Evaluation Of Skeletal Metastases Research Articles

Can a fast T2-Dixon sequence surpass the time obstacle of whole-body MRI in the evaluation of skeletal metastases?

BackgroundWhole-body magnetic resonance imaging (WB-MRI) has shown its accuracy in the diagnosis of skeletal metastases in patients with known primary solid cancers. The standard protocol was a combination of T1 and short tau inversion recovery (STIR) sequences. Herein, this study was conducted to elucidate the role of the T2-Dixon sequence as a rapid alternative to the standard protocol with the assessment of its diagnostic accuracy and comparability to the established methodology.MethodsThis prospective study included 30 patients with primary solid malignancies who underwent WB-MRI. The sequences obtained were T1WI, STIR, and T2-Dixon (fat-only and water-only images). Skeletal metastases were evaluated in each sequence. Results were compared between the T1-STIR combination and T2-Dixon fat and water reconstructions.ResultsThe sensitivity of fat and water reconstructions from a single T2-Dixon in the detection of lytic skeletal metastases was marginally superior to a combination of T1WI and STIR sequences (0–7%). Detection of mixed lesions demonstrated equally high sensitivity in both protocols. Sclerotic metastases detection in WB-MRI showed low sensitivity in both protocols. However, specificity surpassed 95% for all lesion types in both protocols. Overall image quality was favored (in 87–90% of patients) in T2-Dixon images. The overall estimated acquisition timing using T2-Dixon appeared to be approximately half that of the standard T1-STIR combination.ConclusionsWB-MRI using T2-Dixon fat and water reconstructions showed similar accuracy to T1WI and STIR combination in the evaluation of skeletal metastases in patients with primary solid cancers with significantly shorter acquisition time.

A Retrospective Comparative Study of Sodium Fluoride (NaF-18)-PET/CT and Fluorocholine (F-18-CH) PET/CT in the Evaluation of Skeletal Metastases in Metastatic Prostate Cancer Using a Volumetric 3-D Radiomics Analysis.

Bone metastases are common in prostate cancer (PCa). Fluorocholine-18 (FCH) and sodium fluoride-18 (NaF) have been used to assess PCa associated skeletal disease in thousands of patients by demonstrating different mechanism of uptake-cell membrane (lipid) synthesis and bone mineralization. Here, this difference is characterized quantitatively in detail. Our study cohort consisted of 12 patients with advanced disease (> 5 lesions) (M) and of five PCa patients with no skeletal disease (N). They had routine PET/CT with FCH and NaF on consecutive days. Skeletal regions in CT were used to co-register the two PET/CT scans. Bone 3-D volume of interest (VOI) was defined on the CT of PET with a threshold of HU > 150, and sclerotic/dense bone as HU > 600, respectively. Additional VOIs were defined on PET uptake with the threshold values on both FCH (SUV > 3.5) and NaF (SUV > 10). The pathologic skeletal volumes for each technique (CT, HU > 600), NaF (SUV > 10) and FCH (SUV > 3.5) were developed and analyzed. The skeletal VOIs varied from 5.03 L to 7.31 L, whereas sclerotic bone VOIs were from 0.88 L to 2.99 L. Total choline kinase (cell membrane synthesis) activity for FCH (TCA) varied from 0.008 to 4.85 [kg] in M group and from 0.0006 to 0.085 [kg] in N group. Total accelerated osteoblastic (bone demineralization) activity for NaF (TBA varied from 0.25 to 13.6 [kg] in M group and varied from 0.000 to 1.09 [kg] in N group. The sclerotic bone volume represented only 1.86 ± 1.71% of the pathologic FCH volume and 4.07 ± 3.21% of the pathologic NaF volume in M group, and only 0.08 ± 0.09% and 0.18 ± 0.19% in N group, respectively. Our results suggest that CT alone cannot be used for the assessment of the extent of active metastatic skeletal disease in PCa. NaF and FCH give complementary information about the activity of the skeletal disease, improving diagnosis and disease staging.

Evaluation of Skeletal Metastases in Different Clinical Stages of Breast Cancer Patients

Background: Breast cancer is a common form of cancer among women globally. Bone is the most common site to which breast cancer metastasizes. Between 30% and 85% of patients with metastatic breast cancer will develop bone metastases during the course of the disease.Objective: To evaluate the pattern and distribution of skeletal metastases in different clinical stages of breast cancer patients by using Tc-99m MDP bone scan.Materials and methods: A retrospective study was conducted on 305 consecutive female breast carcinoma patients referred for bone scan to Institute of Nuclear Medicine and Allied Sciences, Rajshahi from January 2015 to June 2017. All patients were categorized in one of the three groups; early breast cancer (EBC, comprises clinical stage I and II), locally advanced breast cancer (LABC, clinical stage III) and metastatic breast cancer (MBC, clinical stage IV). Bone scan was performed by an intravenous bolus injection of 20 mCi Tc99m-MDP and bone phase images were taken at three hours after injection of the radiotracer.Results: Out of 305 studied patients, 16 patients (5.25%) were in EBC group, LABC patients were 173 (56.72%) and MBC were 116 (38.03%). 98 patients (32.13%) were positive for skeletal metastases. In 16 EBC patients only 01 patient (6.25%) had skeletal metastasis in thoracic spine. Skeletal metastases were 20.81% in LABC and 52.59% in MBC group. Thoraco-lumbar spine was the commonest site in both groups followed by ribs, pelvic bones, upper and lower extremities, cervical spine, sternum, scapula and skull bone.Conclusion: Bone scan should be done in all LABC and MBC patients and in symptomatic EBC at disease presentation. Parts of bone to focus are thoracic and lumbar spine in all stages, followed by ribs, pelvis and extremities. Tc-99m MDP bone scan play a major role in early detection of skeletal metastasis in breast cancer patients.TAJ 2017; 30(2): 47-53

