Bone Scan Findings Research Articles

Discordance between MRI and bone scan findings in a child with acute complicated osteomyelitis: Scintigraphic features that contribute to the early diagnosis

Early diagnosis and prompt treatment of acute osteomyelitis are of paramount importance in children because they can prevent irreversible bone damage. Magnetic resonance imaging (MRI) with its superior spatial resolution and lack of ionizing radiation is routinely preferred over bone scan for this purpose. Increased blood flow, hyperemia and focally increased tracer uptake shown by "three phase" bone scan are the typical scintigraphic findings of acute osteomyelitis. In addition, diffuse uptake along the shaft of long bones and focal "cold" lesions are two special features that may be highly suggestive of infective periostitis, soft tissue sepsis and subperiosteal abscess formation, due to the loose attachment of periosteum to bone during childhood. We present a case of complicated osteomyelitis in a child with inconclusive MRI correctly diagnosed on the basis of these special scintigraphic findings resulting in treatment change from double i.v. Vancomycin--Ceftriaxone scheme to surgical intervention.

Osseous and Nonosseous Bone Scan Findings in Liver Transplant Candidates with end-stage Chronic Liver Disease

Objective: End-stage chronic liver disease (CLD) adversely affects the function of multiple organ systems including the skeletal system. The aim of this study was to assess osseous and nonosseous bone scintigraphy (BS) findings in liver transplant (LT) candidates with end-stage CLD.Methods: We retrospectively evaluated BS findings in 50 consecutive patients with end-stage CLD who were undergoing preoperative assessment for LT from January 2006 to December 2011. All the patients were analyzed with respect to clinical and laboratory parameters, and BS findings. Scintigrams were visually assessed for the presence of osseous and nonosseous abnormalities. Osseous abnormalities were classified as those indicating bone metabolism changes or metastatic bone disease. Typical scintigraphic findings denoting to changes in bone metabolism were the presence of decreased osseous uptake, increased periarticular uptake, asymmetrical or unusual uptake patterns. Nonosseous findings were classified according to the degree of soft-tissue uptake as mild and severe.Results: The group consisted of 46 adult and 4 adolescent patients. All adolescent patients had normal skeletal accumulation with growth plate uptake and one had mildly increased renal cortical activity. A total of 46 adult patients had one or more of the following osseous findings: generalized decrease in osseous uptake (n=4, 8.7%); bilateral decrease in lower extremity uptake (n=26, 56.5%); symmetrically increased periarticular uptake (n=26, 56.5%); bilateral cortical/periosteal increased uptake in the lower extremity indicating hepatic hypertrophic osteoarthropathy (HOA) (n=8, 17.4%); bilateral increased sacroiliac activity (n=16, 34.8%); sacral activity (n=10, 21.7%), coccygeal activity (n=2, 4.3%), focally increased uptake suggestive of metastases (n=5, 10.9%). Three rib metastases appeared to be linear. Nonosseous findings observed in adult patients were mild diffuse liver uptake (n=4, 8.7%) and bilateral diffuse mild or severe degree of renal cortical uptake (n=20, 43.5%). There was a statistically significant difference in serum creatinine values between mild and severe renal uptake groups (p<0.05). There was also statistically significant difference in serum BUN and creatinine values between patients with severe degree of renal uptake and without renal uptake (p<0.05).Conclusion: The results of the current study has shown that adolescent LT candidates with end-stage CLD had no osseous abnormality on BS. However, all of adult patients exhibited one or one more osseous abnormalities. Typical scintigraphic findings denoting to abnormalities in bone metabolism were generalized decreased osseous uptake, decreased lower extremity osseous uptake, increased periarticular uptake, increased cortical/periosteal uptake indicating hepatic HOA, and other unusual uptake patterns. Hepatocellular carcinoma metastases may present itself as rib metastases linear in pattern. Soft-tissue uptake in the form of diffuse bilateral mild or severe degree of renal uptake and less commonly mild diffuse liver uptake can be observed. Increased renal uptake may be an early marker of renal dysfuntion or a predictor of hepatorenal syndrome. Conflict of interest:None declared.

