Contribution of Bone Scintigraphy in the Metastatic Extension Assessment of Prostate Cancer: A Study of 288 Cases in the Nuclear Medicine Department of Idrissa Pouye General Hospital, Dakar

Introduction: Prostate cancer is the most frequently diagnosed male malignancy and the fifth leading cause of cancer death in men worldwide. Since the advent of screening methods such as Prostate Specific Antigen (PSA) assay, digital rectal examination (DRE) and prostate biopsy, its incidence has increased significantly. The aim of our study was to analyse aspects of bone scintigraphy (BS) as part of the metastatic extension assessment of prostate cancer in Senegal. Patients and Methods: This was a retrospective descriptive and analytical study, running from January 1er 2022 to August 31 2023. Patients with histologically confirmed prostate cancer were included. Whole-body scans (WBS) were performed using a dual-head SPECT gamma camera (Mediso Nucline TM Spirit DH-V type), 3 hours after intravenous injection of 8 MBq/kg (555 to 740 MBq) of 99mTc-HMDP. Results: A total of 288 patients with a mean age of 68.37 ± 7.79 years were included. The median total PSA level was 97.6 ng/ml, with 144 patients having a level greater than or equal to 20 ng/ml. All patients had adenocarcinoma, and the Gleason score was available in 202 (70.13%) patients, 75.75% of whom had a score greater than or equal to 7. BS was contributory in 70.48% of cases, with 30.90% positive and 39.58% negative. The result was inconclusive in 85 patients (29.51%). The mean PSA for patients with a positive scan was 190.2 ng/ml and 40.6 ng/ml for those with a negative scan. Multiple metastatic lesions predominated (87.35% of cases). Metastatic lesions occurred preferentially in the axial skeleton, with a proportion of 68% versus 32% in the appendicular skeleton. Classification of bone metastases according to the SOLOWAY score revealed grade I (62.07%), grade II (35.63%) and grade IV (2.30%). Conclusion: In Senegal, prostate cancer is generally diagnosed in men of advanced age. The presence of bone metastases is frequent in its evolution, transforming a curable localized disease into a generalized disease with a compromised prognosis. Bone scintigraphy remains an essential part of the initial work-up and evaluation of response to treatment.

Contribution of Bone Scintigraphy in the Diagnosis of a Case of SAPHO in the Nuclear Medicine Department of Idrissa Pouye General Hospital (Dakar, Senegal)

Introduction: The acronym SAPHO (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) is a syndrome combining osteoarticular and cutaneous manifestations. It occurs mainly between the ages of 30 and 50. Sternocostoclavicular hyperostosis is one of the main distinguishing features. We report a case of SAPHO in Dakar diagnosed by bone scintigraphy. Observation: 28-year-old Senegalese women presented with left shoulder pain and relative functional impotence for over 2 years. Examination revealed right sternoclavicular hyperostosis and left shoulder pain on palpation. Questioning revealed a history of acne and hyperostosis of the right first toe. Bone scintigraphy, performed after injection of 630 MBq of 99mTc-HMDP, revealed: hyperfixation of the bilateral (right++) manubrio-sternal and sternoclavicular junction, producing the classic bull’s horn image;hyperfixation of the left shoulder with an inflammatory appearance;hyperfixation of the sacroiliac joints suggestive of bilateral sacroiliitis;hyperfixation of the right first toe;two mandibular hyper fixations probably related to dental damage. This scintigraphic appearance in one was strongly suggestive of SAPHO syndrome. Conclusion: SAPHO syndrome, related to spondyloarthropathy, associates cutaneous and osteoarticular signs. It is characterized by frequent delays in diagnosis due to poor recognition. Soy is an invaluable diagnostic tool, enabling us to assess the extent of the disease and its evolution.

Place of Bone Scintigraphy in the Assessment of Extension and Follow-Up of Breast Cancer in Senegal: Study of 165 Cases in the Nuclear Medicine Department of Idrissa Pouye General Hospital (Dakar)