Diagnostic and prognostic value of 18F-FDG PET/CT imaging in suspected recurrence of male breast cancer.

PurposeMale breast cancer (MBC) is a rare malignancy, with recurrence being one of the main adverse predictors for prognosis. The aim of the study was to evaluate the diagnostic and predictive value of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT in the setting of suspected recurrence of MBC.Patients and methodsRetrospective analysis of PET/CT findings was performed in 23 previously treated, histologically proven patients with MBC (mean age: 59.3±10.9 years; range: 36–79 years) with suspected recurrence. Kaplan–Meier disease-specific survival analysis was made with respect to histological, hormonal profile as well as PET/CT findings.ResultsOf the 23 patients, 19 (82.6%) showed recurrence. Recurrence at primary site with/without regional/distant site recurrence was seen in 12 (52.2%) patients. Only metastatic recurrence without primary site was seen in seven (30.4%) patients. Bone was the most common site of distant metastasis (14/23) followed by lungs (9/23), liver (4/23), brain (2/23), and adrenal (1/23). No recurrence (regional/distant) was noted in 4/23 (17.3%) patients; however, three of them had 18F-FDG-avid soft tissue lesions in esophagus, rectum and tongue, correspondingly, confirmed as second primaries with histopathology. Disease-specific survival analysis yielded nodal (P=0.01) as well as distant metastases (P=0.02) as the main survival predictors on PET/CT. Lung (P=0.001), followed by liver (P=0.009), and skeletal (P=0.01) metastases were the most adverse survival predictive factors.Conclusion18F-FDG PET/CT showed good diagnostic and prognostic utility in recurrent MBC. It was better than bone scan in evaluation of skeletal metastases. Most importantly, 18F-FDG PET/CT helped in early detection of second malignancy and their clinical management in studied patients.

The Role of PET/CT in the Evaluation of Skeletal Metastases

Osseous metastatic disease from malignancy is a common occurrence with significant patient morbidity and mortality as well as increasing health care expenditures. Patient management plans frequently change with the identification of skeletal metastasis and the upstaging of disease status. Bone scintigraphy remains the current mainstay of diagnostic imaging procedures in nuclear medicine for the early detection of skeletal metastasis owing to their high sensitivity. Emerging positron tracers and the increasing use and availability of hybrid single-photon emission computed tomography and positron emission tomography (PET)/computed tomography machines enable physicians to diagnose metastatic disease in bones with superior accuracy. This review introduces the basics of PET and the commonly used positron tracers used to evaluate skeletal metastases.

Evaluation of the efficiency of FDG PET/CT in detection and characterization of skeletal metastases

Background and purposeCombined PET/CT using 18F-FDG is widely used in evaluation of various malignancies; in their initial staging and more efficiently in their follow up; hence, the importance of evaluation of its diagnostic role in the imaging of skeletal metastases. The purpose of this study is to evaluate precisely the efficiency of FDG PET/CT in detection and characterization of osseous metastatic lesions compared to isolated PET and CT in various malignancies. Patients and methodsThe study included 123 patients divided into seven groups of malignancies to whom PET/CT was done. In this study population, a detailed retrograde lesion based analysis was performed for a total of 1705 detected bone lesions on PET, CT and fused PET/CT images. Sensitivity, specificity, PPV and NPV of each modality were calculated. Semi-quantitative and ROC curve analysis of the lesions were performed to study the relationship between the lesion’s SUV and its corresponding morphologic pattern on CT and to set a reliable SUVmax cut-off value that can predict the presence of malignant lesion. ResultsThe calculated fused PET/CT sensitivities and specificities in various malignancies ranged from 95.2% to 99.6% and 75% to 100%, respectively. The combined PET/CT has significantly improved the low CT sensitivity (especially in lymphoma) as well as both CT and PET specificities. Our ROC analysis suggested using SUVmax of 3 as a cut off value for malignant osseous lesions. ConclusionFused PET/CT was highly efficient in evaluation of skeletal metastases with superior performance in: detection of early bone marrow infiltration not apparent on CT, resolution of metabolic activity before definite signs of complete healing on CT, detection of missed sclerotic metastases on PET due to their relatively low metabolic activity, detection of intra and extra osseous recurrence and differentiation of benign from malignant bone lesions.

