(99m)Tc-sestamibi myocardial perfusion SPECT is a useful non-invasive imaging modality to detect cardiovascular involvement in SLE patients with non-specific clinical complaints of heart disease.

Most metastatic bone disease appears in the axial skeleton. Appendicular bone metastases are usually found in cases of general spread of the disease, and frequent sites are in the femur and humerus. A solitary appendicular bone metastasis is rare. The authors report a case of lung cancer with unusual presentation of a solitary fibular metastasis. The bone scan showed a solitary fusiform hot lesion in the fibular shaft mimicking the typical appearance of a stress fracture. A metastatic fibular lesion from lung cancer was confirmed by excision biopsy.

Patients with systemic lupus erythematosus (SLE) may develop premature atherosclerosis, notably peripheral vascular disease (PVD) presenting with intermittent claudication or gangrene. Therefore, it is important to investigate if high prevalence of poor muscle perfusion of lower extremities in SLE patients with abnormal myocardial perfusion is related to more cardiovascular risk factors. We used a well-established and noninvasive radionuclide method (xenon 133 muscle washout) to evaluate objectively the anterior tibial muscle perfusion of 34 SLE female patients without symptoms/signs of PVD in the lower extremities. The patients were separated into two groups according to myocardial perfusion imaging results. Meanwhile, 30 normal female controls with matched age distribution were also included for comparison. The muscle perfusion differed significantly ( P <0.05) between patients (1.90+/-0.41 ml/100 g per min) and controls (2.91+/-0.50 ml/100 g per min), as well as between 18 SLE patients with abnormal myocardial perfusion (1.33+/-0.43 ml/100 g per min) and 16 with normal myocardial perfusion (2.26+/-0.45 ml/100 g per min). Based on the xenon 133 muscle washout method, we conclude that muscle perfusion in the lower extremities of SLE patients without symptoms/signs of PVD is significantly decreased and related to abnormal myocardial perfusion.

Pulmonary vascular endothelium damage in 34 patients with systemic lupus erythematosus (SLE) was measured by technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan. The degree of damage was represented as lung/liver uptake (L/L) ratio. The patients were divided into two subgroups according to the following criteria: (a) clinical features, separated as stable or flare stage and (b) chest X-ray findings separated as positive or negative results. Meanwhile, quantitative gallium-67 citrate (Ga-67) lung scan was performed as Ga-67 uptake index (GUI) to evaluate the severity of inflammation in the SLE lungs. The results show (a) no significant statistical differences in the degree of pulmonary vascular endothelium damage (the L/L ratio on Tc-99m HMPAO lung scan) between the two subgroups according to clinical features or chest X-ray findings and (b) no good correlation between the degree of pulmonary vascular endothelium damage and lung inflammation (GUI on Ga-67 lung scan). In conclusion, the change in pulmonary vascular endothelium damage in SLE may be unrelated to the clinical presentation or chest X-ray findings, and its degree is not related to the severity of pulmonary inflammation.