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Fatal Intracranial Hemorrhage Due to Thrombocytopenia in a Patient With Castration-Resistant Prostate Cancer Showing Extensive Bone Uptake of Injected 223Ra Dichloride

Nakahara, Tadaki, MD, PhD*; Owaki, Yoshiki, RT*; Kosaka, Takeo, MD, PhD; Fukada, Junichi, MD, PhD*; Ichimura, Akira, MD*; Jinzaki, Masahiro, MD, PhD*

doi: 10.1097/RLU.0000000000002117
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A 64-year-old man with castration-resistant prostate cancer received 223Ra injection to treat bone metastases. The patient underwent a 223Ra SPECT scan after the first 223Ra injection in which there was increased uptake all over the spine. Spine-to-background activity ratio in the patient was approximately three times greater than normal spine-to-background activity ratios in 223Ra SPECT obtained from the other patients. Eight days after the fifth injection, the patient exhibited a very poor neurologic examination and died of intracranial hemorrhage due to severe thrombocytopenia (platelet counts, 23,000/mm3). The extensive radiation to the spine may have enhanced myelophthisic process in this case.

From the Departments of *Radiology and

Urology, Keio University School of Medicine, Tokyo, Japan.

Received for publication March 16, 2018; revision accepted March 20, 2018.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Tadaki Nakahara, MD, PhD, Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160–8582, Japan. E-mail:

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