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Altered biodistribution of bone seeking agents in the presence of iron-overload.

It is well-known that biodistribution of radiopharmaceuticals in vivo can be altered by different mechanisms, but only a few examples of this have been published. A 72-year-old woman was seen with atrial fibrillation and ultrasonographic features of restrictive cardiomyopathy. She was suspected to have amyloidosis and scintigraphy with Tc-99m pyrophosphate was performed. Curiously, the obtained images showed increased renal activity and blood pool was labeled, but myocardial and bony uptake were not detected. A bone scan with Tc-99m hydroxyphosphonate confirmed our findings. The responsible agent for this phenomenon was a significant iron overload, which we discovered on reviewing the woman's clinical history.