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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="Molecular Imaging and Contrast Agent Database (MICAD) [Internet]" /><meta name="citation_title" content="99mTc-Methyl diphosphonate" /><meta name="citation_publisher" content="National Center for Biotechnology Information (US)" /><meta name="citation_date" content="2009/08/24" /><meta name="citation_author" content="Arvind Chopra" /><meta name="citation_pmid" content="20641923" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK24575/" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="99mTc-Methyl diphosphonate" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Center for Biotechnology Information (US)" /><meta name="DC.Contributor" content="Arvind Chopra" /><meta name="DC.Date" content="2009/08/24" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK24575/" /><meta name="description" content="Invasive procedures are often necessary to treat internal bone injuries or disorders. Therefore it is important for individuals providing treatment to accurately diagnose the disorder to provide the most suitable therapy before subjecting the patient to any invasive procedures. Bone injuries are often investigated either by magnetic resonance imaging (MRI) or single-photon emission computed tomography (SPECT) scans using radionuclides (1). The SPECT technique is based on imaging of radionuclides and the fact that certain elements or compounds concentrate selectively in specific tissue. Compared to other imaging techniques, e.g., planar scintigraphy, SPECT provides detailed information about the anatomy and physiological state of the bone (1, 2). Bone SPECT has been used to detect early osteonecrosis of the femoral head in renal transplant patients (3), to investigate internal derangement and stress fractures of the knee (4, 5) and also to monitor bone metastasis in breast (6), gastric (7), and prostate (8) cancers. Imaging with 99mTc-methylene diphosphonate (99mTc-MDP) is the initial method of choice to detect skeletal metastases in cancer patients (9)." /><meta name="og:title" content="99mTc-Methyl diphosphonate" /><meta name="og:type" content="book" /><meta name="og:description" content="Invasive procedures are often necessary to treat internal bone injuries or disorders. Therefore it is important for individuals providing treatment to accurately diagnose the disorder to provide the most suitable therapy before subjecting the patient to any invasive procedures. Bone injuries are often investigated either by magnetic resonance imaging (MRI) or single-photon emission computed tomography (SPECT) scans using radionuclides (1). The SPECT technique is based on imaging of radionuclides and the fact that certain elements or compounds concentrate selectively in specific tissue. Compared to other imaging techniques, e.g., planar scintigraphy, SPECT provides detailed information about the anatomy and physiological state of the bone (1, 2). Bone SPECT has been used to detect early osteonecrosis of the femoral head in renal transplant patients (3), to investigate internal derangement and stress fractures of the knee (4, 5) and also to monitor bone metastasis in breast (6), gastric (7), and prostate (8) cancers. 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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>Molecular Imaging and Contrast Agent Database (MICAD) [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2004-2013. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/micad/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-micad-lrg.png" alt="Cover of Molecular Imaging and Contrast Agent Database (MICAD)" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>Molecular Imaging and Contrast Agent Database (MICAD) [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK24575_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK24575_dtls__"><div>Bethesda (MD): <a href="https://www.ncbi.nlm.nih.gov/" ref="pagearea=page-banner&amp;targetsite=external&amp;targetcat=link&amp;targettype=publisher">National Center for Biotechnology Information (US)</a>; 2004-2013.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/micad/">Contents</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/micad/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/micad/Z-MaSSS-99mTc/" title="Previous page in this title">&lt; Prev</a><a class="active page_link next" href="/books/n/micad/MCP-1Tc99m/" title="Next page in this title">Next &gt;</a></div></div></div></div></div>
