|Year : 2020 | Volume
| Issue : 2 | Page : 162-164
Rare case of diffuse splenic uptake on methylene diphosphonate bone scan in a patient with sickle cell disease
Girish Kumar Parida, Sujata Mitra, Gopal Sonai Muthu, Akchata Suman
Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur, Jharkhand, India
|Date of Submission||21-Oct-2019|
|Date of Acceptance||30-Nov-2019|
|Date of Web Publication||12-Mar-2020|
Dr. Girish Kumar Parida
Department of Nuclear Medicine and PET-CT, Tata Main Hospital, Jamshedpur - 831 001, Jharkhand
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Extraskeletal tracer uptake in methylene diphosphonate (MDP) bone scan is not a common finding. There have been several case reports in the literature showing diffuse splenic uptake in MDP bone scan. We present a case of sickle cell disease, which showed diffuse splenic uptake on MDP whole-body bone scan.
Keywords: Methylene diphosphonate bone scan, sickle cell disease, splenic uptake
|How to cite this article:|
Parida GK, Mitra S, Muthu GS, Suman A. Rare case of diffuse splenic uptake on methylene diphosphonate bone scan in a patient with sickle cell disease. Indian J Nucl Med 2020;35:162-4
|How to cite this URL:|
Parida GK, Mitra S, Muthu GS, Suman A. Rare case of diffuse splenic uptake on methylene diphosphonate bone scan in a patient with sickle cell disease. Indian J Nucl Med [serial online] 2020 [cited 2020 Jul 10];35:162-4. Available from: http://www.ijnm.in/text.asp?2020/35/2/162/280446
A 33-year-old female with a history of sickle cell disease presented to our hospital complaining of multiple joint pain involving bilateral knee and elbow joints. Diagnostic imaging including X-rays of knee and elbow joints was unremarkable. As she continued to complain of pain, a bone scan was advised. After the intravenous administration of 780 MBq of99m Tc-methylene diphosphonate (99m Tc-MDP), flow and blood-pool images of the joints were obtained, followed by delayed whole-body images. There was no abnormal tracer accumulation in the flow and pool images. Whole-body images showed diffuse increased radiotracer uptake in the left upper quadrant of the abdomen just superolateral to the left kidney, suggesting uptake in the spleen [Figure 1]a and [Figure 1]b, anterior and posterior images, respectively]. There was no other abnormal tracer accumulation in the whole-body images. The patient had undergone noncontrast abdominal computed tomography abdomen for pain abdomen previously, which showed heterogeneous calcification in the splenic parenchyma [Figure 1]c, [Figure 1]e, transaxial images].
|Figure 1:Diffuse increased radiotracer uptake in the left upper quadrant of the abdomen just superolateral to the left kidney, suggesting uptake in the spleen (a: anterior and b: posterior images). Heterogeneous calcification in the splenic parenchyma on computed tomography abdomen (tranaxial images, c-e)|
Click here to view
Few theories have been believed for splenic uptake in sickle cell disease. One of them is microscopic calcium deposits that may not get detected radiographically, but can cause uptake of99m Tc-MDP in spleen. The other mechanism is hemosiderosis that occurs because of recurrent transfusion and increased deposition of iron from the sequestration of abnormal red blood cells within the spleen., Besides sickle cell disease, multiple other causes of splenic uptake have also been described in the literature. They include malignant hematologic diseases;, recent gadolinium contrast agent injection;,, alcoholic cirrhosis; hypercalcemia; hemochromatosis; hypersplenism; chronic hemolysis such as glucose-6-phosphate dehydrogenase deficiency or thalassemia;, splenic hemangioma; splenic hematoma, infarction, abscess, or metastasis; amyloidosis; and renal failure. Hence, we can infer that extraskeletal uptake in MDP bone scan is not a usual finding. However, it should be kept in mind that this finding can be of certain clinical significance and should not be ignored.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Yapar AF, Aydin M, Reyhan M. Diffuse splenic Tc-99m MDP uptake in hypersplenic patient. Ann Nucl Med 2004;18:703-5.
Jones AG, Francis MD, David MA. Bone scanning radionuclide reaction mechanisms. Semin Nucl Med 1976;6:3-18.
De Marini P, Laplace A, Matuszak J, Fornecker LM, Namer IJ. Spleen Uptake on Bone Scan After Frequent Platelet and RBC Transfusions. Clin Nucl Med 2016;41:802-3.
Birch SJ, Garvie NW, Ackery DM. Splenic accumulation of technetium 99m methyl diphosphonate in non-Hodgkin's lymphoma. Br J Radiol 1980;53:161-3.
McHugh K, Lee DM, Batty VB. Splenic accumulation of technetium 99m in chronic lymphocytic leukaemia. Br J Radiol 1988;61:957-9.
Shi X, Jing H, Zhuang H, Zhang Y, Jin X, Li F. Diffuse hepatic and splenic uptake of Tc-99m methylene diphosphonate on bone scintigraphy after intravenous administration of gadolinium-containing MRI contrast. Clin Nucl Med 2011;36:178-82.
Zhang W, Chen B, Deng H, Yang T, Ou X. Hepatic and splenic uptake on bone scintigraphy in patients with intravenous administration of 99mTc methylene diphosphonate prior to gadolinium-containing contrast. Clin Nucl Med 2013;38:219-20.
Pak K, Kim SJ, Kim IJ, Suh KT. Hepatic uptake of Tc-99m DPD on bone scintigraphy: The influence of the interval with gadolinium-containing contrast of MRI. Clin Nucl Med 2012;37:134-6.
Kawamura E, Kawabe J, Hayashi T, Oe A, Kotani J, Torii K, et al
. Splenic accumulation of Tc-99m HMDP in a patient with severe alcoholic cirrhosis of the liver. Clin Nucl Med 2005;30:351-2.
Shimpi MM, Singh N, Gupta N. Unusual visceral distribution of technetium-99m-methylene diphosphonate in a case of hypercalcemia of malignancy. Indian J Nucl Med 2016;31:67-8.
] [Full text]
Sabnis SS, Blend MJ. Splenic uptake of Tc-99m MDP in a patient with hemochromatosis. Clin Nucl Med 1999;24:622-3.
Perlmutter S, Jacobstein JG, Kazam E. Splenic uptake of 99mTc-diphosphonate in sickle cell disease associated with increased splenic density on computerized transaxial tomography. Gastrointest Radiol 1977;2:77-9.
Howman-Giles RB, Gilday DL, Ash JM, Brown RG. Splenic accumulation of Tc-99m diphosphonate in thalassemia major. J Nucl Med 1978;19:976-7.
Katz DS, Wojtowycz AR, Markarian B. Splenic hemangioma. Detection on a technetium-99M MDP bone scan. Clin Imaging 1994;18:279-82.
Costello P, Gramm HF, Steinberg D. Simultaneous occurrence of functional asplenia and splenic accumulation of diphosphonate in metastatic breast carcinoma. J Nucl Med 1977;18:1237-8.
Ravanbod MR, Nemati R, Javadi H, Nabipour I, Assadi M. Diffuse hepatic and spleen uptake of Tc-99m MDP on bone scintigraphy resembling liver-spleen scintigraphy in a patient of plasma cell tumor. Case Rep Radiol 2014;2014:264904.