Detection Of Metastatic Bone Disease Research Articles

Computer-aided diagnosis of skeletal metastases in multi-parametric whole-body MRI

The confident detection of metastatic bone disease is essential to improve patients' comfort and increase life expectancy. Multi-parametric magnetic resonance imaging (MRI) has been successfully used for monitoring of metastatic bone disease, allowing for comprehensive and holistic evaluation of the total tumour volume and treatment response assessment. The major challenges of radiological reading of whole-body MRI come from the amount of data to be reviewed and the scattered distribution of metastases, often of complex shapes. This makes bone lesion detection and quantification demanding for a radiologist and prone to error. Additionally, whole-body MRI are often corrupted with multiple spatial and intensity distortions, which further degrade the performance of image reading and image processing algorithms. In this work we propose a fully automated computer-aided diagnosis system for the detection and segmentation of metastatic bone disease using whole-body multi-parametric MRI. The system consists of an extensive image preprocessing pipeline aiming at enhancing the image quality, followed by a deep learning framework for detection and segmentation of metastatic bone disease. The system outperformed state-of-the-art methodologies, achieving a detection sensitivity of 63% with a mean of 6.44 false positives per image, and an average lesion Dice coefficient of 0.53. A provided ablation study performed to investigate the relative importance of image preprocessing shows that introduction of region of interest mask and spatial registration have a significant impact on detection and segmentation performance in whole-body MRI. The proposed computer-aided diagnosis system allows for automatic quantification of disease infiltration and could provide a valuable tool during radiological examination of whole-body MRI.

Comparison of 68GA-FAPI-04 PET/CT and 18F-FDG PET/CT in detection of metastatic bone disease in various cancers

ObjectiveOur aim in this retrospective study was to compare the diagnostic accuracy of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in detecting bone metastases of various cancers and to evaluate the potential usefulness of 68Ga-FAPI-04 PET/CT in detecting metastatic bone disease. Material and methodOur retrospective study included 44 patients diagnosed with bone metastases due to various cancers between January 2021 and February 2022. All patients underwent 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT imaging within 14 days. In the semi-quantitative analysis of the skeletal system, all regions with higher uptake than background activity were considered pathological. SUVmax and Metastasis-to-background ratio (TBR) values were calculated from metastatic sites. ResultsA total of 827 bone metastases were detected in our study. The diagnostic accuracies of FAPI PET/CT and 18F-FDG PET/CT were 91.8% and 81.5%, respectively (P<0.001). When all bone metastases were compared, the SUVmax of 68Ga-FAPI-04 PET/CT was statistically significantly higher than that of 18F-FDG PET/CT (median 6.15 vs. 5.2; P<0.001). When FDG and FAPI SUVmax values were compared according to metastasis types, FAPI SUVmax and TBR values in osteolytic, medullary and mixed type bone metastases were found to be statistically significantly higher than FDG (P-values: < 0.001, < 0.001, < 0.001, respectively). There was no statistically significant difference between FDG and FAPI SUVmax values in osteoblastic bone metastases (P=0.26). ConclusionIt has been shown that 68Ga-FAPI-04 PET/CT is superior to 18F-FDG PET/CT in detecting metastatic bone disease and may have more clinical impact on disease management.

Diagnostic &amp; prognostic impact of 18F-NaF PET/CT versus 99mTc-MDP bone scan in detection of bone metastases