<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK24575_"><span class="title" itemprop="name"><sup>99m</sup>Tc-Methyl diphosphonate</span></h1><div itemprop="alternativeHeadline" class="subtitle whole_rhythm"><sup>99m</sup>Tc-MDP</div><p class="contrib-group"><span itemprop="author">Arvind Chopra</span>, PhD.</p><a data-jig="ncbitoggler" href="#__NBK24575_ai__" style="border:0;text-decoration:none">Author Information and Affiliations</a><div style="display:none" class="ui-widget" id="__NBK24575_ai__"><div class="contrib half_rhythm"><span itemprop="author">Arvind Chopra</span>, PhD<div class="affiliation small">National Center for Biotechnology Information, NLM, NIH, Bethesda, MD 20894<div><span class="email-label">Email: </span><a href="mailto:dev@null" data-email="vog.hin.mln.ibcn@dacim" class="oemail">vog.hin.mln.ibcn@dacim</a></div></div></div></div><p class="small">Created: <span itemprop="datePublished">March 29, 2007</span>; Last Update: <span itemprop="dateModified">August 24, 2009</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="MDP99mTc.T.nc_chemical_name99mtcmethyl_d" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK24575/table/MDP99mTc.T.nc_chemical_name99mtcmethyl_d/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__MDP99mTc.T.nc_chemical_name99mtcmethyl_d_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Chemical name:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><sup>99m</sup>Tc-Methyl diphosphonate</td><td rowspan="9" colspan="1" style="text-align:center;vertical-align:middle;">
<a href="https://pubchem.ncbi.nlm.nih.gov/substance/24423397" title="View this structure in PubChem" class="img_link" ref="pagearea=body&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&amp;sid=24423397" alt="image 24423397 in the ncbi pubchem database" /></a>
</td></tr><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Abbreviated name:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><sup>99m</sup>Tc -MDP</td></tr><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Synonym:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><sup>99m</sup>Tc -Methylene diphosphonate, Technetium 99mTc Medronate</td></tr><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Agent Category:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Compound</td></tr><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Target:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Type 2 class of aminoacyl-tRNA synthetases</td></tr><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Target Category:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Enzymes</td></tr><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Method of detection:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Single photon emission computed tomography (SPECT); planar gamma imaging</td></tr><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Source of signal / contrast:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><sup>99m</sup>Tc</td></tr><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Activation:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No</td></tr><tr><td rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
<b>Studies:</b>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
<ul class="simple-list"><li class="half_rhythm"><div>
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<img alt="Checkbox" src="/corehtml/pmc/css/bookshelf/2.26/img/studies.checkbox.png" /> Rodents
</div></li><li class="half_rhythm"><div>
<img alt="Checkbox" src="/corehtml/pmc/css/bookshelf/2.26/img/studies.checkbox.png" /> Non-primate non-rodent mammals
</div></li><li class="half_rhythm"><div>
<img alt="Checkbox" src="/corehtml/pmc/css/bookshelf/2.26/img/studies.checkbox.png" /> Non-human primates
</div></li><li class="half_rhythm"><div>
<img alt="Checkbox" src="/corehtml/pmc/css/bookshelf/2.26/img/studies.checkbox.png" /> Humans
</div></li></ul>
</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Structure of <sup>99m</sup>Tc-MDP. Click on the above structure for additional information in <a href="http://pubchem.ncbi.nlm.nih.gov/" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">PubChem</a>.</td></tr></tbody></table></div></div><div id="MDP99mTc.Background"><h2 id="_MDP99mTc_Background_">Background</h2><p>[<a href="/sites/entrez?Db=pubmed&#x00026;Cmd=DetailsSearch&#x00026;Term=99mTc-MDP" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">PubMed</a>]</p><p>Invasive procedures are often necessary to treat internal bone injuries or disorders. Therefore it is important for individuals providing treatment to accurately diagnose the disorder to provide the most suitable therapy before subjecting the patient to any invasive procedures. Bone injuries are often investigated either by magnetic resonance imaging (MRI) or single-photon emission computed tomography (SPECT) scans using radionuclides (<a class="bk_pop" href="#MDP99mTc.REF.1">1</a>). The