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  1. ORIGINAL ARTICLE Annals of Nuclear Medicine Vol. 18, No. 3, 235–241, 2004 A comparative study of 201Tl scintigraphy and three-phase bone scintigraphy following therapy in patients with bone and soft-tissue tumors Yoshihiro NISHIYAMA,* Yuka YAMAMOTO,* Koiku YOKOE,* Yoji KAWAGUCHI,** Yoshihiro TOYAMA,* Katashi SATOH* and Motoomi OHKAWA* Departments of *Radiology and **Orthopedics, Faculty of Medicine, Kagawa University Objective: The purpose of this study was to evaluate the usefulness of 201Tl scintigraphy in comparison with three-phase bone scintigraphy in the differentiation of residual/recurrent tumors from post-therapeutic changes, in patients previously treated for bone and soft-tissue tumors. Methods: Thirty-five 201Tl and three-phase bone scintigraphy scans were obtained for 30 patients with a history of bone or soft-tissue tumor who had undergone chemotherapy, radiation therapy, tumor resection, or a combination of these treatments. The planar 201Tl images were acquired 10 mins (early) and 2 hrs (delayed) after the intravenous injection of 111 MBq 201Tl-chloride. Three- phase bone scintigraphy was performed using 740 MBq 99mTc-HMDP at the same lesion site as for 201Tl imaging. The blood flow images were obtained every 10 sec for 2 mins and were immediately followed by the blood pool image after 5 mins. Three to 4 hrs later, bone images were obtained. 201Tl and three-phase bone scintigraphies were correlated with the histopathologic findings and/or clinical follow-up of more than 3 months. Results: Of the 35 cases, 15 were free of disease and 20 had residual or recurrent tumors. Of the 20 residual or recurrent cases, all had true-positive 201Tl early and delayed scans, while bone scintigraphy was true-positive on the blood flow, blood pool and bone images in 16, 18 and 12 cases, respectively. 201Tl early and delayed images and 99mTc- HMDP blood flow and blood pool images were false-positive in one patient. The histology of this false-positive case showed the presence of lymph proliferative tissue. Conclusions: Although 201Tl uptake after treatment does not always indicate recurrence, 201Tl scintigraphy may still be more useful than three-phase bone scintigraphy in the follow-up of patients with bone and soft-tissue tumors following therapy. Key words: bone and soft-tissue tumor, recurrence, 201Tl, scintigraphy