Which diphosphonate for routine bone scintigraphy (MDP, HDP or DPD)?

Of 790 patients, 772 with proven cancerous disease have been studied without any selection using either MDP (three different kits), HDP (two types) or DPD. The groups were identical in age distribution, male/female ratio, body weight and verified percentage metastatic involvement. Technical conditions (Mo/Tc-generator used, dilution volume, total activity of the final product per vial, preparation/injection and injection/examination delays) were identical. Analogous scintigrams according to qualitative criteria (image quality, bone delineation, soft tissue fixation, metastatic/normal tissue contrast, aspecific uptake by non-target organs) and superior to MDP. Quantitative data were quite similar for all types of diphosphonates spine; metastatic/normal bone fixation ratio, bone/soft tissue ratio) have been evaluated. The results obtained showed that there was no criterion to demonstrate that HDP or DPD would be superior to MDP. Quantitative data were quite similar for all types of diphosphonates studied. Two out of the three MDPs were slightly superior to the other products with regard to detectability of metastatic lesions. Our results show, that in non-selected clinical routine work for bone scintigraphy HDP and DPD do not present any decisive qualitative or quantitative advantage in comparison to MDP.