Introduction: Breast cancer is the most common cancer in women worldwide, accounting for an estimated 22% of all female cancers. It is the leading cause of cancer mortality in women, almost all of which is due to metastases, with 73% of metastases occurring in the bone. In oncology, metastable technetium 99-labelled methylene bisphosphonate bone scintigraphy (BS) remains the standard examination for detecting and assessing the extent of bone metastases. The aim of this study was to assess the role of BS in the evaluation and follow-up of breast cancer in Senegal. Methodology: This was a retrospective study of breast cancer patients who underwent bone scintigraphy with 99mTc-HMDP in the nuclear medicine department of Idrissa Pouye General Hospital (IPGHO), from July 2009 to June 2022. Results: We enrolled 165 patients, mean age 46.79 years (27 - 87 years). BS was performed in 94.37% of cases for post-therapeutic monitoring and in 5.63% for pre-therapeutic assessment. Results were contributory in 131 patients (92.25%), of whom 72 cases (50.70%) were normal and 59 cases (41.55%) positive or presenting bone metastases;and non-contributory or doubtful in 11 cases (7.75%). Secondary bone locations were multiple in 57 cases (96.61%) and single or solitary in 2 cases (3.39%). The scintigraphic appearance of bone metastases was hyper-fixative in 58 cases (98.31%) and mixed in 1 case (1.69%). Bone lesions were quantified using the Soloway’s grading classification. Conclusion: BS with 99mTc-labelled bisphosphonates remains the examination of choice for skeletal exploration, in the detection and extension of bone metastases in breast cancer. Performance has been enhanced by the development of SPECT coupled with CT (SPECT-CT).

The value of bone scintigraphy on the determination of the full extent of tumor involvement in jaw bones

Objective： To prospectively investigate the value of bone scintigraphy on determining the full extent of tumor involvement in jaw bones and to assess the presence of metastases. Methods： This study had local ethical committee approval, and all patients gave written informed consent. Thirty seven consecutive patients with primary malignant tumor in jaw bones were recruited for the study. Bone scintigraphy was performed in all patients before surgery to measure the full extent of bony involvement, which was compared with histologic findings. Results： Whole body scan revealed one case with multiple bony metastases. Resection specimens of 36 bone neoplasms were pathologically analyzed to identify type and size of each tumor. The lengths of the tumor involvement in jaw bones defined by bone scintigraphy and pathology were 5.62 ± 1.58 cm, 4.48 ± 1.57 cm, respectively （P 〈 0.05）. The tumor negative margins from removed specimens according to bone scintigraphy were pathologically confirmed. With histologic findings as the standard of reference, the accuracy of bone scintigraphy was 100% （36 of 36 patients） in determining the full extent of tumor involvement in jaw bones. Conclusion： Bone scintigraphy tends to offer specific guidelines in determining the appropriate extent of bone resection while entirely clearing the tumor cells and preserving functions whenever possible and in establishing the bony metastases.

The diagnostic correlations of bone scintigraphy,pathological grade and PSA for metastatic prostate cancers

Objective： The aim of the study was to investigate the correlations between pathological grade, serum prostatespecific antigen （PSA） and bone scintigraphy in the diagnosis of metastasis diseases for prostate cancers, and to explore the characteristics of bone metastases for prostate cancer. Methods： Seventy-seven newly diagnosed prostate cancers were reviewed in the study. All the cases underwent bone scintigraphy, total serum PSA measurement by luminescent immunoassay before operation and were classified according to post-operative pathology diagnosis. We analyzed the correlations of the bone metastasis incidences and different pathological grades or different PSA levels. Results： Bone scans were indicative of metastases in 33 cases （42.86%）. Significantly higher incidence of bone metastasis was observed in patients with poorly differentiated prostate cancer compared with patients with well （X2 = 10.880, P = 0.001 〈 0.05） and moderately （X2 = 6.166, P = 0.013 〈 0.05） differentiated prostate cancers. No significant difference between the well differentiated and moderately differentiated prostate cancers was found （X2 = 0.612, P = 0.434 〉 0.05）. The serum PSA concentration had＇significant correlation with the incidence of bone metastasis. In 26 patients with PSA 〈 20 ng/mL, 5 cases （19.23%） had bone metastasis while 28 of 51 cases （54.90%） with PSA〉 20 ng/mL had bone metastasis. The serum PSA concentration had positive correlation with pathological grades of prostate cancer （r = 0.535, P = 0.01）. Conclusion： Bone scintigraphy plays a great role in the diagnosis of bone metastasis for prostate cancer patients currently. The poorly differentiated prostate cancer and PSA 〉 20 ng/mL most likely suggested the possibility of bone metastasis.

