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J Nucl Med Technol. 2018 Dec;46(4):368-372. doi: 10.2967/jnmt.118.210534. Epub 2018 Jun 8.

99mTc-Sulfur Colloid Bone Marrow Scintigraphy in Diagnosis of Diffuse Pulmonary Extramedullary Hematopoiesis Secondary to Myelofibrosis.

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Department of Radiology, Mayo Clinic in Arizona, Scottsdale, Arizona
Mallinckrodt Institute Radiology, Washington University in St. Louis, St. Louis, Missouri.
Department of Radiology, Mayo Clinic in Arizona, Scottsdale, Arizona.
Department of Radiology, Mayo Clinic in Rochester, Rochester, Minnesota; and.
Division of Hematology, Mays Cancer Center at UT Health San Antonio, MD Anderson Cancer Center, San Antonio, Texas.


Our objective was to define the role of combined 99mTc-sulfur colloid bone marrow (SC BM) scintigraphy, SPECT or SPECT/CT, and chest CT in diagnosing diffuse pulmonary extramedullary hematopoiesis (PEMH) in patients with myelofibrosis. Methods: We retrospectively reviewed 99mTc-SC BM scintigraphy scans performed at our institution for the diagnosis of diffuse PEMH, as well as accompanying chest CT and SPECT/CT imaging findings. Relevant clinical information, including respiratory manifestations, pulmonary hypertension, and subjective response to whole-lung radiation therapy, was also summarized. Results: Twenty-two myelofibrosis patients with 27 99mTc-SC BM scintigraphy scans were diagnosed with diffuse PEMH. In 21 patients (95%) with accompanying chest CT and SPECT/CT scans, the most common CT findings were ground-glass opacity, interstitial infiltration, and pleural effusion. Of 20 patients (91%) who underwent 2-dimensional echocardiography studies, 12 (55%) were diagnosed with pulmonary hypertension. All 12 patients exhibited the aforementioned nonspecific CT imaging findings, with 8 (66%) of them presenting with respiratory symptoms, including dyspnea, shortness of breath, and cough. In the remaining 8 patients, without pulmonary hypertension, half had similar respiratory symptoms. Fourteen patients (64%) of this cohort received whole-lung radiation therapy, of whom 7 (50%) experienced symptom relief after therapy. Conclusion: Nonspecific respiratory symptoms should raise concern about pulmonary hypertension and diffuse PEMH in patients with advanced-stage myelofibrosis. Combined 99mTc-SC BM scintigraphy and SPECT/CT is a promising noninvasive imaging tool to diagnose this rare clinical entity.Key Words: hematology; respiratory; SPECT/CT; pulmonary hematopoiesis; Tc-99m sulfur colloid scintigraphy; myelofibrosis.

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