title: Extramedullary Soft Tissue Involvement and Discrepant Osseous Uptake on Tc-99m MDP and Ga-67 Citrate Scintigraphy in a Patient With Multiple Myeloma: A Case Report and Literature Review.
abstract: Multiple myeloma (MM) is a plasma cell neoplasm with skeletal destruction which could also spread to extramedullary regions. Common diagnostic imaging modalities include skeletal radiography, computed tomography (CT), magnetic resonance imaging (MRI). Recently, PET/CT is proposed as an ideal tomographic tool for diagnosis and follow-up, but impending factors includes high cost, limited availability of cameras and radiotracers. Bone scan and gallium scan are usually considered of limited clinical value. Herein, we present a 66-year-old Taiwanese man with MM, who was hospitalized to our hospital for bone pain control. Bone and gallium scintigraphies were obtained for bone pain and infection workup. However, unexpected features of discordant osseous uptake with high gallium-to-bone uptake ratio and extramedullary gallium uptake were noted which both indicated poor prognosis of MM. The patient then passed away due to rapid disease progression. In conclusion, although gallium and bone scintigraphies are considered less sensitive for MM, combined use may be a good alternative for 18F-FDG PET/CT in evaluation of disease extent and prognosis, especially in high-risk patients or with suspicion of disease progression.
authors.affiliation: From Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan (S-YT, S-YW, Y-CS, Y-WW); National Yang-Ming University School of Medicine, Taipei, Taiwan (Y-WW); and Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (Y-WW).
authors.forename: Szu-Ying
authors.initials: SY
authors.lastname: Tsai
authors.forename: Shan-Ying
authors.initials: SY
authors.lastname: Wang
authors.forename: Yu-Chien
authors.initials: YC
authors.lastname: Shiau
authors.forename: Yen-Wen
authors.initials: YW
authors.lastname: Wu
mesh_terms: D000368:Aged; D001842:Bone and Bones / Q000378:metabolism; D002951:Citrates / Q000493:pharmacokinetics; D005708:Gallium / Q000493:pharmacokinetics; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000000981:diagnostic imaging*; D011379:Prognosis; D011859:Radiography; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D013669:Technetium Tc 99m Medronate / Q000493:pharmacokinetics; D014055:Tomography, Emission-Computed / Q000379:methods*
chemical_list: D002951:Citrates; D019275:Radiopharmaceuticals; D005708:Gallium; C103850:gallium citrate; D013669:Technetium Tc 99m Medronate