SPECT technique is based on imaging of radionuclides and the fact that certain elements or compounds concentrate selectively in specific tissue. Compared to other imaging techniques, e.g., planar scintigraphy, SPECT provides detailed information about the anatomy and physiological state of the bone (<a class="bk_pop" href="#MDP99mTc.REF.1" data-bk-pop-others="MDP99mTc.REF.2">1, 2</a>). Bone SPECT has been used to detect early osteonecrosis of the femoral head in renal transplant patients (<a class="bk_pop" href="#MDP99mTc.REF.3">3</a>), to investigate internal derangement and stress fractures of the knee (<a class="bk_pop" href="#MDP99mTc.REF.4" data-bk-pop-others="MDP99mTc.REF.5">4, 5</a>) and also to monitor bone metastasis in breast (<a class="bk_pop" href="#MDP99mTc.REF.6">6</a>), gastric (<a class="bk_pop" href="#MDP99mTc.REF.7">7</a>), and prostate (<a class="bk_pop" href="#MDP99mTc.REF.8">8</a>) cancers. Imaging with <sup>99m</sup>Tc-methylene diphosphonate (<sup>99m</sup>Tc-MDP) is the initial method of choice to detect skeletal metastases in cancer patients (<a class="bk_pop" href="#MDP99mTc.REF.9">9</a>).</p><p>For SPECT of the bone, metastable technetium (<sup>99m</sup>Tc) is tagged onto a phosphonate compound such as MDP to generate <sup>99m</sup>Tc-MDP, which selectively concentrates in the bone. Although accumulation of <sup>99m</sup>Tc-MDP in the bone is caused by its chemical adsorption onto, and into, the crystalline structure of hydroxyapatite (<a class="bk_pop" href="#MDP99mTc.REF.10">10</a>), but the enzyme aminoacyl-tRNA synthetase is believed to convert it into ATP analogues that inhibit any ATP-dependent enzymes and result in cellular apoptosis (<a class="bk_pop" href="#MDP99mTc.REF.11">11</a>). For scintigraphy the labeled compound is administered intravenously to the patient and SPECT is subsequently performed after suitable time periods.</p><p><sup>99m</sup>Tc-MDP has been approved by the US Food and Drug Administration as an imaging agent to investigate osteogenesis and is commercially available in kit form (<a class="bk_pop" href="#MDP99mTc.REF.12">12</a>).Results obtained with any new radiolabeled compound being evaluated for bone imaging in <a href="http://clinicaltrials.gov/ct2/results?term=99mTc-MDP" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">clinical trials</a> are compared to those obtained with <sup>99m</sup>Tc-MDP.</p><div id="MDP99mTc.other"><h3>Other sources of information:</h3><p><a href="/protein/NP_446209.1" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">Protein</a> and <a href="/nuccore/NM_053757.1" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">mRNA</a> sequence of rat aminoacyl-tRNA synthetase</p><p><a href="/sites/nuccore?Db=gene&#x00026;DbFrom=nuccore&#x00026;Cmd=Link&#x00026;LinkName=nuccore_gene&#x00026;IdsFromResult=75832034" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">Gene information</a> regarding rat aminoacyl-tRNA synthetase (GeneID: 114632) (Source: Entrez Gene)</p><p>Aminoacyl tRNA synthetase in <a href="/omim?term=aminoacyl%20tRNA%20synthetase" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">Online Mendelian Inheritance in Man (OMIM)</a></p><p><a href="/Structure/mmdb/mmdbsrv.cgi?uid=80673" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">Structure</a> of human cytosolic phenylalanyl-tRNA synthase (Source: NCBI)</p></div></div><div id="MDP99mTc.Synthesis"><h2 id="_MDP99mTc_Synthesis_">Synthesis</h2><p>[<a href="/entrez/query.fcgi?cmd=PureSearch&#x00026;db=pubmed&#x00026;details_term=99mTc-MDP%20synthesis" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">PubMed</a>]</p><p>Because synthesis of <sup>99m</sup>Tc-MDP can be performed at room temperature, a kit for its preparation immediately before use is commercially available (<a class="bk_pop" href="#MDP99mTc.REF.12">12</a>). The kit includes a vial containing a lyophilized, sterile, nonpyrogenic, and nonradioactive mixture of medronic acid, stannous chloride dehydrate, and p-aminobenzoic acid that is packed under nitrogen. Prior to lyophilization, pH of the mixture is adjusted to between 6.5 and 7.5 with hydrochloric acid or sodium hydroxide. To prepare <sup>99m</sup>Tc-MDP, sodium pertechnetate (<sup>99m</sup>Tc), available as a sterile nonpyrogenic preparation from commercial sources, is injected into the vial containing the lyophilized mixture. To mix the solution, the vial is swirled gently until the contents are completely dissolved. According to the manufacturer, the labeling is rapid and quantitative. The maximum recommended amount of <sup>99m</sup>Tc to add to the vial is 500 mCi (18.5 GBq). The product information and insert can be viewed at the <a href="http://usa.braccoimaging.com/images/stories/pdf/nuclear/mdp-bracco/MDP-Bracco8.5x11.pdf" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">manufacturers website</a>.