{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T03:42:33Z","timestamp":1767066153155,"version":"build-2065373602"},"reference-count":53,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shanghai Municipal Health Commission scientific research project","award":["No. YG2019ZDA09"],"award-info":[{"award-number":["No. YG2019ZDA09"]}]},{"name":"Shanghai Sixth People\u2019s Hospital scientific research project","award":["No.YNLC201903"],"award-info":[{"award-number":["No.YNLC201903"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Here, we reported a panel of rare diseases involving bilateral lower extremities with similar imaging patterns on 99mTc-MDP bone scans. Glucose-6-phosphate dehydrogenase deficiency (G-6PD deficiency), Gaucher disease (GD), steroid-induced osteonecrosis, progressive diaphyseal dysplasia (PDD), Erdheim\u2013Chester disease (ECD) and Langerhans cell sarcoma (LCS) were included and imaging characteristics were analyzed. The rare properties of these diseases and mimicking features on 99mTc-MDP bone scans rendered differential diagnosis difficult but necessary. We believe that the rarely known imaging features of the reported diseases will undoubtedly help nuclear medicine physicians make differential diagnoses in clinical practice.<\/jats:p>","DOI":"10.3390\/diagnostics12040910","type":"journal-article","created":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T16:21:30Z","timestamp":1649262090000},"page":"910","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Differential Diagnosis of Rare Diseases Involving Bilateral Lower Extremities with Similar 99mTc-MDP Bone Scan Patterns: Analysis of a Case Series"],"prefix":"10.3390","volume":"12","author":[{"given":"Zhenkui","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People\u2019s Hospital, Shanghai 200233, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5943-4418","authenticated-orcid":false,"given":"Chentian","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People\u2019s Hospital, Shanghai 200233, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/S0140-6736(08)60073-2","article-title":"Glucose-6-phosphate dehydrogenase deficiency","volume":"371","author":"Cappellini","year":"2008","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1097\/00003072-197910000-00002","article-title":"Splenic visualization in a patient with glucose-6-phosphate dehydrogenase deficiency","volume":"4","author":"Lieberman","year":"1979","journal-title":"Clin. Nucl. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1111\/j.1751-553X.2011.01309.x","article-title":"Modification to reporting of qualitative fluorescent spot test results improves detection of glucose-6-phosphate dehydrogenase (G6PD)-deficient heterozygote female newborns","volume":"33","author":"Nadarajan","year":"2011","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e369","DOI":"10.1097\/MD.0000000000000369","article-title":"Malignant transformation in monostotic fibrous dysplasia: Clinical features, imaging features, outcomes in 10 patients, and review","volume":"94","author":"Qu","year":"2015","journal-title":"Medicine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.2214\/AJR.15.15294","article-title":"Standardization of MRI and Scintigraphic Scores for Assessing the Severity of Bone Marrow Involvement in Adult Patients With Type 1 Gaucher Disease","volume":"206","author":"Mariani","year":"2016","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_6","first-page":"1253","article-title":"Severity of bone marrow involvement in patients with Gaucher\u2019s disease evaluated by scintigraphy with 99mTc-sestamibi","volume":"44","author":"Mariani","year":"2003","journal-title":"J. Nucl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.2967\/jnumed.113.121871","article-title":"99mTc-sestamibi scintigraphy to monitor the long-term efficacy of enzyme replacement therapy on bone marrow infiltration in patients with Gaucher disease","volume":"54","author":"Erba","year":"2013","journal-title":"J. Nucl. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/00003072-200207000-00008","article-title":"Tc-99m sestamibi bone marrow scintigraphy in Gaucher disease","volume":"27","author":"Aharoni","year":"2002","journal-title":"Clin. Nucl. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1007\/BF01247378","article-title":"Scintigraphic findings on 99mTc-MDP, 99mTc-sestamibi and 99mTc-HMPAO images in Gaucher\u2019s disease","volume":"23","author":"Mariani","year":"1996","journal-title":"Eur. J. Nucl. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1007\/s00256-010-0992-3","article-title":"Radiological aspects of Gaucher disease","volume":"40","author":"Katz","year":"2011","journal-title":"Skeletal Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1093\/qjmed\/90.1.19","article-title":"Pro-inflammatory cytokines and the pathogenesis of Gaucher\u2019s disease: Increased release of interleukin-6 and interleukin-10","volume":"90","author":"Allen","year":"1997","journal-title":"QJM Int. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1080\/08897077.2011.562751","article-title":"Osteonecrosis following alcohol, cocaine, and steroid use","volume":"32","author":"Ziraldo","year":"2011","journal-title":"Subst. Abuse"},{"key":"ref_13","first-page":"1347","article-title":"Multifocal osteonecrosis following chemotherapy and short-term corticosteroid therapy in a patient with small-cell bronchogenic carcinoma","volume":"35","author":"Jones","year":"1994","journal-title":"J. Nucl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/S0009-9260(97)80253-X","article-title":"Avascular necrosis of bone following an intensified chemotherapy regimen including high dose steroids","volume":"52","author":"Thornton","year":"1997","journal-title":"Clin. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3478","DOI":"10.1007\/s11999-012-2550-x","article-title":"The natural progression of adult elbow osteonecrosis related to corticosteroid treatment","volume":"470","author":"Younes","year":"2012","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/jmg.2005.033522","article-title":"Camurati-Engelmann disease: Review of the clinical, radiological, and molecular data of 24 families and implications for diagnosis and treatment","volume":"43","author":"Janssens","year":"2006","journal-title":"J. Med. Genet."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1136\/ard.41.2.183","article-title":"Engelmann\u2019s disease of bone\u2014A systemic disorder?","volume":"41","author":"Crisp","year":"1982","journal-title":"Ann. Rheum. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1007\/s00259-008-0913-z","article-title":"Camurati-Engelmann disease on a 99mTc-HMDP bone scan","volume":"35","author":"Momose","year":"2008","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_19","first-page":"244","article-title":"Ribbing\u2019s disease: Radiographic-scintigraphic correlation and comparative analysis with Engelmann\u2019s disease","volume":"28","author":"Shier","year":"1987","journal-title":"J. Nucl. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1148\/radiology.140.1.6454165","article-title":"Progressive diaphyseal dysplasia (Engelmann disease(: Scintigraphic-radiographic-clinical correlations","volume":"140","author":"Kumar","year":"1981","journal-title":"Radiology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1097\/RLU.0b013e3181e05ea3","article-title":"Bone scintigraphy in Engelmann-Camurati disease","volume":"35","author":"Moron","year":"2010","journal-title":"Clin. Nucl. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/00005792-199605000-00005","article-title":"Erdheim-Chester disease. Clinical and radiologic characteristics of 59 cases","volume":"75","author":"Cacoub","year":"1996","journal-title":"Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.critrevonc.2015.02.004","article-title":"Erdheim-Chester disease: A systematic review","volume":"95","author":"Cives","year":"2015","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2778","DOI":"10.1182\/blood-2010-06-294108","article-title":"CNS involvement and treatment with interferon-alpha are independent prognostic factors in Erdheim-Chester disease: A multicenter survival analysis of 53 patients","volume":"117","author":"Arnaud","year":"2011","journal-title":"Blood"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/BF00243099","article-title":"Case report 710: Symmetrical eosinophilic granuloma of the lower extremities (proven) and Erdheim-Chester disease (probable)","volume":"21","author":"Strouse","year":"1992","journal-title":"Skeletal Radiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1016\/j.mayocp.2015.03.019","article-title":"Erdheim-Chester Disease","volume":"90","author":"Shah","year":"2015","journal-title":"Mayo Clin. Proc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1148\/radiology.142.2.7054816","article-title":"Erdheim-Chester disease","volume":"142","author":"Resnick","year":"1982","journal-title":"Radiology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/00003072-200501000-00011","article-title":"Radionuclide bone imaging in Erdheim-Chester disease","volume":"30","author":"Nunez","year":"2005","journal-title":"Clin. Nucl. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1007\/s00259-005-1817-9","article-title":"Erdheim-Chester disease: 99mTc-MDP bone scan provides the diagnosis","volume":"32","author":"Canbaz","year":"2005","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/01.rlu.0000249758.49841.fa","article-title":"Tc-99m MDP bone scintigraphy and positron emission tomography\/computed tomography (PET\/CT) imaging in Erdheim-Chester disease","volume":"32","author":"Namwongprom","year":"2007","journal-title":"Clin. Nucl. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/s12149-007-0110-3","article-title":"Erdheim-Chester disease: A rare syndrome with a characteristic bone scintigraphy pattern","volume":"22","author":"Spyridonidis","year":"2008","journal-title":"Ann. Nucl. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1097\/RLU.0000000000000452","article-title":"Visualization of orbital involvement of Erdheim-Chester disease on PET\/CT","volume":"39","author":"Beylergil","year":"2014","journal-title":"Clin. Nucl. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3128","DOI":"10.1002\/art.24848","article-title":"18F-fluorodeoxyglucose-positron emission tomography scanning is more useful in followup than in the initial assessment of patients with Erdheim-Chester disease","volume":"60","author":"Arnaud","year":"2009","journal-title":"Arthritis Rheum."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.ctrv.2015.02.011","article-title":"Langerhans cell sarcoma: A systematic review","volume":"41","author":"Howard","year":"2015","journal-title":"Cancer Treat. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s12185-008-0063-x","article-title":"Leukemic transformation of Langerhans cell sarcoma","volume":"87","author":"Sumida","year":"2008","journal-title":"Int. J. Hematol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.critrevonc.2015.12.017","article-title":"Langerhans cell sarcoma of the head and neck","volume":"99","author":"Howard","year":"2016","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1532\/IJH97.NA0604","article-title":"Cutaneous Langerhans cell sarcoma: A case report and review of the literature","volume":"85","author":"Bohn","year":"2007","journal-title":"Int. J. Hematol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1002\/1097-0142(197312)32:6<1421::AID-CNCR2820320620>3.0.CO;2-Y","article-title":"Malignant histiocytosis with eosinophilia","volume":"32","author":"Henderson","year":"1973","journal-title":"Cancer"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1532\/IJH97.04142","article-title":"CD56\/NCAM-positive Langerhans cell sarcoma: A clinicopathologic study of 4 cases","volume":"81","author":"Kawase","year":"2005","journal-title":"Int. J. Hematol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1002\/1097-0142(197108)28:2<467::AID-CNCR2820280228>3.0.CO;2-9","article-title":"Malignant histiocytosis: A case of generalized histiocytosis with infiltration of Langerhans\u2019 granule-containing histiocytes","volume":"28","author":"Imamura","year":"1971","journal-title":"Cancer"},{"key":"ref_41","first-page":"1848","article-title":"Fibrous dysplasia. Pathophysiology, evaluation, and treatment","volume":"87","author":"DiCaprio","year":"2005","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1186\/1750-1172-7-80","article-title":"An epidemiological and clinical analysis of craniomaxillofacial fibrous dysplasia in a Chinese population","volume":"7","author":"Cheng","year":"2012","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/01.rlu.0000113856.77103.7e","article-title":"The role of radionuclide bone scintigraphy in fibrous dysplasia of bone","volume":"29","author":"Zhibin","year":"2004","journal-title":"Clin. Nucl. Med."},{"key":"ref_44","first-page":"127","article-title":"Comparison of SPET\/CT, SPET and planar imaging using 99mTc-MIBI as independent techniques to support minimally invasive parathyroidectomy in primary hyperparathyroidism: A meta-analysis","volume":"18","author":"Wei","year":"2015","journal-title":"Hell. J. Nucl. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1007\/s12149-014-0876-z","article-title":"Dual-phase (99m)Tc-MIBI scintigraphy with delayed neck and thorax SPECT\/CT and bone scintigraphy in patients with primary hyperparathyroidism: Correlation with clinical or pathological variables","volume":"28","author":"Qiu","year":"2014","journal-title":"Ann. Nucl. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1053\/j.semnuclmed.2003.12.005","article-title":"Diffuse increased uptake on bone scan: Super scan","volume":"34","author":"Pour","year":"2004","journal-title":"Semin. Nucl. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"49","DOI":"10.3109\/2000-1967-110","article-title":"Super bone scan due to bone marrow metastases appearing 19 years after surgery for early gastric cancer\u2014A case report","volume":"109","author":"Omi","year":"2004","journal-title":"Upsala J. Med. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1719","DOI":"10.2169\/internalmedicine.48.2397","article-title":"\u201cSuper bone scan\u201d in a case of diffuse bone marrow metastasis of gastric adenocarcinoma","volume":"48","author":"Kanazawa","year":"2009","journal-title":"Intern. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.kjms.2012.08.038","article-title":"Bone metastasis versus bone marrow metastasis? Integration of diagnosis by (18)F-fluorodeoxyglucose positron emission\/computed tomography in advanced malignancy with super bone scan: Two case reports and literature review","volume":"29","author":"Lin","year":"2013","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1097\/RLU.0b013e318053ed37","article-title":"Super scan in a patient with diffuse bone metastases from intracranial glioma","volume":"32","author":"Shinya","year":"2007","journal-title":"Clin. Nucl. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/RLU.0b013e318208f503","article-title":"Super-superscan on a bone scintigraphy","volume":"36","author":"Liu","year":"2011","journal-title":"Clin. Nucl. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/BF03164875","article-title":"Sub-super bone scan caused by bone marrow involvement of prostate cancer","volume":"13","author":"Seo","year":"1999","journal-title":"Ann. Nucl. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1097\/01.rlu.0000093084.55297.f5","article-title":"Super scan leading to definitive diagnosis in a patient with recurrent syncope","volume":"28","author":"Khoury","year":"2003","journal-title":"Clin. Nucl. Med."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/4\/910\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:49:10Z","timestamp":1760136550000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/4\/910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,6]]},"references-count":53,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["diagnostics12040910"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12040910","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2022,4,6]]}}}