Occult Fractures in the Carpal Region:Incidental Findings on Bone Scintigraphy

The aim of this study was to evaluate the number and distribution of fractures around the wrist found on bone scintigraphy in patients with a clinically suspected scaphoid fracture and negative initial radiographs. We retrospectively included 445 consecutive patients with a suspected scaphoid fracture who underwent routine bone scintigraphy. None of the radiographs showed evidence of a fracture. We analyzed the type and number of other fractures incidentally found on bone scintigraphy. On average, bone scintigraphy was done in 4 days (1 - 9). The outcome of bone scintigraphy: 80 (18.0%) a scaphoid fracture, 145 (32.6%) another fracture in the carpal region, 208 (46.7%) normal and the diagnosis of 12 (2.8%) was unclear. In the present study, we demonstrated that in patients with a clinically suspected scaphoid fracture and negative initial radiographs, bone scintigraphy detected in many cases (64.4%) other fractures in the carpal region. This suggests that radiographs not only miss scaphoid but also many other carpal and distal radius fractures. Solutions should be found to solve this problem and probably advanced imaging techniques like CT, MRI or bone scintigraphy should be used in the correct clinical scenario.

The value of ^(99m)Tc methylene diphosphonate bone scintigraphy in diagnosing relapsing polychondritis

Relapsing polychondritis （RP） is a recurrent disease involving cartilage mainly of the ear,nose, larynx, trachea, and bronchus. The typical manifestations of the disease in the ear and nose can be easily recognized, but the symptoms could be ignored or easily confused with those of other diseases when the cartilage of other sites is involved. Thus, it is necessary to develop a new technique for the diagnosis of this disease. Few cases of abnormal accumulation of radioactivity at cartilage shown by ^99mTc methylene diphosphonate （MDP） bone scintigraphy are described in the literature. In this report, we present 4 patients of whom 3 had positive findings on ^99mTc MDP bone scintigraphy with an assessment of ^99mTc MDP bone scintigraphy in the diagnosis of RP.

Contribution of Scintigraphy in the Assessment of Extension of Osteophilic Cancers in Senegal from 2018 to 2021

The aim of this study was to highlight the contribution of bone scintigraphy in the assessment of extension of osteophilic cancers in Senegal. This was a retrospective study, with a descriptive and analytical purpose, carried out over a period of four (04) years between January 01, 2018 and December 31, 2021. It focused on the files of patients who underwent bone scintigraphy for extension assessment of an osteophilic cancer during the study period. According to the study, prostate cancer was by far the most representative primary cancer (86.9%). Scintigraphy contributed in 75% of cases (362 cases) with 35% positive scintigraphy and 40% negative scintigraphy. The result was doubtful in 25% of cases (120 cases). The metastatic lesions were located preferentially at the level of the axial skeleton and only one case was of an exclusive appendicular site. More than half of patients with metastases (70%) had a poor prognosis with the SOLOWAY score greater than or equal to II. With the improvement of the nuclear imaging technical platform in Senegal (performance of SPECT/CT examinations), doubtful cases in our sample could be better explored with the advantage of adequate patient care.

Correlation of PSA Level and ISUP Grade Group with Scintigraphic Bone Metastases Detection in 36 Prostate Cancer Patients

Background: We need population-specific clinical features that can predict bone metastases as an affordable therapeutic decision-making tool in newly diagnosed prostate cancer patients as scintigraphy or positron emission tomography are not available and as no such study had ever been performed in our country. Objective: To determine biologic and pathologic criteria that can predict the scintigraphic detection of bone metastases in our prostate cancer patients. Patients and Method: We analyzed with student’s t test and logistic regression the PSA level, the ISUP grade and the scintigraphic data retrospectively collected in newly diagnosed prostate cancer patients. Results: In ten years, 36 prostate cancer patients were sent to the Korle Bu Teaching Hospital in Accra (Ghana) for bone scintigraphy (mean age = 63.9 years;55.6%, 19.4% and 25.0% ISUP grade ≤ 2, 3 or ≥4). Among 28 patients who had performed the bone scintigraphy, 6 (21.4%) presented bone metastases, 22 (78.6%) had no bone metastasis. The mean PSA level was 36.7ng/mL in the non-metastatic patients and 97.7 ng/mL in the metastatic patients. The difference in PSA level between the 2 groups was significative (p = 0.041). 63.6% of the non-metastatic cancers versus 16.7% of the metastatic cancers were ISUP grade 2 or less. Inversely, 36.4% of the non-metastatic cancers versus 83.3% of the metastatic cancers were ISUP grade 3 or more. The difference was significative in the ISUP grade 2 or less (p = 0.035), was significative in the ISUP grade group 3 or more (p = 0.035). Metastasis was more likely in prostate cancer patients with PSA equal 30 ng/mL or more and ISUP grade 3 or more (83.3%) than in prostate cancer patients with PSA less than 30 ng/mL and ISUP grade less than 3 (16.7%) [OR = 13.7;CI 95% (1.59;31.0);p = 0.035]. Conclusion: The scintigraphic detection of bone metastases is low in patients with PSA < 30 ng/mL and ISUP grade < 3. This can be helpful in curative therapy decision making for prostate cancer when nuclear medicine or other metastases detection tools are lacking.