</p></div><div id="MDP99mTc.In_Vitro_Studies_Testing_in_Cel"><h2 id="_MDP99mTc_In_Vitro_Studies_Testing_in_Cel_"><i>In Vitro</i> Studies: Testing in Cells and Tissues</h2><p>[<a href="/entrez/query.fcgi?cmd=PureSearch&#x00026;db=pubmed&#x00026;details_term=99mTc-MDP%20in%20vitro" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">PubMed</a>]</p><p>The mechanism of <sup>99m</sup>Tc-MDP accumulation in bone was investigated in mice calvaria, osteoblast-like cells, collagen sponges, and hydroxyapatite powder (<a class="bk_pop" href="#MDP99mTc.REF.10">10</a>). Uptake of the label was observed only in cells growing out from the calvaria fragments and in calvaria fragments fixed with ethanol. Pyrophosphate and EDTA reduced the accumulation of <sup>99m</sup>Tc-MDP on the calvaria fragments. No correlation was observed between the number of osteoblast-like cells and the accumulation of <sup>99m</sup>Tc-MDP. No accumulation of <sup>99m</sup>Tc-MDP was seen in the collagen sponges. These observations suggest that <sup>99m</sup>Tc-MDP accumulates on the bone by chemical adsorption and incorporation into the hydroxyapatite structure.</p><p>The uptake of <sup>99m</sup>Tc-MDP was investigated in two rat tibial bone models (<a class="bk_pop" href="#MDP99mTc.REF.13">13</a>). In one model, the bone had a specific injury, and in the other there was osteomyelitis. Both models were evaluated by scintigraphy and <sup>31</sup>P magnetic resonance spectroscopy for pH, mineral phosphate/creatinine phosphate ratio (Pi/PCr), and ATP/PCr ratio over a three-week period. In both models the <sup>99m</sup>Tc-MDP uptake peaked at ~one week and gradually decreased thereafter. With the scintigram the injured bone demonstrated distinct uptake, but there was a diffused uptake in the osteomyelitis model. Only the osteomyelitis model showed a significant change in pH and ATP/PCr, but not Pi/Cr. This indicated that the accumulation of <sup>99m</sup>Tc-MDP in the bone was affected by the disease type and environmental factors such as pH and phosphate concentration.</p></div><div id="MDP99mTc.Animal_Studies"><h2 id="_MDP99mTc_Animal_Studies_">Animal Studies</h2><div id="MDP99mTc.Rodents"><h3>Rodents</h3><p>[<a href="/sites/entrez?Db=pubmed&#x00026;Cmd=DetailsSearch&#x00026;Term=99mTc-MDP+rodentia" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">PubMed</a>]</p><p>The uptake of <sup>99m</sup>Tc-MDP and <sup>32</sup>P incorporation was used as a measure of bone healing during endosteal healing with titanium, hydroxyapatite (these are considered bone-bonding materials), or stainless steel (does not bind to bone) implants in rat tibial bone after bone marrow ablation (<a class="bk_pop" href="#MDP99mTc.REF.14">14</a>). The distribution of <sup>99m</sup>Tc-MDP and <sup>32</sup>P was observed to vary according to the implant, which indicated that the implants influenced bone healing. The investigators suggest that the distribution and uptake of the two labels may be useful parameters to study bone bonding.</p><p>The effect of mitomycin-C, a drug used to treat cancer, on the biodistribution of <sup>99m</sup>Tc-MDP in mice was investigated (<a class="bk_pop" href="#MDP99mTc.REF.15">15</a>). Although the drug affected radioactivity uptake in the stomach, ovary, pancreas, uterus, kidneys, spleen, thymus, heart, liver, and lungs, no significant change was observed in thyroid, brain, or bones of the animals. The investigators concluded that mitomycin-C did not interfere with <sup>99m</sup>Tc-MDP bone SPECT; however, because it changed the uptake in some organs, any hot spots should be examined carefully for diagnosis.</p><p>The whole-body (WB) retention of <sup>47</sup>CaCl and <sup>99m</sup>Tc-MDP was investigated in three bone disease models (osteomalacic, steroid-induced osteoporosis, and osteoporosis) in rats (<a class="bk_pop" href="#MDP99mTc.REF.16">16</a>). The three disease models showed marked differences in WB retention of the two radiopharmaceuticals after 24 h of administration. On the basis of these observations, the investigators suggest that these radiopharmaceuticals can be used to differentiate the various bone diseases prior to detection of radiological changes in the animal models.