99mTc-MDP bone scan guides in the identification of mesenteric vein thrombosis

Document Type : Case Report


Department of Nuclear Medicine and Molecular Imaging, Amrita Institute of Medical Sciences and Research Center, Cochin, Kerala, India


A 50-year-old man with postprandial abdominal pain, weight loss, and generalized body ache was referred to Nuclear medicine department for a whole body bone scan to look for any malignancy. Clinical examination did not reveal any specific positive findings. He underwent aTechnetium-99m Methylene Diphosphonate (99mTc-MDP) bone scan which showed no obvious bone pathology. But there was abnormal increased MDP uptake in the entire transverse colon, splenic flexure, and sigmoid colon prompting further evaluation. Contrast-enhanced computed tomography (CECT) was performed and it suggested superior mesenteric vein thrombosis. Thus MDP uptake in bowel loops reflects the extra osseous tracer uptake at the cellular and tissue level due to chronic inflammation and plasma protein binding due to edema. Colonoscopy and segmental biopsy were non-contributory.


Main Subjects

  1. Györke T, Duffek L, Bártfai K, Makó E, Karlinger K, Mester A, Tarján Z. The role of nuclear medicine in inflammatory bowel disease. A review with experiences of aspecific bowel activity using immunoscintigraphy with 99mTc anti-granulocyte antibodies. Eur J Radiol. 2000 Sep;35(3):183-92.
  2. Wale DJ, Wong KK, Savas H, Kandathil A, Piert M, Brown RK. Extraosseous Findings on bone scintigraphy using fusion SPECT/CT and correlative imaging. AJR Am J Roentgenol. 2015;205(1):160-72.
  3. Ergün EL, Kiratli PO, Günay EC, ErbaƟ B. A report on the incidence of intestinal 99mTc-methylene diphosphonate uptake of bone scans and a review of the literature. Nucl Med Commun. 2006 Nov;27(11):877-85.
  4. McCarthy KE, Heyman S. Diphosphonate intestinal activity seen on two bone images in neuroblastoma. Clin Nucl Med.1986;11:501-502.
  5. Lee KH, Chung JK, Lee DS, Lee MC, Song IS, Koh CS. Intestinal leakage of technetium-99m-MDP in primary intestinal lymphangiectasia. J Nucl Med. 1996;37:639-641.
  6. Roach PJ, Itrato D, Treves ST. Bowel visualization on bone scan because of protein losing enteropathy. Clin Nucl Med. 1994;19:1114-16.
  7. Sundaram P, Padma S. 99mTc-MDP abdominal scintigraphy in a paediatric case of GI protein loss - A viable and simple alternate to HSA imaging. Iran J Nucl Med. 2013;21(1):40-43.
  8. Suga K, Ohono Y, Yoneshiro S, Fujita T, Nakanishi T, Utsumi H, Yamada N, Shimabukuro T. A case of squamous cell carcinoma of urinary bladder with an ileo-vesical fistula detected on bone scintigraphy. Kaku Igaku. 1992 Jan;29(1):105-10.
  9. Barth KH, Alderson PO, Strandberg JD, Strauss HW, White RI Jr. 99mTc-pyrophosphate imaging in experimental mesenteric infarction: relationship of tracer uptake to the degree of ischemic injury. Radiology. 1978;129:491-495.
  10. Lee VW, Leiter BE, Weitzman F, Shapiro JH. Occult gastric bleeding demonstrated by bone scan and Tc-99m-DTPA renal scan. Clin Nucl Med. 1981;6:470–473.
  11. Safakianakis G, Ortiz VN, Haase GM. 99m Tc-diphosphonate abdominal imaging in necrotizing enterocolitis: a prospective study. J Nucl Med 1978;19:691–692.
  12. Janssen S, van Rijswijk MH, Piers DA, de Jong GM. Soft-tissue uptake of 99mTc-diphosphonate in systemic AL amyloidosis. Eur J Nucl Med. 1984;9(12):538-41.
  13. Zuckier LS, Martineau P. Altered Biodistribution of Radiopharmaceuticals Used in Bone Scintigraphy. Semin Nucl Med. 2015 Jan;45(1):81-96.
  14. Wale DJ, Wong KK, Savas H, Kandathil A, Piert M, Brown RK. Extraosseous findings on bone scintigraphy using fusion SPECT/CT and correlative imaging. AJR Am J Roentgenol. 2015 Jul;205(1):160-72.