| خلاصه مقاله | Aim/Introduction: Detection of possible malignant involvement
by radionuclide scan according to a patient’s clinical symptoms,
laboratory biomarkers, or occasionally even without them
Materials and Methods: A 77-year-old man with a history of
multinodular goiter operated (total thyroidectomy) one year ago.
The pathology report was benign goiter, but when he was referred
to the endocrinologist for periodic management of the disease,
his physician accidently noticed an increase in the serum alkaline
phosphatase level (ALP=536, normal range =44-147 IU/L). The
patient’s other tests were as follows (Ur = 49, Cr = 2.3, Ph = 3.8, Ca
= 8.9). It is important to note that the patient did not mention any
obvious bone pain. Whole body bone scan was requested by the
attending physician for further evaluation of the patient. After an
intravenous injection of 630 MBq of 99mTc-MDP, the whole body
scan was performed three hours later in poster, anterior, and some
spot views. Results: Several osteoblastic lesions were observed
and reported at the regions of the Post. skull, Rt. lateral upper ribs,
and Lt. ischium, suggesting metastatic involvement. Then the
spiral chest CT was requested and showed a suspicious lesion in
the superior segment of the right lung. During the evaluation by
an interventional radiologist, a CT-guided biopsy was performed,
and pulmonary carcinoma was diagnosed by the pathologist.
Chemotherapy was prescribed for the patient in accordance with
his condition. Conclusion: It is possible for bone metastasis to
cause an increase in the serum alkaline phosphatase (ALP) titer
or other biomarkers without even skeletal pain. Consequently, in
such cases, it is recommended to perform whole body functional
imaging, speciÄcally bone scintigraphy |