</p></div><div id="MDP99mTc.Other_NonPrimate_Mammals"><h3>Other Non-Primate Mammals</h3><p>[<a href="/entrez/query.fcgi?cmd=PureSearch&#x00026;db=pubmed&#x00026;details_term=99mTc-MDP%20non-primate%20mammals" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">PubMed</a>]</p><p>Drost et al. (<a class="bk_pop" href="#MDP99mTc.REF.17">17</a>) investigated the use of <sup>99m</sup>Tc-MDP scintigraphy to determine the onset time frame, distribution, and appearance of bone lesions in dogs infected with <i>Hepatozoon americanum</i> oocytes. These protozoans proliferate on the long bones, pelvis, vertebrae, and skull of the animals. The investigators described the appearance of the lesions and concluded that scintigraphy can be used to evaluate the <i>H. americanum</i> lesions in the animals.</p><p>Scintigraphy using <sup>99m</sup>Tc-MDP was performed on lame dogs after clinical examination; radiography and synovial fluid analysis could not localize the cause of lameness to a specific area of pain (<a class="bk_pop" href="#MDP99mTc.REF.18">18</a>). After bone scintigraphy, the investigators concluded that the highly sensitive and relatively specific uptake of the label could be used to localize and characterize, or exclude, the skeletal lesions that caused lameness in most dogs examined in this study.</p><p>The effect of <sup>99m</sup>Tc-MDP and <sup>99m</sup>Tc-dicarboxypropane diphosphonate (<sup>99m</sup>Tc-DPD) on bone scan image quality and time in dogs with osteoarthritis was evaluated (<a class="bk_pop" href="#MDP99mTc.REF.19">19</a>). The investigators observed that both labels yielded similar results for radioactivity uptake and image quality; however, <sup>99m</sup>Tc-DPD was more efficient than <sup>99m</sup>Tc-MDP in reducing the overall time of scintigraphy.</p><p>Some SPECT work has also been done to diagnose tooth infections (<a class="bk_pop" href="#MDP99mTc.REF.20">20</a>) and paranasal disorders (<a class="bk_pop" href="#MDP99mTc.REF.21">21</a>) in horses.</p></div><div id="MDP99mTc.NonHuman_Primates"><h3>Non-Human Primates</h3><p>[<a href="/entrez/query.fcgi?cmd=PureSearch&#x00026;db=pubmed&#x00026;details_term=99mTc-MDP%20non-human%20primates" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">PubMed</a>]</p><p>Scintigraphy with <sup>99m</sup>Tc-MDP was used to evaluate the healing of long bone fractures in baboons (<a class="bk_pop" href="#MDP99mTc.REF.22">22</a>). The investigators concluded that <sup>99m</sup>Tc-MDP scintigraphy was an accurate technique to investigate the physiological activity of bones. The same investigators also concluded that this technique was a valuable diagnostic tool in traumatic orthopedic surgery for the quantitative and qualitative evaluation of long bone healing in these animals (<a class="bk_pop" href="#MDP99mTc.REF.23">23</a>).</p></div></div><div id="MDP99mTc.Human_Studies"><h2 id="_MDP99mTc_Human_Studies_">Human Studies</h2><p>[<a href="/entrez/query.fcgi?cmd=PureSearch&#x00026;db=pubmed&#x00026;details_term=%22SUBSTANCENAME%22%5BSubstance%20Name%5D%20AND%20human" ref="pagearea=body&amp;targetsite=external&amp;targetcat=link&amp;targettype=uri">PubMed</a>]</p><p>Several investigators have shown that <sup>99m</sup>Tc-MDP scans (WB bone or specific body parts) can be used to monitor, diagnose, and detect a variety of human diseases (<a class="bk_pop" href="#MDP99mTc.REF.24" data-bk-pop-others="MDP99mTc.REF.25 MDP99mTc.REF.26 MDP99mTc.REF.27">24-27</a>).</p><p>A retrospective study assessed the use of WB bone scintigraphy (WB BSc) with <sup>99m</sup>Tc-MDP to monitor the effect of biphosphonate treatment in patients with breast cancer and bone metastasis (<a class="bk_pop" href="#MDP99mTc.REF.6">6</a>). After compiling the results the investigators concluded that WB BSc with <sup>99m</sup>Tc-MDP was a reliable method to assess this therapy in the treatment planning of breast cancer patients. Binnie et al. have suggested the use of pre-therapeutic <sup>99m</sup>Tc-MDP bone scans to plan targeted radionulide therapy for bone metastases caused by prostate cancer (<a class="bk_pop" href="#MDP99mTc.REF.28">28</a>). On the other hand, it has been suggested that <sup>18</sup>F-fluoride positron emission tomography/computed tomography is a more sensitive and specific method than <sup>99m</sup>Tc-MDP planar scintigraphy to detect bone metastases in prostate cancer patients (<a class="bk_pop" href="#MDP99mTc.REF.8">8</a>). The use of bone scintigraphy in common osteolytic tumors has been discussed and illustrated by Wang et al. (<a class="bk_pop" href="#MDP99mTc.REF.29">29</a>).</p><p>A WB BSc with <sup>99m</sup>Tc-MDP of a man with medullary carcinoma of the thyroid revealed hepatic metastases that were later confirmed with a computed tomography scan (<a class="bk_pop" href="#MDP99mTc.REF.24">24</a>), which indicated that WB BSc with <sup>99m</sup>Tc-MDP can be used to detect hepatic metastasis. In another study, WB BSc with <sup>99m</sup>Tc-MDP revealed an unusually extensive metastatic disease in the abdominal region, without lung involvement, in a patient who underwent intensive chemotherapy (<a class="bk_pop" href="#MDP99mTc.REF.25">25</a>). The investigators recommend that patients with osteosarcoma who have signs of intestinal or abdominal obstruction should be subject to bone scintigraphy to reveal any unexpected metastatic foci.