Nuclear Imaging of Bone Tumors: Thallium-201 Scintigraphy

Abstract

(201)Tl scintigraphy provides important information for the management of patients with bone tumors. Although the role for staging the disease of bone tumors and for differentiation of benign from malignant lesions is limited, (201)Tl scintigraphy reflects the disease activity after treatment and it should be used to determine the treatment response and for early diagnosis of recurrence. Baseline study is essential for future reference to evaluate the response to preoperative chemotherapy and to detect recurrence after surgery. Sequential (201)Tl scintigraphy before and after treatment is useful in assessing the grade of response of the tumor to chemotherapy. The early prediction of chemotherapeutic effect by (201)Tl scintigraphy during treatment will affect the management of patients who do not respond to the therapy. This is of special importance to determine whether the patient needs an amputation or a limb-salvage surgery.

Diagnostic value of Thallium-201 scintigraphy in differentiating malignant bone tumors from benign bone lesions

“…On the other hand, most of all chondrosarcoma showed lower uptake than the cut-off values. In the previous report, this behavior has been seemed to be the result of the poor vascularity and less cellular matrix [7]. Thus the characteristics of tumor component, such as the cellularity, vascularity, and intercellular matrix, result in false positive by GCT and false negative by chondrosarcoma.…”

“…We considered that no statistical significance of WR might be due to relatively small volume of bone lesion compared with surrounding soft tissue and the change of 201Tl uptake to the surrounding muscle had the bigger impact on WR in both benign and malignant bone lesions. According to the previous reports [2,4,7,11,[14][15][16][17][18][19][20][21], 201Tl uptake depends on cell viability and metabolic condition and a high metabolic rate with malignancy was the most important factor determining differences in 201Tl uptake between malignant tumors and benign lesions. Moreover, 201Tl uptake on early imaging is affected by tumor vascularity and cellularity.…”

“…Functional nuclear scans reflect the metabolic activity of tumors and may provide important information regarding the biologic behavior. 201Tl scintigraphy has been used in clinical oncology to estimate the presence and biologic activity of tumors including bone and soft tissue tumors, and the utility of 201Tl scintigraphy has been reported to differentiate malignant tumors from benign lesions in bone and soft tissue [2][3][4][5][6][7][8][9][10][11][12][13]. However, these previous studies were composed of a relatively small number of bone tumors and most of the studies used only visual analysis [2,3,5].…”

“…There has been growing interest in using 201Tl scintigraphy for management of bone and soft tissue tumors since the early 1990s [3]. Several studies have reported 201Tl scintigraphy to be an effective diagnostic tool to differentiate malignant from benign areas of interest [2][3][4][5][6][7][8][9][10]. However, there are little published data for 201Tl scintigraphy dealing with only bone lesions [3] and no report has statistically evaluated the diagnostic capacity of 201Tl scintigraphy in a large number of bone lesions.…”

Thallium

“…* In the medical field, 201 Tl (radioactive half-life 73 h) is used for diagnostic purposes in the heart and circulatory system, as well as for nuclear imaging of bone tumors (thallium scintigraphy) (Sumiya et al 2001). …”