MULTIVARIATE ANALYSIS OF BONE METASTASES IN BREAST CARCINOMA

Objective： To investigate the risk factors of bone metastases in breast carcinoma. Methods： By cross sectional study, the data of 225 breast cancer patients who were inpatients in four hospitals in Hangzhou were analyzed. All patients underwent total body bone scan with single photon emission computed tomography （SPECT） at least once during 1995 to 2000. Results： All patients were followed-up to 294 months after operation, bone metastases were found in 113 cases, suspected bone metastases 3 cases, with a bone metastases rate of 50.9% （113/222）. Multivariate analysis by Cox＇s proportional hazards regression model showed that there were four risk factors of bone metastases in breast cancer： （1） clinical stage, Ⅰ～Ⅳ stages with a hazard ratio of bone metastases of 1.945, 95% confidence interval 1.396～2.710; （2） number of invaded axillary lymph nodes, with a hazard ratio of 1.039, 95% confidence interval 1.0142～1.068; （3） skeletal complications （yes vs. no）, with a hazard ratio of bone metastases of 1.722, 95% confidence interval 1.060～2.796; （4） age at the time of surgery or diagnosis, with a hazard ratio of 2.048, 95% confidence interval 1.123～3.876 for patients of age 40～50 y versus patients bellow 40 y of age and 2.837, 95% confidence interval 1.473～5.465 for patients of age above 50 y versus patients of ages between 40 and 50. Kaplan-Meier curves showed that for patients with more than 5 invasive axillary lymph nodes, compared with those with 1～5, the bone metastasis rates increased significantly （x^2 =6.3319, P=0.012）. Conclusion： The clinical stage, number of metastatic axillary lymph nodes, age at the time of operation and skeletal complications are essential risk factors of bone metastases.

Contribution of ^99mTc-DPD Scintigraphy in the Diagnosis of Cardiac Amyloidosis in Black Africans

Cardiac amyloidosis presents a picture of hypertrophic cardiomyopathy with heart failure with preserved ejection fraction. It is largely underdiagnosed, especially in black Africans, and therefore falls under the category of heart disease classified as idiopathic. Light chain amyloidosis (AL) is mainly found in Caucasian subjects and the mutant variant of transthyretin (TTRm) in negroid subjects. Numerous studies have shown that ATTRm was found predominantly in black American and black British patients. In African countries the entity of idiopathic heart failure is quite important because of lack of diagnosis, ETT, MRI and immuno-histochemistry are expensive or not available. We can probably assume that the proportion of cardiac amyloidosis is quite important in black Africans. The question is if 99mTc-DPD really easy to perform, can probably help to investigate in the nuclear medicine department in Africa. No large-scale study has been able to demonstrate the prevalence or not of cardiac amyloidosis in black-African subjects and by extension reduce this nosological entity of idiopathic heart disease. The 99mTc-DPD scintigraphy using Perrugini’s visual sore allows localization and classification of amyloid damage. The mechanism of binding of 99mTc-DPD to amyloid fibril deposits is not well known, its binding to TTR-type (mutated or wild type) amyloidosis is greater than the AL variant. In the diagnostic algorithm, endomyocardial biopsy is the gold standard but remains invasive, ETT with the strain allows a presumptive diagnosis and remains an operative examination dependent and is not reproducible. Cardiac MRI allows some localization of amyloid deposits but still remains less sensitive than scintigraphy. In addition, performing the whole-body MRI is very restrictive (time, antenna change and cost). The aim of this literature review was to show the superiority of 99mTc-DPD scintigraphy compared to other diagnostic modalities and to consider its use given its simplicity when it comes to usage in Sub-Saharan Africa to diagnose the disease. cardiac amyloidosis and by extension reduce the number of cases of heart disease classified as idiopathic and thus allow early and appropriate management.

Adult-onset hypophosphatemic osteomalacia as a cause of widespread musculoskeletal pain:A retrospective case series of single center experience