</p><p><sup>99m</sup>Tc-MDP scintigraphy has also been used to detect femoral head avascular osteonecrosis (<a class="bk_pop" href="#MDP99mTc.REF.26">26</a>) and the characteristic lesions of Erdheim-Chester disease (<a class="bk_pop" href="#MDP99mTc.REF.27">27</a>).</p></div><div id="MDP99mTc.Supplemental_Information"><h2 id="_MDP99mTc_Supplemental_Information_">Supplemental Information</h2><p>[<a href="/books/n/micad/disclaimer/">Disclaimer</a>]</p><p>No information is currently available.</p></div><div id="MDP99mTc.References"><h2 id="_MDP99mTc_References_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.1">Prasad V.R.
<em>Derangement of knee: role of radionuclide imaging in the diagnosis.</em>
<span><span class="ref-journal">Imaging Decisions MRI. </span>2006;<span class="ref-vol">10</span>:813.</span></div></dd><dt>2.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.2">Kajan Z.D., Motevasseli S., Nasab N.K., Ghanepour H., Abbaspur F.
<em>Assessment of growth activity in the mandibular condyles by single-photon emission computed tomography (SPECT).</em>
<span><span class="ref-journal">Aust Orthod J. </span>2006;<span class="ref-vol">22</span>(2):12730.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17203576" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 17203576</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.3">Ryu J.S., Kim J.S., Moon D.H., Kim S.M., Shin M.J., Chang J.S., Park S.K., Han D.J., Lee H.K.
<em>Bone SPECT is more sensitive than MRI in the detection of early osteonecrosis of the femoral head after renal transplantation.</em>
<span><span class="ref-journal">J Nucl Med. </span>2002;<span class="ref-vol">43</span>(8):100611.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12163624" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 12163624</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.4">So Y., Chung J.K., Seong S.C., Sohn Y.J., Kang H.S., Lee D.S., Lee M.C.
<em>Usefulness of 99Tcm-MDP knee SPET for pre-arthroscopic evaluation of patients with internal derangements of the knee.</em>
<span><span class="ref-journal">Nucl Med Commun. </span>2000;<span class="ref-vol">21</span>(1):1039.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10717910" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 10717910</span></a>]</div></dd><dt>5.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.5">Yildirim M., Gursoy R., Varoglu E., Oztasyonar Y., Cogalgil S.
<em>99mTc-MDP bone SPECT in evaluation of the knee in asymptomatic soccer players.</em>
<span><span class="ref-journal">Br J Sports Med. </span>2004;<span class="ref-vol">38</span>(1):158.</span> [<a href="/pmc/articles/PMC1724727/" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pmc">PMC free article<span class="bk_prnt">: PMC1724727</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/14751939" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 14751939</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.6">Chavdarova L., Piperkova E., Tsonevska A., Timcheva K., Dimitrova M.
<em>Bone scintigraphy in the monitoring of treatment effect of bisphosphonates in bone metastatic breast cancer.</em>
<span><span class="ref-journal">J Buon. </span>2006;<span class="ref-vol">11</span>(4):499504.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17309184" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 17309184</span></a>]</div></dd><dt>7.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.7">Choi C.W., Lee D.S., Chung J.K., Lee M.C., Kim N.K., Choi K.W., Koh C.S.
<em>Evaluation of bone metastases by Tc-99m MDP imaging in patients with stomach cancer.</em>
<span><span class="ref-journal">Clin Nucl Med. </span>1995;<span class="ref-vol">20</span>(4):3104.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7788986" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 7788986</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.8">Even-Sapir E., Metser U., Mishani E., Lievshitz G., Lerman H., Leibovitch I.
<em>The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT.</em>
<span><span class="ref-journal">J Nucl Med. </span>2006;<span class="ref-vol">47</span>(2):28797.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16455635" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 16455635</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.9">Uematsu T., Yuen S., Yukisawa S., Aramaki T., Morimoto N., Endo M., Furukawa H., Uchida Y., Watanabe J.
