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Increased technetium‐99 m hydroxy diphosphonate soft tissue uptake on bone scintigraphy in chronic kidney disease patients with secondary hyperparathyroidism: correlation with hyperphosphataemia
Author(s) -
Enevoldsen Lotte Hahn,
Heaf James,
Højgaard Liselotte,
Zerahn Bo,
Hasbak Philip
Publication year - 2017
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/cpf.12276
Subject(s) - medicine , hyperparathyroidism , secondary hyperparathyroidism , hypercalcaemia , soft tissue , kidney disease , dialysis , gastroenterology , coronary artery disease , urology , parathyroid hormone , pathology , calcium
Summary In bone scan patients with dialysis‐treated chronic kidney disease ( CKD ) and hyperparathyroidism, soft tissue accumulation of technetium‐99 m hydroxy/methylene diphosphonate ( T c‐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 T c‐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 T c‐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.