Research ArticleImaging

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

Ming Yang, Matthew F. Covington, Ba D. Nguyen, Geoffrey B. Johnson, Ruben A. Mesa and Michael C. Roarke
Journal of Nuclear Medicine Technology December 2018, 46 (4) 368-372; DOI: https://doi.org/10.2967/jnmt.118.210534

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Whole-body planar 99mTc-SC BM scintigraphy of 2 patients with secondary myelofibrosis. (A) In patient without diffuse PEMH, uptake in both lung fields (arrows) is visually equivalent to that of blood pool. (B) In patient with diffuse PEMH, uptake in lung fields (arrows) is greater than that of blood pool. Both patients exhibited EMH in liver and spleen, as well as decreased bone marrow uptake in central compartment of skeleton.

  • FIGURE 2.
    FIGURE 2.

    A 72-y-old man with end-stage myelofibrosis. (A) Planar imaging shows diffuse, mildly increased uptake in both lung fields (arrows), compared with blood pool. (B) Low-dose chest CT shows bilateral diffuse GGO at level of lower lobes. (C) Fused SPECT/CT at same level shows diffusely increased uptake, corresponding to findings on planar imaging. Patient died 5 mo later, after receiving whole-lung radiation therapy.

  • FIGURE 3.
    FIGURE 3.

    A 59-y-old woman with myelofibrosis after splenectomy. (A and B) Anterior (A) and posterior (B) thoracic static scintigraphy with partially shielded liver shows diffusely increased uptake in both lungs (arrows), compared with blood pool. (C) Chest CT shows diffuse, smooth interstitial thickening (arrows).

  • FIGURE 4.
    FIGURE 4.

    A 54-y-old female myelofibrosis patient with diffuse PEMH who underwent splenectomy and whole-lung radiation therapy, with additional radiation to liver. (A) Scintigraphy before radiation therapy shows diffusely increased uptake in both lung fields (arrows), compared with blood pool. (B) Two months later, near-complete resolution of pulmonary tracer uptake is seen (arrows), with accompanying substantial relief of respiratory discomfort. (C) Eleven months later, increased uptake in both lung fields reappears (arrows), suggesting recurrence of diffuse PEMH.

Tables

  • TABLE 1

    Pulmonary Hypertension Versus CT Findings

    CT findingsPH presentPH absentEcho findings absentTotal
    Present127221
    Absent0101
    Total128222

    • PH = pulmonary hypertension; echo = echocardiography.

  • TABLE 2

    Pulmonary Hypertension Versus Respiratory Symptoms

    Respiratory symptomsPH presentPH absentEcho findings absentTotal
    Present84113
    Absent4419
    Total128222

    • PH = pulmonary hypertension; echo = echocardiography.

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