Role of Skeletal Scintigraphy in Evaluation of Low Backache in Treated Cases of Carcinoma Cervix

Abstract

The presence of bone metastases indicates advanced disease in cervical cancer. Lumbar spine is the most common site affected followed by pelvis with rare involvement of distal extremities. Low back ache in these patients has wide spectrum of etiologies including benign conditions like musculoskeletal causes, inflammatory, Infectious and metastatic spread of disease. In this study, we evaluated the causes of low back ache in treated cases of carcinoma cervix based on different patterns of radio tracer uptake on 99m Tc Methylene diphosphonate (99m Tc MDP) bone scan.To evaluate the role of 99m Tc MDP bone scan in differential diagnosis of low back ache in treated cases of carcinoma cervix. 99m Tc MDP bone scans of treated carcinoma cervix patients presenting with low back ache were reviewed retrospectively from May 2012 to May 2016. A total of 120 patients were reviewed, 99m Tc MDP bone scan detected metastases in 69 (57.5%) patients, degenerative changes in 26 (21.6%) patients, insufficiency fractures in 13 (10.8%) patients, erosion from adjacent nodal mass in 4 (3.3%) patients. No abnormality was detected on bone scan in 8 patients (6.6%). Skeletal scintigraphy plays a vital role in the evaluation of low back ache in carcinoma cervix and changes management in significant proportion of patients. Pattern recognition especially in identifying insufficiency fractures and erosion of bone from adjacent nodal mass is an important aspect in the interpretation of skeletal scintigraphy.