Use of bone scans during initial prostate cancer (CaP) workup, downstream procedures, and associated Medicare costs.

5040 Background: Bone scans are not recommended in the routine workup for patients with apparent low and intermediate risk CaP. We quantified the use of bone scans in low and intermediate risk patients, uses of other imaging and procedures after the bone scan, and costs to Medicare. Methods: Patients in the Surveillance Epidemiology and End Results (SEER)-Medicare database diagnosed with CaP from 2004 to 2007 were included. PSA, Gleason score and clinical T stage were used to define D’Amico risk categories. Patients with metastatic disease were included because the decision to order a staging bone scan for patients with apparent low and intermediate risk cancers occurs before knowledge about metastasis. We report use of bone scans from the date of diagnosis to the earlier of treatment or 12 months. In patients who received bone scans, we report use of X-ray, CT, MRI, and bone biopsy following bone scan to the earlier of treatment or 12 months. Cost was estimated using Medicare reimbursement rates. Results: 28% and 47% of patients with apparent low- and intermediate-risk prostate cancer received a bone scan (Table); &lt;1% of these patients were found to have metastatic disease after work-up. A high proportion of patients had other imaging studies or biopsies after bone scan. For low and intermediate risk patients, the combined cost to Medicare of bone scan, X-ray, and bone biopsy as part of initial workup is estimated at $11,000,000 per year. The cost from CT and MRI after bone scan costs Medicare approximately $15,400,000 per year. Conclusions: Overuse of bone scans is common in workup of apparent low and intermediate risk CaP, even with an almost 0% risk of metastatic disease. X-rays, bone biopsies, and perhaps additional scans such as CT and MRI may result from bone scan findings, which are mostly false positives for these patients. These unnecessary procedures are costly to Medicare. [Table: see text]

Bone scan findings of chest wall pain syndrome after stereotactic body radiation therapy: implications for the pathophysiology of the syndrome.

We present a case of a 72-year-old woman treated with stereotactic body radiation therapy (SBRT) for peripherally located stage I non-small cell lung cancer (NSCLC). After treatment she developed ipsilateral grade II chest wall pain. A bone scan showed nonspecific and heterogeneous increased radiotracer uptake in the volume of ribs receiving 30% of the prescription dose of radiation (V30). We present a color wash image demonstrating excellent concordance between the V30 and the area of scintigraphic uptake on bone scan. We present a discussion of the current state of knowledge of dose volume parameters for chest wall toxicity following SBRT. This is the first case in the literature demonstrating bone scan findings corresponding to chest wall pain from SBRT. To explain these findings we propose a mechanism whereby SBRT results in bone degeneration, which prompts an increase in bone repair and an increased inflammatory state.

Should Bone Scan be Performed in Chinese Prostate Cancer Patients at the Time of Diagnosis?

Background: Prostate cancer (PCa) is increasingly being diagnosed in China. Early detection of bone metastases (BM) is critical in the management of patients with high-risk PCa. The aim of this study is to establish a screening model to determine if bone scan should be performed for BM in Chinese patients at the time when PCa is diagnosed. Materials and Methods: The study included 488 patients who were diagnosed with PCa between 2009 and 2011 at a single center. All patients received bone scans using technetium ^99mTc methylene diphosphonate at the initial staging. If the bone scan finding was equivocal, computed tomography or magnetic resonance imaging was performed to confirm the diagnosis. Age, prostate-specific antigen (PSA) at diagnosis, clinical stage assigned according to the TNM 2002 staging system and biopsy Gleason score were collected in all patients. Multivariate logistic regression analysis was performed to identify statistically significant covariates and then receiver operating characteristic (ROC) curves were generated to identify optimal cut-off values. Using these cut-off values, a formula was devised to calculate an index value for BM screening at diagnosis. The model was cross-validated using the leave-one-out method. Results: Of the 488 patients, 65 patients (13.3%) had BM. The area under the ROC curve was 0.87 (95% confidence interval 0.83-0.94). The sensitivity of the cut-off point was 87.7% and the specificity was 73.1%. Bone scan is needed for all cT4 PCa patients, however, it is also advisable for cT1-T3 PCa patients who have a biopsy Gleason score ≤3 + 4 and a PSA >132.1, and for cT1-T3 patients having a Gleason score of ≥4 + 3 and PSA >44.5. Conclusions: The regression model may help determine if bone scan is needed to detect BM from PCa at the time of diagnosis. The model was generated upon a single center experience. Further validation is needed in future studies.

