Increased technetium‐99 m hydroxy diphosphonate soft tissue uptake on bone scintigraphy in chronic kidney disease patients with secondary hyperparathyroidism: correlation with hyperphosphataemia. (4th July 2015)

• Record Type: Journal Article
• Authors: Enevoldsen, Lotte Hahn; Heaf, James; Højgaard, Liselotte; Zerahn, Bo; Hasbak, Philip
• Is Part Of: Clinical physiology and functional imaging. Volume 37:Number 2(2017:Mar.)
• Page Start: 131
• Page End: 136
• Publication Date: 2015-07-04
• Subjects: atherosclerosis -- bone scan -- hyperparathyroidism -- soft tissue uptake -- Tc‐99 m‐HDP; Physiology, Pathological -- Periodicals; Diagnostic imaging -- Periodicals; 612
• DOI: 10.1111/cpf.12276
• Languages: English
• ISSNs: 1475-0961

Abstract

Summary: In bone scan patients with dialysis‐treated chronic kidney disease (CKD) and hyperparathyroidism, soft tissue accumulation of technetium‐99 m hydroxy/methylene diphosphonate (Tc‐99 m‐HDP/MDP) has been reported primarily in case reports and usually explained by hypercalcaemia and/or hyperphosphataemia. As human vascular smooth muscle cells produce hydroxyapatite during cell culture with increased phosphate levels and as Tc‐99 m‐HDP/MDP primarily binds to hydroxyapatite, we hypothesized that soft tissue accumulation would be found in patients with hyperphosphataemia. We identified 63 CKD patients diagnosed with secondary hyperparathyroidism admitted for Tc‐99 m‐HDP bone scan. Baseline characteristics and mean concentrations of biochemical markers (including P‐calcium and P‐phosphate) taken 0–3 months prior to the bone scans were collected. Soft tissue uptake was detected on bone scans in 37 of 63 (59%) patients. Primary locations were in the heart (27/37 = 73%), muscles (12/37 = 32%), lung (9/37 = 24%) and gastrointestinal tract (6/37 = 16%), and 13 of 37 (35%) patients had simultaneous uptake in more than one location. Regarding biochemical markers, patients with soft tissue uptake only differed from patients without in terms of plasma phosphate levels (1·95 ± 0·15 ( n = 37) versus 1·27 ± 0·08 ( n = 26), P = 0·0012). All patients with myocardial uptake ( n = 27) had a coronary arteriography‐verified history of coronary artery disease (CAD), whereas CAD was only present in six of the 36 patients without myocardial uptake. In conclusion, dialysis‐treated CKD patients with secondary hyperparathyroidism have a high incidence of soft tissue uptake, and this finding is strongly correlated with elevated phosphate, but not calcium values.