Aakif Ullah Khan, Shakil Ahmad, Amjad A Khan, Sher M Khan, Muhammad Rauf.
Causes of Superscan Picture on Bone Scintigraphy.
J Coll Physicians Surg Pak Jan ;11(12):765-75.

Objective: To identify causes of the superscan picture on 99mTc-MDP bone scintigraphy in our clinical environment. Design : A descriptive study. Place and Duration of Study: The study was conducted over a period of two years (January 1997 to December 1998) at the Nuclear Medicine Department (NMD), Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar. Subjects and Methods: A total of 27 cases (23 females and 4 males) having super-scan pictures of metabolic bone disease were prospectively evaluated. After three-observer confirmation of bone scan, serum calcium and parathyroid hormone (PTH) estimation was done. The patients having serum PTH greater than 250 pg /ml underwent two-phase parathyroid MIBI scintigraphy (2PP MIBI scan) for the detection of parathyroid adenoma. The patients having positive scans for parathyroid adenoma were subjected to surgery and histopathological confirmation was obtained. Selected cases (N=19) underwent a trial of depot-preparation of vitamin D3 and calcium supplementation. Results: The final diagnosis of 16 patients was osteomalacia (59%), six were histopathologically confirmed cases of parathyroid adenoma (22.2%), One case had toxic adenoma thyroid (3.7%) and one had chronic renal failure (3.7%). In three cases, final diagnosis could not be made (11.1%). Conclusion: Osteomalacia and parathyroid adenoma are the two most common causes for the superscan picture on bone scintigraphy.

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