Potential role of multislice SPECT/CT in impingement syndrome and soft-tissue pathology of the ankle and foot

Impingement syndrome and soft-tissue pathology have been recognized as significant causes of chronic ankle pain. Conventional bone scintigraphy was traditionally used for osseous pathology, but with the advent of single photon emission computed tomography/computed tomography (SPECT/CT) the role of bone scintigraphy in these patients is being reconsidered. The aim of this study was to assess the potential role of multislice SPECT/CT in diagnosing impingement syndrome and soft-tissue pathology of the ankle and foot. A total of 209 patients (age range: 19-80 years) underwent a two-phase Tc-99m methylene diphosphonate bone scan followed by SPECT/CT between 2006 and 2009 for various ankle and foot pathologies. These scans were reviewed for impingement syndrome and soft-tissue pathology. The diagnosis made on SPECT/CT was compared with the clinical diagnosis, and two-phase bone scan findings and additional findings obtained from SPECT/CT were noted. Out of the 209 patients, 43 (21%) were diagnosed with impingement syndrome or soft-tissue pathology. Clinical diagnosis versus bone SPECT/CT: in 24/43 (56%) patients, SPECT/CT provided information not suspected on clinical diagnosis. In 19/43 (44%) patients, SPECT/CT confirmed the clinical diagnosis. Two-phase bone scan versus SPECT/CT: in 31/43 (72%) patients, SPECT/CT provided additional information, which was not diagnosed on the conventional two-phase bone scan. The findings of the two-phase bone scan and SPECT/CT were concordant in 12/43 (28%) patients. Tc-99m methylene diphosphonate bone SPECT/CT is useful in localizing and characterizing impingement syndrome and soft-tissue pathology in patients with ankle/foot pain. SPECT/CT may complement MRI and ultrasonography in the investigation of impingement syndrome and soft-tissue pathology.

Thigh splints presenting as groin pain: A case with whole body bone scan findings

A thigh splint (adductor insertion avulsion syndrome) is a relatively uncommon diagnosis analogous to shin splints. This article reports a case of 19-year-old female NOT a regular athlete who presented with groin pain. Physical examination was nonspecific, MRI pelvis did not reveal any abnormality. Patient referred for whole body bone scan, especially to locate any abnormality in the spine. This study highlights the role of whole body bone scan in the evaluation of groin pain and importance of evaluation of whole lower extremity.

Bone scintigraphic patterns in patients of tumor induced osteomalacia

Tumor induced osteomalacia (TIO) or oncogenic osteomalacia is a rare condition associated with small tumor that secretes one of the phosphaturic hormones, i.e., fibroblast growth factor 23, resulting in abnormal phosphate metabolism. Patients may present with non-specific symptoms leading to delay in the diagnosis. Extensive skeletal involvement is frequently seen due to delay in the diagnosis and treatment. The small sized tumor and unexpected location make the identification of tumor difficult even after diagnosis of osteogenic osteomalacia. The bone scan done for the skeletal involvement may show the presence of metabolic features and the scan findings are a sensitive indicator of metabolic bone disorders. We present the bone scan findings in three patients diagnosed to have TIO.

