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01.12.2019 | Research article | Ausgabe 1/2019 Open Access

BMC Medical Imaging 1/2019

Accurate characterization of 99mTc-MDP uptake in extraosseous neoplasm mimicking bone metastasis on whole-body bone scan: contribution of SPECT/CT

BMC Medical Imaging > Ausgabe 1/2019
Linqi Zhang, Qiao He, Tao Zhou, Bing Zhang, Wei Li, Hao Peng, Xi Zhong, Liwu Ma, Rusen Zhang
Wichtige Hinweise
Linqi Zhang and Qiao He contributed equally to this work.

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99mTc-labelled methylene diphosphonate (99mTc-MDP) uptake can occasionally be identified in extraosseous neoplasms on whole-body scans (WBSs) and may be misinterpreted as bone metastasis. The purpose of our study was to investigate the frequency of 99mTc-MDP uptake in extraosseous neoplasms and to assess the additional value of SPECT/CT for the localization and characterization of this unusual uptake.


Data from 7308 patients (SPECT/CT was performed in 2147 patients) with known cancer who underwent WBSs for metastatic work-up between May 2015 and July 2018 were retrospectively reviewed. The locations, numbers, and intensities of extraosseous 99mTc-MDP uptake were evaluated by WBS, and the intratumoural calcification was evaluated by SPECT/CT. The diagnostic accuracy of SPECT/CT in locating 99mTc-MDP uptake in extraosseous neoplasms was compared to that of WBS.


A total of 41 patients showed 99mTc-MDP uptake in extraosseous neoplasms. Of these patients, 23 patients had uncertain lesions by WBS, and further SPECT/CT was performed. The incidence of 99mTc-MDP uptake in extraosseous neoplasms was observed to be 0.6% by WBS and 1.1% (by) SPECT/CT. During imaging analysis, WBS had an accuracy of only 35% (14/40), whereas SPECT/CT correctly located and diagnosed all 40 lesion sites in the 23 patients. Twenty-three lesion sites (57.5%, 23/40) showed moderate or high intensity of extraosseous 99mTc-MDP uptake. Of the 23 patients, 17 patients (73.9%, 18/23) with 31 lesion sites (77.5%, 31/40) presented with intratumoural calcification.


99mTc-MDP uptake in extraosseous neoplasms can be observed as 0.6% on WBS and is usually localized to the breast, liver, and lung. Nuclear physicians should be familiar with such extraosseous uptake when interpreting WBSs. SPECT/CT offers better accuracy than WBS alone for locating the majority of lesions present with intratumoural calcification.
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