Purpose: To assess the role of 18F-NaF PET/CT in the detection of metastatic bone disease compared to 99mTc-MDP bone scan (+/-SPECT/CT). Methods: 64 adult patients with locally advanced primary tumor were enrolled in this study. All patients underwent pretherapy 18F-NaF PET/CT and 99mTc-MDP bone scan. Results: Among the 64 patients 18F-NaF PET/CT revealed positive bone metastases in 26 patients, only 19 of them have positive results in 99mTc-MDP bone scan, while the remaining 7 patients were falsely negative in 99mTc-MDP bone scan. On the other hand 18F-NaF PET/CT diagnosed 38 patients free of osseous metastases, 5 patients of them were falsely diagnosed having osseous metastases by 99mTc-MDP bone scan. None of patient has positive bone metastases by 99mTc-MDP &amp; negative 18F-NaF PET/CT for bone metastases in our study group. The overall results revealed significant higher sensitivity for 18F-NaF PET/CT (100%) compared to 99mTc-MDP bone scan (73.08%) (P&lt;0.05) as well as higher specificity for 18F-NaF PET/CT (100%) compared to 99mTc-MDP bone scan (86.8%) (P&lt;0.05). Conclusion: 18F-NaF PET/CT is a high-quality skeletal imaging with convenient diagnostic performance in either lytic or sclerotic bone lesions surpassing that of Tc99m MDP, with lower equivocal interpretations.

Which red flags aid the early detection of metastatic bone disease in back pain?

Which red flags aid the early detection of metastatic bone disease in back pain?

Red flags associated with the early detection of metastatic bone disease as a cause of back pain

Red flags associated with the early detection of metastatic bone disease as a cause of back pain

Serum bone sialoprotein levels and bone metastases

The skeleton is the most common site of tumor metastasis. The detection of metastatic bone disease is critical for primary cancer staging because it will condition the therapeutic decision and the prognosis. For the diagnosis of bone metastases, imaging techniques are usually employed, even if these techniques have some limitations in terms of accuracy and costs. An innovative, cheaper method for the screening of skeletal metastases could be the measurement of bone turnover markers. This article is aimed at providing a literature review on the clinical significance of increased serum levels of bone sialoprotein (BSP) observed in patients suffering from metastatic bone lesions. In addition, we have briefly summarized recent studies reporting the biological and pathological roles of BSP in bone remodeling and bone metastasis. Some studies have demonstrated that serum BSP can be considered as an early marker and a prognostic factor for the development of bone metastases. BSP may help in assessing osteolytic bone disease, in evaluating additional prognostic information and in monitoring treatment modalities.

Conventional Tc‐99m‐based Bone Scan Versus Fluoride Positron Emission Tomography Combined with Computed Tomography in the Assessment of Bone Metastases in Prostate Cancer Patients

SummaryIn prostate cancer, bone metastasis is related to a poor prognosis and is one of the major causes of morbidity and mortality. Detection of metastatic bone disease is particularly important in prostate cancer patients with high probability for distant metastases before embarking on radical prostatectomy or radiation therapy. The choice of imaging modalities that best depict the metastatic bony lesions may vary depending on different patterns of bone metastases. Bone scintigraphy has been used routinely in the evaluation of prostate cancer patients in the last decades. However, it suffers from adequate specificity. Single photon emission tomography (SPECT) increases the sensitivity and specificity of planar bone scanning especially for the evaluation of the spine. Recently, positron emission tomography (PET) using F‐18 Fluoride shows promising results in the detection of bone metastases especially in cancers with prominent osteoblasic pattern of bone metastases such as prostate cancer. This article reviews the value of conventional planar bone scanning, SPECT, SPECT/CT as well as F‐18 Fluoride PET/CT in the assessment of bone metastases in prostate cancer patients.

Biochemical approach to the detection and monitoring of metastatic bone disease: What do we know and what questions need answers?

Metastatic spread to bones frequently occurs in several types of cancer diseases, in particular breast, prostate, and lung cancer. Infiltration of bone by tumour cells is a source of several complications including severe bone pain, spinal cord compression, hypercalcemia, pathologic fractures, all reducing quality of life and worsening prognosis. Therefore, early recognition of bone metastases is among the highest priorities in the clinical management of cancer disease. Currently, detection and staging relies on radiological imaging techniques (scintigraphy, radiography, computer tomography, etc.). Due to their limited sensitivity and/or inconveniences, irradiation, and considerable costs related to serial use, they are not suited for close monitoring of cancer patients to capture skeletal spread in an early stage or to follow-up on therapeutical responses. Interaction of tumour cells with surrounding bone cells leads to enhanced bone resorption and/or bone formation. These cellular processes result in the release of numerous epitopes that, if detected by immunoassays, can reflect the changes of the rate of bone turnover and the occurrence of metastatic spread to bone. Numerous studies reported elevated levels of bone turnover markers in patients with bone metastases proportionally to the extent of skeletal involvement. Furthermore, preliminary data suggest that biomarkers can predict skeletal-related events (SREs), disease progression, and even cancer-related death. The present review intends to summarize the list of emerged biomarkers, major studies assessing their relative utility for detection of bone metastases in different types of cancer disease, and discuss their potentials for becoming part of screening protocols for improving our success rate in the early detection of metastatic bone disease.