Diagnostic Imaging and Image-Guided Therapy of Skeletal Metastases

The high incidence of skeletal metastases in cancer patients warrants careful detection with imaging and follow-up. Efforts are needed to manage pain associated with skeletal metastases as part of overall patient management. This article reviews the current methods of diagnostic imaging in the evaluation of skeletal metastases and image-guided treatment of bone metastases for the palliation of pain based primarily on the assessment of imaging and interventional radiologic literature. Approaches to diagnostic imaging of skeletal metastases are summarized. Skeletal scintigraphy provides high sensitivity for detecting skeletal metastases, but targeted computed tomography (CT) or magnetic resonance imaging (MRI) may be needed to increase specificity. Newer imaging modalities, such as positron emission tomography (PET)/CT, improve detection of both lytic and blastic metastases. Minimally invasive percutaneous ablative treatment techniques, including radiofrequency ablation, microwave ablation, and cryoablation, are examined. They provide alternative approaches to radiation therapy to effectively palliate pain of bone metastases. Preliminary results of MR-guided focused ultrasound surgery (MRgFUS) demonstrate its effectiveness in palliating pain from skeletal metastases. Skeletal scintigraphy is the most common imaging modality for detecting skeletal metastases. Additional imaging may be required based on the type of tumor, the disease state, or treatment options. External-beam radiation therapy remains the mainstay for palliation of pain from bone metastases. Alternative minimally invasive and noninvasive image-guided treatment options can provide effective pain palliation.

Bilateral Paget Disease of the Calcaneus Diagnosed by Conventional Bone Scintigraphy

An 85-year-old woman who had an invasive ductal carcinoma of the breast and elevated alkaline phosphatases (420 U/L) was referred for Tc-99m MDP bone scintigraphy for initial evaluation of skeletal metastases. Bone symptoms were limited to chronic pain in both knees. A bone scan revealed pagetoid findings in both calcanei. Feet and toes on plain x-rays of the calcaneus were unremarkable. Findings were stable in the 2-year follow up, excluding other potential diagnosis as extensive metastases or stress fractures.

Frequency of skeletal metastases in nasopharyngeal carcinoma after initiation of therapy: should bone scans be used for follow-up?

Previous reports have indicated a relatively high incidence of distant metastases in patients with nasopharyngeal carcinoma (NPC), one of the most common sites being the skeleton. Although bone scintigraphy offers the advantage of whole-body imaging in patients with cancer by providing useful information about disease spread, its value in patients with NPC is not well defined because of cost-effectiveness considerations. In this study, we assessed the value of follow-up bone scintigraphy for the evaluation of skeletal metastases in patients with different stages of NPC. Between 1994 and 2001, 230 patients with histologically proven NPC were admitted to the Department of Radiation Oncology. Out of 230 patients, 171 were examined for skeletal metastases with bone scintigraphy prior to therapy and at 1 year intervals. Bone scintigraphy detected increased uptake in 29 patients, which was reported as suggestive of metastases or equivocal. Twenty-six of these were true-positive, confirmed by radiography or clinical follow-up. Bone pain was present in 67% of these patients and serum lactate dehydrogenase and alkaline phosphatase were elevated in 35% and 37%, respectively. The incidence of bone metastases correlated with the extent of lymph node involvement, which were detected after a median time of 10.5 months following the diagnosis of the primary disease. No correlation was observed between the metastatic status and local T stage, histological differentiation age or gender of the patient. We can therefore recommend that bone scintigraphy be used in determining the presence of bone metastases, but its utilization should be preserved for those with nodal involvement.

Paget disease of the thumb.

A 69-year-old man who had an elevated prostate-specific antigen level and newly diagnosed biopsy-proved prostate cancer was referred for Tc-99m MDP bone scintigraphy for initial evaluation of skeletal metastases. He had no skeletal pain or deformities. The bone scintigram unexpectedly revealed pagetoid findings in the hips, femurs, left scapula, and the right thumb. Paget disease of the thumb is extremely rare but has characteristic findings on plain radiographs.

The role of computed tomography in evaluation of skeletal metastases

Computed tomography was performed in 100 patients for additional evaluation of suspected skeletal metastases following radionuclide bone scanning in 86 patients and conventional radiography in all. A retrospective review of these cases revealed that the majority (78%) involved the spine and pelvis. Computed tomography contributed to the diagnosis of a malignancy by revealing a definite destructive lesion of bone in 27 patients who had an abnormal radionuclide bone scan, a normal or inconclusive radiograph, or both. It excluded a malignant lesion in 19 patients. In 38 patients, computed tomography provided additional information that contributed to such aspects of patient care as obtaining tissue diagnosis, determining the extent of lesions, and evaluating the response to treatment. False diagnoses were made in two patients. Detection by computed tomography of a skeletal lesion and histologic documentation, frequently by computed tomography-guided percutaneous needle aspiration biopsy, greatly curtailed an otherwise extensive search for the primary site. Furthermore, this information altered the treatment plan by obviating the need for radical resection or biopsy of the primary tumor and by directing the choice of an appropriate chemotherapeutic regimen.