<em>Comparison of FDG PET and SPECT for detection of bone metastases in breast cancer.</em>
<span><span class="ref-journal">AJR Am J Roentgenol. </span>2005;<span class="ref-vol">184</span>(4):126673.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15788608" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 15788608</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.10">Kanishi D.
<em>99mTc-MDP accumulation mechanisms in bone.</em>
<span><span class="ref-journal">Oral Surg Oral Med Oral Pathol. </span>1993;<span class="ref-vol">75</span>(2):23946.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8381217" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 8381217</span></a>]</div></dd><dt>11.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.11">Roelofs A.J., Thompson K., Gordon S., Rogers M.J.
<em>Molecular mechanisms of action of bisphosphonates: current status.</em>
<span><span class="ref-journal">Clin Cancer Res. </span>2006;<span class="ref-vol">12</span>(20 Pt 2):6222s6230s.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17062705" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 17062705</span></a>]</div></dd><dt>12.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.12">. Bracco, <em>Kit for the preparation of technetium Tc 99m Medronate.</em> 2006, Bracco Diagnostics Inc.: Princeton, NJ 08543.</div></dd><dt>13.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.13">Okamoto Y.M.
<em>Mechanism of accumulation of 99mTc-MDP to bone: correlation of in vivo data with in vitro data.</em>
<span><span class="ref-journal">Radiat Med. </span>1997;<span class="ref-vol">15</span>(4):20915.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9311035" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 9311035</span></a>]</div></dd><dt>14.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.14">Sela J., Shani J., Kohavi D., Soskolne W.A., Itzhak K., Boyan B.D., Schwartz Z.
<em>Uptake and biodistribution of 99mtechnetium methylene-[32P] diphosphonate during endosteal healing around titanium, stainless steel and hydroxyapatite implants in rat tibial bone.</em>
<span><span class="ref-journal">Biomaterials. </span>1995;<span class="ref-vol">16</span>(18):137380.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8590763" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 8590763</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.15">Gomes M.L., de Souza Braga A.C., de Mattos D.M., de Souza Freitas R., Boasquevisque E.M., Bernardo-Filho M.
<em>The effect of mitomycin-C on the biodistribution of 99Tcm-MDP in Balb/c mice.</em>
<span><span class="ref-journal">Nucl Med Commun. </span>1998;<span class="ref-vol">19</span>(12):11779.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/9885808" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 9885808</span></a>]</div></dd><dt>16.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.16">Seto H., Ihara F., Futatsuya R., Kamei T., Kakishita M., Noda M.
<em>Simultaneous measurements of twenty-four-hour whole-body retention of 47Ca-chloride and 99mTc-MDP: early differentiation of metabolic bone diseases in rat models.</em>
<span><span class="ref-journal">Nucl Med Biol. </span>1993;<span class="ref-vol">20</span>(3):33742.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8485493" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 8485493</span></a>]</div></dd><dt>17.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.17">Drost W.T., Cummings C.A., Mathew J.S., Panciera R.J., Ko J.C.
<em>Determination of time of onset and location of early skeletal lesions in young dogs experimentally infected with Hepatozoon americanum using bone scintigraphy.</em>
<span><span class="ref-journal">Vet Radiol Ultrasound. </span>2003;<span class="ref-vol">44</span>(1):8691.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12620057" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 12620057</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.18">Schwarz T., Johnson V.S., Voute L., Sullivan M.
<em>Bone scintigraphy in the investigation of occult lameness in the dog.</em>
<span><span class="ref-journal">J Small Anim Pract. </span>2004;<span class="ref-vol">45</span>(5):2327.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15163049" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 15163049</span></a>]</div></dd><dt>19.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.19">Lee J.Y., Lee W.G., Kim J.H., Kang S.S., Bae C.S., Koong S.S., Choi S.H.
<em>Comparison of the effect of 99mTc-DPD and 99mTc-MDP on experimentally-induced osteoarthritis in the stifle joint of the dog.</em>
<span><span class="ref-journal">In Vivo. </span>2005;<span class="ref-vol">19</span>(4):7815.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15999549" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 15999549</span></a>]</div></dd><dt>20.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.20">Weller R., Livesey L., Maierl J., Nuss K., Bowen I.M., Cauvin E.R., Weaver M., Schumacher J., May S.A.