BACKGROUND Osteomalacia(OM)is frequently confused with various musculoskeletal or other rheumatic diseases,especially in patients with adult-onset widespread musculoskeletal pain because of its low prevalence and non-specific manifestations.AIM To facilitate the early diagnosis and etiology-specific treatment of adult-onset hypophosphatemic OM.METHODS A retrospective review of medical records was performed to screen adult patients who visited a physiatry locomotive medicine clinic(spine and musculoskeletal pain clinic)primarily presenting with widespread musculoskeletal pain at a single tertiary hospital between January 2011 and December 2019.We enrolled patients with hypophosphatemia,high serum bone-specific alkaline phosphatase levels,and at least one imaging finding suggestive of OM.RESULTS Eight patients with adult-onset hypophosphatemic OM were included.The back was the most common site of pain.Proximal dominant symmetric muscle weakness was observed in more than half of the patients.Bone scintigraphy was the most useful imaging modality for diagnosing OM because radiotracer uptake in OM showed characteristic patterns.Six patients were diagnosed with adefovir(ADV)-induced Fanconi syndrome,and the other two patients were diagnosed with tumor-induced OM and light-chain nephropathy,respectively.After phosphorus and vitamin D supplementation and treatment for the underlying etiologies,improvements in pain,muscle strength,and gait were observed in all patients.CONCLUSION Mechanical pain characteristics,hypophosphatemia,and distinctive bone scintigraphy patterns are the initial diagnostic indicators of adult-onset hypophosphatemic OM.ADV-induced Fanconi syndrome is the most common etiology of hypophosphatemic OM in hepatitis B virus-endemic countries.

Nuclear medicine and the failed joint replacement: Past, present, and future

Soon after the introduction of the modern prosthetic joint,it was recognized that radionuclide imaging provides useful information about these devices.The bone scan was used extensively to identify causes of prosthetic joint failure.It became apparent,however,that although sensitive,regardless of how the images were analyzed or how it was performed,the test was not specific and could not distinguish among the causes of prosthetic failure.Advances in anatomic imaging,notably cross sectional modalities,have facilitated the diagnosis of many,if not most,causes of prosthetic failure,with the important exception of infection.This has led to a shift in the diagnostic paradigm,in which nuclear medicine investigations increasingly have focused on diagnosing infection.The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies,first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging.Labeled leukocyte imaging,combined with bone marrow imaging is the most accurate(about90%)imaging test for diagnosing joint arthroplasty infection.Its value not withstanding,there are significant disadvantages to this test.In-vivo techniques for labeling leukocytes,using antigranulocyte antibodieshave been explored,but have their own limitations and the results have been inconsistent.Fluorodeoxyglucose(FDG)-positron emission tomography(FDG-PET)has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established.Antimicrobial peptides bind to bacterial cell membranes and are infection specific.Data suggest that these agents may be useful for diagnosing prosthetic joint infection,but large scale studies have yet to be undertaken.Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection,the advent of hybrid imaging with singlephoton emission computed tomography(SPECT)/electronic computer X-ray tomography technique(CT)and the availability of fluorine-18 fluoride PET suggests that the diagnostic paradigm may be shifting again.By providing the anatomic information lacking in conventional radionuclide studies,there is renewed interest in bone scintigraphy,performed as a SPECT/CT procedure,for detecting joint instability,mechanical loosening and component malpositioning.Fluoride-PET may provide new insights into periprosthetic bone metabolism.The objective of this manuscript is to provide a comprehensive review of the evolution of nuclear medicine imaging of joint replacements.

Malignant giant cell tumors of the tendon sheath of the right hip:A case report

BACKGROUND Malignant giant cell tumor of the tendon sheath(MGCTTS)is an extremely rare malignant tumor originating from synovial and tendon sheath tissue with highly aggressive biological behavior and a high rate of local recurrence and distant metastasis which should be considered a highly malignant sarcoma and managed aggressively.How to systemically treat MGCTTS remains a challenge.In this case,a patient with MGCTTS suffered a recurrence after 2 surgical resections received adjuvant chemotherapy and radiation therapy,but the treatment outcome remained poor.More clinical trials and better understanding of the biology and molecular aspects of this subtype of sarcoma are needed while novel medicines should be developed to efficiently target particular pathways.CASE SUMMARY A 52-year-old man presented with persistent dull pain in the right groin accompanied by limited right hip motion starting 6 mo ago.Two months before his attending to hospital,the patient’s pain worsened,presenting as severe pain when standing or walking,limping,and inability to straighten or move the right lower extremity.Surgical excision was performed and MGCTTS was confirmed by pathology examination.Two recurrences occurred after surgical resection,moreover,the treatment outcome remained poor after adjuvant chemotherapy and radiation therapy.The patient died only 10 mo after the initial diagnosis.CONCLUSION MGCTTS is characterized by a joint mass with pain and limited motion.It typically grows along the tendons and infiltrated into the surrounding muscle and bone tissue,with a stubborn tendency to relapse,as well as pulmonary metastasis.Radically surgical resection provides a choice of treatment whereas post-operation care should be taken to preserve the function of the joint.Chemotherapy and radiotherapy can be used as alternative treatments when radical resection cannot be performed.