Diagnostic Role of 18F-FECH-PET/CT Compared with Bone Scan in Evaluating the Prostate Cancer Patients Referring with Biochemical Recurrence

18F-FECH-PET/CT has been proved to be an imaging agent for prostate carcinoma. However, its role in detecting the bone metastases is still blurred owing to the lack of related studies. The purpose of our study was to assess the efficacy of PET with 18F-ethylcholine in assessing the bone status and to compare the results with that of conventional bone scan findings. For this purpose, we selected 37 patients (mean age 69 ± 7), who had been referred for restaging purposes due to biochemical recurrences and underwent both 18F-FECH-PET/CT and bone scan in a short interval. Generally 18 patients out 37 patients referred with biochemical relapse were confirmed to have bone involvement. From 18 confirmed bone involvement cases, 18F-FECH-PET/CT identified correctly the bone involvement in 15 cases with overall sensitivity of 83.3%. On the other hand, bone scan identified 17 out of 18 confirmed cases with overall sensitivity of 94.4%. The lesion-related results show that the sensitivity of each investigation differs with the anatomical regions, and by comparing both results, 18F-FECH-PET/CT was mostly superior to bone scan; however, without a statistical significance (P > 0.1). In conclusion, no significant gain in sensitivity was achieved using bone scan compared with 18F-FECH-PET/CT.

Is there a correlation between symptoms and bone scintigraphic findings in patients with complex regional pain syndrome?

Complex regional pain syndrome (CRPS) is characterized by pain in combination with sensory, vasomotor, sudomotor, trophic and motor abnormalities. The diagnosis of CRPS is based primarily on clinical criteria and the presence of distinct signs and symptoms. The role of bone scintigraphy in the diagnosis of these patients has been limited by its variable sensitivity. In this study, we aim to look if the presence of specific symptoms or symptom subgroups in patients with clinically diagnosed CRPS correlates with scintigraphic findings in bone scan. We retrospectively reviewed clinical records of patients referred for bone scintigraphy with the clinical diagnosis of CRPS during the period December 2006 until February 2011. Patients were classified into 4 distinct subgroups according to the presence of specific symptoms namely sensory subgroup, sudomotor and/or edema subgroup, vasomotor subgroup and finally motor and/or trophic changes subgroup. We looked specifically for the correlation between these specific symptoms and scintigraphic bone findings. 37 patients were referred for bone scintigraphy with the clinical diagnosis of CRPS and were enrolled in the study. The presence of vasomotor symptoms and (motor and/or trophic changes) was significantly higher in patients with positive bone scintigraphy (P value 0.0133, 0.018 respectively). There was no other statistically significant correlation between the presence of specific symptoms or symptom subgroups on one hand and the result of bone scintigraphy on the other hand. The probability of positive bone scintigraphy increased significantly in patients with vasomotor symptoms and in patients with motor and/or trophic changes. This may contribute to the reported variability of the diagnostic performance of bone scintigraphy in CRPS patients.

