Ewing sarcoma - scintigraphic image

Summary

Aim:
To present the scintigraphic image of Ewing sarcoma in a 15-years-old girl.

Methods:
15-years-old girl without specific family history of disease was admitted to a regional hospital having various problems such as fatigue, a lack of appetite, weight loss, pain in her joints and bones. According to the laboratory tests infection parameters were: CRP 160 mg/l, FW 120/128 and anemia. The patient underwent three phase bone scintigraphy to exclude the possibility of infection in the right sacroiliac area. The patient weight was 59,5 kg. Applied activity of the ^99mTc-methylendiphosphonate (MDP) was 750 MBq. The scintigraphy started 10 minutes after an intravenous injection of the radiotracer. Three hours later started whole body scintigraphy using dual-head SPECT gamma camera AXIS PICKER with low-energy, high resolution, parallel-hole collimators.

Results:
In the third phase scintigraphy demonstrated significantly patchy increased accumulation in the axial skeleton, in the occipital region of the cranium, in both coxal joints and in the left fibula. This result suggested hematologic malignancy. The patient was referred to Department of Hematooncology Olomouc University Hospital. MRI of the skeletal system and an examination of bone marrow were done there. Cells of Ewing sarcoma were found. This clinical diagnosis was confirmed in the Department of Oncology in Brno. It was considered that the primary tumor was the left fibular lesion.

Conclusion:
The three-phase bone scintigraphy demonstrates important role of high sensitive nuclear medicine methods in the diagnostics of disease in children. The result significantly changed the clinical approach in this case.

Key Words:
three–phase bone scintigraphy, ^99mTc-methylendiphosphonate, hematologic malignancy, Ewing sarcoma