Liver and lymph node metastases of prostate cancer visualized on post-therapy imaging after treatment with 188Re-HEDP.

A 76-year-old man with bone metastases of prostate cancer diagnosed a year ago was admitted for relief of bone pain (visual analogue scale: 90%) most markedly in cervical spine and upper extremities due to skeletal metastases. His serum prostate specific antigen level was markedly increased (351 ng/ml). After documentation of sufficient tracer uptake in multiple bone metastases on whole-body 99mTc-MDP bone scan, we treated him with a single intravenous injection of 2.4 GBq 188Re-HEDP. Quality control of 188Re-HEDP was performed with TLC within 30 min prior to injection, radiochemical purity was >95%, free rhenium and colloid ratios were less than 3%. For pain, he was taking Novalgin 30 drops t.i.d. and used Fentanyl patch 50 g/72 h. Fig. 1 shows increased activity localization in multiple bone metastases and the liver lesion after treatment with 188Re-HEDP, as well as on the whole-body scans obtained a week prior to treatment. This metastatic liver lesion was diagnosed on a conventional CT scan 6 months before treatment. The SPECT/CT study (obtained at 24 h after injection) shows tracer accumulation in the liver lesion, in abdominal lymph nodes (in the hepatoduodenal ligament) and in stomach (Fig. 2A and B). An abdominal section of the SPECT/CT study shows that the area of activity localization on right side of abdomen on whole body image corresponds to intestinal contents (Fig. 2C). Liver metastases of various malignant tumors such as breast cancer have been reported to show accumulation on bone scintigraphy with 99mTc-MDP. Limouris and Skukla reported 186Re-HEDP uptake in the stomach in two patients with osseous metastases because of prostate and breast cancer1; however, we could not find any reports on visualization of lymph node metastases on posttherapy scan after administration of 188Re-HEDP. Accumulation of