측두하악관절 골관절염 환자의 진단에서 단층촬영과 골스캔 검사의 유용성에 대한 예비연구

측두하악관절 골관절염은 관절조직에 가해지는 과부하에 의해 관절면과 하부 골조직에서 일련의 퇴행성과정과 함께 관절부의 국소적 압통, 하악운동에 의한 관절의 염발음, 하악의 운동범위 제한, 심한 경우에는 과두지지가 없어져 구치부 과다접촉과 전치부 개교합이 나타날 수 있는 퇴행성질환이다. 일반적으로는 임상검사 후 파노라마방사선사진, 측두하악관절 파노라마, 경두개방사선사진을 촬영한 뒤 진단하게 되는데 이들 일반적인 방사선사진들은 질환 초기의 미세한 골변화를 평가하는데 제한적이다. 따라서 본 연구에서는 일반방사선학적 검사에서 골조직의 퇴행성변화가 의심되어 확진을 위해 단층촬영 및 골스캔 검사를 시행한 환자의 영상의학적 검사소견들 간의 일치도와 임상소견과의 관계를 평가하여 골관절염의 진단에서 이들 다양한 검사법들의 한계와 그 유용성을 평가하고 향후 추가연구를 위한 예비자료를 얻기위해 시행하였다. 골관절염의 진단에서 일반방사선사진과 단층촬영, 골스캔 검사의 결과 일치도가 비교적 높게 나타났지만 위음성 가능성이 존재하므로 임상검사소견에 따른 단계적인 영상의학적 검사 시행이 바람직할 것으로 사료된다. TMJ Osteoarthritis is a degenerative disease caused by overload on joint tissue, and often accompany with local tenderness on the joint, crepitus by mandibular movement, restriction of mandibular movement, and anterior openbite. In general, panoramic radiography, TMJ panoramic radiography, and transcranial radiography are conducted to diagnose osteoarthritis after clinical examination, however, these radiographic evaluations are limited in detecting minute bony changes of early pathologic lesion. The aim of this pilot study was to evaluate the limitation and usefulness of several TMJ imaging techniques, so we compare the findings from clinical examination, plain film radiographs, tomograph, and bone scan from 81 patients with temporomandibular joint disorder. The proportion of patients showing same findings in plain film radiographs, TMJ tomograph, and bone scan was high, however, it is desirable that clinician should conduct phased imaging examinations according to the clinical findings due to the possibilities of false negative findings in diagnosis of osteoarthritis.

99mTc-MDP- and 18F-FDG-Avid Metastatic Liver Lesion

Although 99mTc-MDP uptake in the extraskeletal tissues was presented before in the literature, FDG PET/CT and conventional bone scan findings have not been discussed together yet. Herein, we presented 99mTc-MDP- and 18F-FDG-avid metastatic liver lesion in a breast cancer patient and compared 2 modal

Adult onset Still′s disease: Role of scintigraphy

Adult onset Still's disease (AOSD) often poses a diagnostic and therapeutic challenge and clinical guidelines are lacking. It is often diagnosed after a considerable delay; bone scintigraphy imaging may offer new imaging techniques for early diagnosis and successful therapy in follow-up examinations. We describe the liver and bone scan findings in a 21-year old female patient with AOSD, who had been having fever of high grade, recurrent and intermittent in character, associated with severe sore throat and joint pains. She had been extensively investigated for possible infectious disease. She had received antibiotics and antimalarial drugs without any response.

Shoulder Joint Infectious Arthritis and Acromioclavicular Joint Osteomyelitis due to Candida

Candida species inhabit the skin and mucous membranes of healthy individuals with low virulence, and osteomyelitis due to candida is very rare. However, the incidence of invasive candidal infection caused by intravenous drug use, broad-spectrum antibiotics, and indwelling central venous catheter is increasing. A 73-year old man visited the outpatient clinic complaining of right shoulder pain that radiated to the right acromioclavicular joint. He had undergone multiple injection procedures followed by nonsteroidal anti-inflammatory drug therapy for several weeks. The ultrasonographic findings showed a heterogeneous mass around the right acromioclavicular joint, while the right shoulder MRI and the overall findings of the body bone scan were suggestive of osteomyelitis. Pathologic findings of ultrasonographically guided joint aspiration fluid showed acute and chronic nonspecific inflammation, while the tissue culture and staining revealed Candida parapsilosis.

Association of non-traumatic complex regional pain syndrome with adenocarcinoma lung on 99mTc-MDP bone scan

Complex regional pain syndrome (CRPS) is usually associated with trauma. Rarely, it may be seen in association with malignancies. We present here the bone scan and X-ray findings in the case of a 56-year-male-patient with adenocarcinoma lung who also had non-traumatic CRPS without involvement of the stellate ganglion. The case highlights the fact that spontaneous development of reflex sympathetic dystrophy may be associated with a neoplastic etiology.

