Pentavalent 99Tcm-DMSA imaging in patients with bone metastases.
Pentavalent 99Tcm-dimercaptosuccinic acid (99Tcm-(V)DMSA) has an established role in imaging medullary thyroid carcinoma. There have been case reports of uptake in bone metastases. Our aims were to compare 99Tcm-(V)DMSA with 99Tcm-hydroxymethylene diphosphonate (99Tcm-HDP) in bone metastases, to assess its value in imaging of bone metastases, and to assess the prospects of the beta-emitting analogues 186/188Re-(V)DMSA as palliative agents for painful bone metastases. Ten patients confirmed by a 99Tcm-HDP bone scan to have bone metastases secondary to carcinoma of the prostate, lung or breast were injected with 99Tcm-(V)DMSA (600 MBq). Whole-body scans acquired at 3 and 24 h were compared with the 99Tcm-HDP bone scans. 99Tcm-(V)DMSA showed high soft tissue background, kidney retention and avid uptake in most bone metastases: 86% of bone lesions identified on bone scans were detected with 99Tcm-(V)DMSA. The lesion-to-normal ratios were comparable to or lower than those for 99Tcm-HDP at 3 h, but increased by 24 h. Instances of abnormal uptake in liver, primary lung tumour, lymph nodes and pleural effusion were observed. We conclude that 99Tcm-(V)DMSA is a tracer for bone metastases (with lower sensitivity than 99Tcm-HDP) and soft tissue tumours. If 186/188Re-(V)DMSA behave similarly, they may find use in therapy for soft tissue tumours and bony metastases.
Lam
A S
AS
Department of Biosciences, University of Canterbury, Kent, UK.
Kettle
A G
AG
O'Doherty
M J
MJ
Coakley
A J
AJ
Barrington
S F
SF
Blower
P J
PJ
D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D004164:Diphosphonates / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D015609:Organotechnetium Compounds / Q000493:pharmacokinetics; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010166:Palliative Care; D011471:Prostatic Neoplasms / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000737:chemistry / Q000493:pharmacokinetics; D012983:Soft Tissue Neoplasms / Q000378:metabolism; D019783:Technetium Tc 99m Dimercaptosuccinic Acid / Q000737:chemistry / Q000493:pharmacokinetics
D004164:Diphosphonates; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C060491:technetium Tc 99m hydroxydiphosphonate; D019783:Technetium Tc 99m Dimercaptosuccinic Acid