Utility of ¹¹¹In-Cl₃ Scintigraphy for Differentiating Between Bone Marrow Reconversion and Bone Metastasis with Esophageal Adenocarcinoma

Abstract

Indium chloride (In-Cl) scintigraphy has been used to evaluate various hematological diseases for many years. However, there have been few reports on patients with bone marrow reconversion showing high uptake in In-Cl scintigraphy. Herein, we report a case of a 68-year-old man with esophageal cancer who underwent F-FDG PET/CT for staging of the disease.F-FDG PET/CT demonstrated high uptake in the first lumbar vertebral body, which was difficult to distinguish bone metastasis and bone marrow reconversion. In-Cl scintigraphy demonstrated specific findings with high uptake in the lesion, indicating bone marrow hyperplasia or reconversion.

Bone marrow reconversion mimicking pelvis metastases in a patient with rectal cancer: a pitfall on magnetic resonance images

“…In patients with malignancies, it is occasionally difficult to differentiate BMR from bone metastasis. Sporadic literatures reported BMR located in vertebrae (5)(6)(7)(8). For example, Okuda et al reported the MRI of a patient with esophageal adenocarcinoma showed patchy signal changes in the thoracic vertebral body, which mimicked bone metastases on MR (5).…”

“…Regarding the patients with malignancies, it is occasionally difficult to differentiate BMR from bone metastasis, raising the risk of delayed or missed diagnoses. BMR located in some vertebrae of patients with malignant tumor mimicking bone metastases has been reported by sporadic literatures (5)(6)(7)(8). However, little literature reports BMR located in the pelvis.…”

“…It is often difficult to distinguish bone metastasis and BMR with conventional MRI. The MRI chemical shift technique assesses fatty infiltration, which suggests yellow bone marrow, and distinguishes between BMR and bone metastasis (5). However, MRI chemical shift techniques, for instance, the proton density fat fraction (PDFF) technique, is commonly used for hepatic MRI rather than pelvic MRI for clinical purposes.…”

“…Therefore, whole body bone scintigraphy with 99 mTc-MDP could not differentiate the BMR from bone metastases. It is reported that imaging of 111 In-Cl 3 scintigraphy is effective when differentiating BMR from bone metastases (5,8). 111 In-Cl 3 scintigraphy is a noninvasive technique to evaluate the anatomic extent of the erythropoietic element, because of its transportation in the plasma by transferrin and its suitable energy characteristics (5).…”