Bone scan findings in a North African ethnic group and relation to PSA levels and Gleason score of the biopsy

ObjectiveA number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in North-African population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. Material and methodsRecords of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher's exact test, by a statistical software (statistical package for the social sciences “SPSS”, version 11.5.1, Chicago, IL) with differences at P<0.05 considered significant. ResultsBased on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of lower than 10ng/ml. Six metastatic patients had PSA level between 11 and 20ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101ng/ml, 51 men had positive bone scan. ConclusionBased on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level lower than 10ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.

A Comparative Study of Bone Scan Findings and Serum Levels of Tumor Marker CA15-3 in Patients with Breast Carcinoma

Breast cancer is one of the most frequent malignancies in the world. Available staging procedures to detect breast cancer are bone scan, chest X-ray, liver ultrasonography, computerized tomography, estimation of tumor markers like carbohydrate antigen (CA15-3) and carcino embryonic antigen. These procedures are expensive and may not be required in all cases. Out of 70 patients studied, 55 had normal CA15-3 and 15 had elevated levels of Ca15-3. Eight (14.5%) of the 55 patients with normal CA15-3 had abnormal bone scan. Fifteen patients had CA15-3 levels above the normal range and among these 9 (60%) had abnormal bone scan. While prime facie it would appear that a high level of CA15-3 correlate with abnormal bone scan, it is also true that the numbers are small at present and conclusions about the validity of CA15-3 as marker of bone metastasis may be premature.

Whole-Body Bone Scan Findings after High-Intensity Focused Ultrasound (HIFU) Treatment.

This study aims to examine the findings of (99m)Tc-diphosphonate bone scans in cancer patients with a history of HIFU treatment. Bone scan images of patients with a history of HIFU treatment for primary or metastatic cancer from January 2006 to July 2010 were retrospectively reviewed. Cases of primary bone tumor or HIFU treatment reaching only the superficial soft tissue layer were excluded. Bone scan images of 62 patients (26 female, 36 male; mean age 57 ± 9years) were studied. HIFU treatment was performed in the liver (n = 40), pancreas (n = 16), and breast (n = 6). Mean interval time between HIFU treatment and bone scan was 106 ± 105days (range: 1-572days). Of 62 scans, 43 showed diffusely decreased uptake of bone within the path of HIFU treatment: antero-axillary and/or posterior arcs of right 5th to 11th ribs in 34 cases after treatment of hepatic lesions; anterior arcs of 2nd to 5th ribs in 5 cases after treatment for breast tumors; and posterior arcs of left 9th to 11th ribs or thoraco-lumbar vertebrae in 4 cases after treatment for pancreas tumor. Of 20 patients who had bone scans more than twice, five showed recovered uptake of the radiotracer in the involved ribs in the follow-up bone scan. Of 62 bone scans in patients with a history of HIFU treatment for primary or metastatic cancer, 69% presented diffusely decreased uptake in the bone in the path of HIFU treatment.

Resultados de gammagrafías óseas en individuos de etnia norteafricana y su relación con los niveles de APE y con la escala de Gleason obtenida en biopsia

Objective A number of large-scaled studies carried out in western countries have proven a positive relationship between serum prostate specific antigen (PSA) level and prevalence of positive bone scan findings, in newly diagnosed prostate cancer patients. The aim of our study is to verify that the tendency occurs as well in north-african population, as well as to establish a possible correlation between PSA level, bone scan result, and Gleason score. Material and methods Records of 348 patients diagnosed to have prostatic adenocarcinoma were reviewed retrospectively for bone scan results, PSA levels, and Gleason score. Statistical analyses were performed using the Fisher exact test, by a statistical software (statistical package for the social sciences “SPSS”, version 11.5.1, Chicago, IL) with differences at P < 0,05 considered significant. Results Based on positive bone scintigraphy 102 patients were proven to have bone metastases. None of these patients had a PSA level of less than 10 ng/ml. Six metastatic patients had PSA level between 11 and 20 ng/ml. 45 metastatic cases had serum PSA between 21 and 100. Concerning PSA level over 101 ng/ml, 51 men had positive bone scan. Conclusion Based on the PSA level, the likelihood of positive bone scan result can be postulated. According to PSA levels, staging investigations can be more selective for our patients. The risk of positive bone scan is so low that it is not required for patients with PSA level less than 10 ng/ml. On the other hand, on studying the correlation between Gleason score and PSA level or bone scan results, no statistically significant relationship was established.