Incidence and imaging characteristics of skeletal metastases detected by bone scintigraphy in lung cancer patients

Detection of metastatic bone disease by skeletal scintigraphy is a classical application of nuclear medicine in cancer patients. Detection of bone metastases in patients with lung cancer is necessary for an appropriate treatment modality. The aim of this study was to report the frequency and imaging characteristics of bone metastases detected by bone scintigraphy (BS) using technetium-99m phosphonates in patients with lung cancer. We retrospectively analyzed a total of one hundred patients (78 males and 22 females), mean age of 63.3 years, with the diagnosis of lung cancer, who underwent BS during a three-year-period (2003-2005). Scintiscans were classified as positive, negative and suspicious with regard to the presence of bone metastases. The incidence of positive, negative and suspicious findings were 57%. 32% and 11%, respectively. Out of 57 patients with bone metastases, 51 had multiple asymmetric foci of increased tracer activity localized in the ribs, spine, extremities, pelvis, sternum, scapula and skull in 72%, 54%, 49%, 37%, 12%, 9% and 5% of scans, respectively. BS revealed solitary metastases in 6 of the patients. The lesions were located in the lower limbs in three patients and in the upper limbs, pelvis and sternum in the remaining three patients. Bone scintigraphy plays a significant role in staging and selecting of patients for curative lung surgery. Due to the fact that metastatic involvment of the extremities was frequently shown, our study suggests that systematic inclusion of the limbs in BS acquisition should be obligatory.

Prognostic indicators of metastatic bone disease in human breast cancer

The time to detection of metastatic bone disease (MBD) by radiographic examination was studied in 221 patients with advanced breast cancer. None of the patients had bone metastases by radiography or bone marrow carcinosis, evaluated by bilateral iliac crest biopsy. The period of follow-up after first recurrence was 46 months. Fifty-five patients (25%) had MBD; 89 patients died without MBD. The cumulated rate of MBD was 14% and 27% after 1 and 2 years, respectively. The actuarial time to MBD was associated significantly with the presence of positive regional lymph nodes at primary diagnosis, the occurrence of metastases in the mediastinum, and the presence of visceral metastases. Moreover, a positive bone scintigraphic scan at the time of first recurrence and abnormal biochemical analyses from serum also were associated significantly with a shortened time to MBD. Micrometastases in the bone marrow, as detected by monoclonal antibodies against epithelial markers (epithelial membrane antigen and cytokeratin), were present in 18% of the patients. The presence of such tumor cells was not associated with development of radiologic MBD. Cox analyses revealed that the result of bone scintigraphic scanning and the presence of visceral metastases were the most important and independent predictors of the time of MBD. Four distinct prognostic groups were identified based on the status of these two variables. The recognition of these prognostic groups has several implications for clinical and therapeutic management of patients with recurrent breast cancer.

Limitations of Bone Scanning In Clinical Oncology

Radioisotope bone scanning is frequently used as the major, and sometimes the only, diagnostic test for neoplasia in bone. While the evidence is convincing that bone scans are frequently more sensitive than roentgenographic bone surveys for detection of metastatic bone disease, there are false-negative results for a variety of reasons, and positive findings must be interpreted with caution. Scans also appear more limited than roentgenograms in their usefulness for evaluating changes in abnormal bone structure. Case histories and discussion are offered to indicate that usually both radioisotope bone scans and roentgenographic bone surveys should be obtained for initial screening and subsequent assessment of bone metastases.