Extensive soft tissue uptake of 99Tcm methylene diphosphonate in a patient with multiple myeloma.

Abstract

Bone scintigraphy is not usually performed in multiple myeloma (MM), as marrow deposits characteristically show no tracer uptake. However, metastatic bone disease often mimics MM both clinically and biochemically, resulting in a substantial number of MM patients undergoing bone scintigraphy. Variable appearances in these cases have been reported, ranging from normal to a superscan, the latter a result of massive tracer uptake within bone. Soft tissue uptake has been documented, often when MM is complicated by secondary amyloidosis. This usually results in mainly solid organ uptake of tracer. We report a case of MM where massive soft tissue uptake occurred, primarily within muscles, with very little isotope elsewhere.

Diffuse Hepatic and Spleen Uptake of Tc-99m MDP on Bone Scintigraphy Resembling Liver-Spleen Scintigraphy in a Patient of Plasma Cell Tumor

“…Furthermore, extraosseous uptake on bone scan is observed in patients with renal failure as a result of a failure to excrete the radiopharmaceuticals through the kidneys [14]. Hypercalcemia and hyperparathyroidism resulting from chronic renal failure cause soft tissue microcalcification [14].…”

Absent skeletal uptake of 99mTc-hydroxymethylene diphosphonate in the presence of AL-type amyloidosis associated with multiple myeloma

“…2 On bone scintigraphy, multiple myeloma with or without amyloidosis can present with varied skeletal uptakes (i.e., absent, normal, superscan). 7 The reason for this variation in the degree of bone tracer accumulation among multiple myeloma patients is not known. Evans et al reported a case of minimal skeletal uptake and marked bone tracer accumulation in the muscles on the bone scintigram in multiple myeloma and hypercalcemia patients.…”

“…Although they suggested an accumulation mechanism for muscular amyloid deposits and metastatic calcifi cations, they could not confi rm this hypothesis pathologically. 7 Kanoh et al reported that amyloid deposits, rather than metastatic calcifi cation, may affect bone tracer accumulation in soft tissues, 3 which suggests that amyloid deposits have a stronger affi nity for bone tracers than calcifi ed tissues, such as the skeleton.…”

Manifestations ostéoarticulaires des amyloses

“…Une atteinte érosive est rare, à type de géodes et/ou d'érosions souschondrales finement cernées d'ostéosclérose, correspondant à des dépôts focaux d'amylose [8] (Fig. 5 [2] peut montrer une fixation non spécifique des articulations atteintes, mais l'existence d'une fixation extrasquelettique du coeur ou de la moelle osseuse est évocatrice d'amylose [4,19].…”