increased uptake consistent with the spread of osteoblastic metastatic bone cancer. The patient has elected to discontinue further cancer treatment in an effort to maintain his quality of life as long as possible.
Patient History:
Patient is an 84-year old white male with a history of prostate cancer, which was diagnosed in 1992. A whole body bone scan was recommended to determine if the prostate malignancy had metastized to bone. At the time of diagnosis, a whole body bone scan was performed using a 20 mCi dose of 99mTC MDP. Uniform isotope distribution was observed throughout the osseous structures. No metastitic bone disease was observed at that time.
An April 1997 whole body bone scan shows increased uptake in the left pubic ramus and symphysis, the L2-3 spinal area, and the dorsal spine (centered at D8 and D9) and the ribs. Some bone degeneration in the feet is also noted. These findings are consistent with metastatic prostate carcinoma. Radiographs of the pelvis, lumbar spine, and dorsal spine are recommended.
A subsequent whole body bone scan done in October 1998 depicts
areas of increased radiopharmaceutical uptake in the acetabulum on the right side; the pedicle of the L2 vertebrae; the T6, T7, and T8 vertebrae; the medial aspect of the 6th and 7th ribs on the left side; the second rib on the left posteriolaterally; and the manubrium of the sternum. When compared with the Aprill 1997 scan, these hot spots are consistent with metastitic lesions. Some increased uptake in the hands, ankles, and feet is consistent with arthritis.
The patient presents in April 2000 with back, neck, and shoulder pain following a fall in his home. Radiographs of the left shoulder, lumbar and cervical spine, and a whole body bone scan are requested.
The whole body scan showed areas of increased uptake in the areas seen in previous scans, with areas of increased uptake also seen in the 8th and 9th ribs, T5-8 and T-10 vertebrae, sacrum, and right femur. A follow-up whole body bone scan was requested for September 2000. (Findings described above)