<em>Comparison of radiography and scintigraphy in the diagnosis of dental disorders in the horse.</em>
<span><span class="ref-journal">Equine Vet J. </span>2001;<span class="ref-vol">33</span>(1):4958.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11191610" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 11191610</span></a>]</div></dd><dt>21.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.21">Barakzai S., Tremaine H., Dixon P.
<em>Use of scintigraphy for diagnosis of equine paranasal sinus disorders.</em>
<span><span class="ref-journal">Vet Surg. </span>2006;<span class="ref-vol">35</span>(1):94101.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16409416" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 16409416</span></a>]</div></dd><dt>22.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.22">Dormehl I.C., Mennen U., Goosen D.J.
<em>A technique to evaluate bone healing in non-human primates using sequential 99mTc-methylene diphosphonate scintigraphy.</em>
<span><span class="ref-journal">Nuklearmedizin. </span>1982;<span class="ref-vol">21</span>(3):1059.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/6215626" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 6215626</span></a>]</div></dd><dt>23.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.23">Mennen U., Dormehl I.C., Goosen D.J.
<em>Evaluation of the healing process of bone fractures in the non-human primate using sequential 99mTc-methylene diphosphonate scintigraphy.</em>
<span><span class="ref-journal">S Afr J Surg. </span>1985;<span class="ref-vol">23</span>(3):98101.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/4049154" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 4049154</span></a>]</div></dd><dt>24.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.24">Ali I., Johns W., Gupta S.M.
<em>Visualization of hepatic metastases of medullary thyroid carcinoma on Tc-99m MDP bone scintigraphy.</em>
<span><span class="ref-journal">Clin Nucl Med. </span>2006;<span class="ref-vol">31</span>(10):6113.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16985365" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 16985365</span></a>]</div></dd><dt>25.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.25">Karacalioglu O., Ilgan S., Kuzhan O., Emer O., Ozguven M.
<em>Disseminated metastatic disease of osteosarcoma of the femur in the abdomen: unusual metastatic pattern on Tc-99m MDP bone scan.</em>
<span><span class="ref-journal">Ann Nucl Med. </span>2006;<span class="ref-vol">20</span>(6):43740.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16922473" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 16922473</span></a>]</div></dd><dt>26.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.26">Lee E.J., Lee K.H., Huh W.S., Yoon J.K., Chung H.W., Choi J.Y., Choe Y.S., Choi Y., Oh H.Y., Kim B.T.
<em>Incidence and radio-uptake patterns of femoral head avascular osteonecrosis at 1 year after renal transplantation: a prospective study with planar bone scintigraphy.</em>
<span><span class="ref-journal">Nucl Med Commun. </span>2006;<span class="ref-vol">27</span>(11):91924.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17021433" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 17021433</span></a>]</div></dd><dt>27.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.27">Namwongprom S., Nunez R., Kim E.E., Macapinlac H.A.
<em>Tc-99m MDP bone scintigraphy and positron emission tomography/computed tomography (PET/CT) imaging in Erdheim-Chester disease.</em>
<span><span class="ref-journal">Clin Nucl Med. </span>2007;<span class="ref-vol">32</span>(1):358.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17179801" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 17179801</span></a>]</div></dd><dt>28.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.28">Binnie D., Divoli A., McCready V.R., Dearnaley D., Flux G.
<em>The potential use of 99mTc-MDP bone scans to plan high-activity 186Re-HEDP targeted therapy of bony metastases from prostate cancer.</em>
<span><span class="ref-journal">Cancer Biother Radiopharm. </span>2005;<span class="ref-vol">20</span>(2):18994.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15869454" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 15869454</span></a>]</div></dd><dt>29.</dt><dd><div class="bk_ref" id="MDP99mTc.REF.29">Wang K., Allen L., Fung E., Chan C.C., Chan J.C., Griffith J.F.
<em>Bone scintigraphy in common tumors with osteolytic components.</em>
<span><span class="ref-journal">Clin Nucl Med. </span>2005;<span class="ref-vol">30</span>(10):65571.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16166837" ref="pagearea=cite-ref&amp;targetsite=entrez&amp;targetcat=link&amp;targettype=pubmed">PubMed<span class="bk_prnt">: 16166837</span></a>]</div></dd></dl></div><div id="bk_toc_contnr"></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK24575/?report=reader">PubReader</a></li><li><a href="/books/NBK24575/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK24575" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK24575" style="display:none" title="Cite this Page"><div class="bk_tt">Chopra A. 99mTc-Methyl diphosphonate. 2007 Mar 29 [Updated 2009 Aug 24]. 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