Subacute cerebral infarction incidentally detected by 99mTc-MDP bone scan

Tian, Xun; Su, Rui; Dai, Chenyang; Lu, Wei

doi:10.1016/j.remnie.2019.02.002

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She had no known history of cerebrovascular disease. The whole-body 99mTc-MDP bone scintigraphy revealed a focal tracer uptake in the left side of the head, suggestive of skull metastasis, with no evidence of radiotracer uptake in the rest of the skeleton (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A, arrow). SPECT/CT images of the corresponding area were then performed for further evaluation, which demonstrated the activity was located in the left parietal lobe but not in the skull, and there was no abnormality on non-diagnostic CT images (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B and C, from top to bottom, axial and coronal CT images, corresponding SPECT and fused image, respectively, arrows). The next day, the subsequent MRI images showed only slightly high signal intensity on diffusion weighted imaging (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A, arrow) and obvious enhancement in the same area as SPECT/CT images (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B, arrow). Subsequently, a diagnosis of subacute cerebral infarction was made.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Incidental cerebral uptake of 99mTc-MDP is rare, accounting for less than 0.2% of patients undergoing bone scintigraphy, which includes intracranial meningioma, metastatic neuroblastoma, dural metastasis, and Sturge–Weber syndrome, etc.<a class="elsevierStyleCrossRefs" href="#bib0020">1,2</a> Previous reports state that brain ischaemia can also lead to elevated 99mTc-MDP activity in the affected parts of the brain which is due to a breakdown in the normal blood–brain barrier and the appearances can revert to normal 4 months following infarction.<a class="elsevierStyleCrossRef" href="#bib0030">3</a> In previously published cases there was usually a hypoattenuation area corresponding to the radiotracer uptake lesion.<a class="elsevierStyleCrossRef" href="#bib0030">3</a> However, in our case, the CT did not show any special finding. We consider that the non-diagnostic CT used in our daily SPECT/CT acquisition process is a potential reason.FundingThis paper was sponsored by National Natural Science Foundation of China (81801732).Conflicts of interestThe authors declare no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Tian X, Su R, Dai C, Lu W. Infarto cerebral subagudo detectado accidentalmente mediante gammagrafía ósea con 99mTc-MDP. Rev Esp Med Nucl Imagen Mol. 2019;38:245–246." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1532 "Ancho" => 1500 "Tamanyo" => 231973 ] ] "descripcion" => array:1 [ "en" => "The whole-body 99mTc-MDP bone scintigraphy showed a focal tracer uptake in the left side of the head. (A, arrow) SPECT/CT revealed the activity was located in the parietal lobe but not in the skull, and there was no abnormality in the non-diagnostic CT images (B and C, arrows)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 559 "Ancho" => 900 "Tamanyo" => 50567 ] ] "descripcion" => array:1 [ "en" => "Subsequent MRI images showed slightly high signal intensity on diffusion weighted imaging and obvious enhancement (A and B, arrows)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dural metastasis demonstrated on Tc-99m MDP bone scintigraphy in staging workup for a patient with breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.X. Truong" 1 => "A.C. Ting" 2 => "M.A. Rossleigh" 3 => "S.L. Carroll" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.rlu.0000204488.87491.73" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2006" "volumen" => "31" "paginaInicial" => "223" "paginaFinal" => "224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16550022" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intracranial Tc99m MDP uptake in Sturge–Weber syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Hui" 1 => "K.K. Lau" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Aust Radiol" "fecha" => "2003" "volumen" => "47" "paginaInicial" => "75" "paginaFinal" => "77" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "18F-NaF PET demonstrating unusual focal tracer activity in the brain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Thenkondar" 1 => "L. Jafari" 2 => "R. Sooriash" 3 => "F. Hajsadeghi" 4 => "G.R. Berenji" 5 => "Y. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RLU.0000000000001458" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2017" "volumen" => "42" "paginaInicial" => "127" "paginaFinal" => "128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27879488" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003800000004/v1_201907020628/S2253808919300199/v1_201907020628/en/main.assets" "Apartado" => array:4 [ "identificador" => "47121" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting image" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003800000004/v1_201907020628/S2253808919300199/v1_201907020628/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919300199?idApp=UINPBA00004N"]

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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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Vol. 38. Issue 4.

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