191 CLINICAL YIELD OF INITIAL STAGING WORKUP FOR HIGH GRADE PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Staging1 Apr 2011191 CLINICAL YIELD OF INITIAL STAGING WORKUP FOR HIGH GRADE PROSTATE CANCER Kenneth M. Smith, Matthew J. O'Shaughnessy, Rachel M. Meuleners, and Joel W. Slaton Kenneth M. SmithKenneth M. Smith Minneapolis, MN More articles by this author , Matthew J. O'ShaughnessyMatthew J. O'Shaughnessy Minneapolis, MN More articles by this author , Rachel M. MeulenersRachel M. Meuleners Minneapolis, MN More articles by this author , and Joel W. SlatonJoel W. Slaton Minneapolis, MN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.261AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current guidelines recommend staging of newly diagnosed prostate cancer patients with a bone scan and computed tomography (CT) or magnetic resonance imaging (MRI) scan when the prostate-specific antigen (PSA)>20 ng/ml, Gleason score ≥8, or stage ≥T3. These guidelines are based on studies with relatively low numbers of patients with high grade prostate cancer. Our objectives were to use a large patient population with high grade prostate cancer to (1) quantify the diagnostic yield of existing staging guidelines for this high risk population, and (2) determine if there is a subset of this population who could be accurately staged with limited imaging. METHODS We reviewed the records of all patients with high grade (Gleason 8–10) prostate cancer who underwent a bone scan and CT abdomen/pelvis at time of initial prostate cancer diagnosis from 2003 to 2009 at the Minneapolis Veterans Affairs Medical Center. The bone scan and/or CT findings were analyzed for correlation with variables including patient age, PSA at diagnosis, Gleason sum, clinical stage, and positive biopsy core volume. RESULTS Two hundred sixty patients had both CT and bone scan at time of diagnosis of high grade prostate cancer. 18.5% were positive for metastasis based on bone scan only and 19.6% were positive based on CT abdomen/pelvis only. When CT pelvis-only findings plus bone scan were considered, 18.8% had evidence of metastasis. Of those with a positive bone scan, 64.6% had CT findings consistent with metastatic disease. PSA>20 ng/ml, stage ≥cT2c, and core volume >50% were associated with increased risk of positive bone scan (P<0.001, P<0.001, P=0.018 respectively). Of patients with a negative bone scan, 9.1% had CT findings of metastasis. PSA>20 ng/ml (P<0.02) and stage ≥cT2c (P< 0.02) were associated with positive CT after negative bone scan. Interestingly, for all patients with a positive bone scan (n=48), follow-on CT staging did not yield information that changed clinical management. CONCLUSIONS Bone scans should be performed for staging on all patients with PSA>20 ng/ml, stage ≥cT2c, or Gleason ≥8. If the bone scan is positive, CT may be deferred as initial treatment would not be affected. If the bone scan is negative, CT imaging should be obtained due to the modest risk of additional findings. CT pelvis appears to be a suitable alternative to full CT abdomen/pelvis for accurately staging new high grade prostate cancer. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e79 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kenneth M. Smith Minneapolis, MN More articles by this author Matthew J. O'Shaughnessy Minneapolis, MN More articles by this author Rachel M. Meuleners Minneapolis, MN More articles by this author Joel W. Slaton Minneapolis, MN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...