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Eilsberger F, Girmond C, Boekhoff J, Librizzi D, Luster M, Pfestroff A. [High clinical value of bone scintigraphy as a staging method for breast cancer]. Nuklearmedizin 2022; 61:308-313. [PMID: 35388441 DOI: 10.1055/a-1780-8378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bone scintigraphy is a sensitive method for imaging bone metastases in patients with breast cancer. Despite its firm establishment in clinical routine, there are hardly any reliable data from larger homogeneous collectives on the value of bone scintigraphy in the context of staging of first diagnosed breast cancer patients. AIM The aim of our work was to evaluate the real-life performance of bone scintigraphy as a staging examination in female patients with the initial diagnosis of breast cancer. PATIENTS AND METHODS We retrospectively evaluated the data of the patients examined in the year 2015 with the first diagnosis of breast cancer at the University Hospital Marburg by bone scintigraphy. In addition a follow-up over a period of 30 months after the first bone scintigraphy was performed. For this purpose we evaluated whether the results of this initial diagnostic could be confirmed in following diagnostic. RESULTS 207/258 patients showed no suspicious findings in the initial bone scintigraphy, 48 had an unclear finding, which is why 42 patients received further diagnostics. In follow-up, new bone metastases were found in 4 patients, all of these had scintigraphic findings in the primary diagnosis, which were considered "unclear". Depending on the evaluation of the event (suspicious for metastasis/suspicious for metastasis and unclear), the sensitivity was 37.5%/100%, the specificity 100%/80%, the positive predictive value 100%/15.7% and the negative predictive value 98%/100%. CONCLUSION By using bone scintigraphy and, if necessary, subsequent further imaging or histological clarification, a clinically significant diagnosis was obtained in 99,2% of the examined patients and confirmed in the follow-up. This result shows the good real-life performance of bone scintigraphy as a staging examination in patients with first diagnosed breast carcinomas.
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Affiliation(s)
- Friederike Eilsberger
- Nuclear Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Clara Girmond
- Nuclear Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Jelena Boekhoff
- Gynecology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Damiano Librizzi
- Nuclear Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Markus Luster
- Nuclear Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
| | - Andreas Pfestroff
- Nuclear Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany
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2
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Hoppe J, Kalckreuth T, Metelmann M, Rumpf JJ, Klagges S, Dietzsch S, Scherlach C, Kuhnt T, Kortmann RD, Seidel C. [Skull base metastases with cranial nerve deficits : Clinical profile of a severe disease]. DER NERVENARZT 2022; 93:812-818. [PMID: 35024880 PMCID: PMC9363291 DOI: 10.1007/s00115-021-01229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund und Ziele Schädelbasismetastasen sind eine seltene Manifestation onkologischer Erkrankungen. Wenn Hirnnerven beteiligt sind, können schon kleine Läsionen erhebliche funktionelle Beeinträchtigungen hervorrufen. Spezifische klinische Charakteristika wie neurologische Symptome, assoziierte Primärtumoren, Prognose und optimale Therapie der Erkrankung sind schlecht definiert und sollen in dieser Arbeit systematisch dargestellt werden. Methoden Mit einem monozentrischen retrospektiven Ansatz wurden Schädelbasismetastasen bei Patienten, die im Zeitraum von 2006 bis 2018 behandelt wurden, detailliert hinsichtlich klinischer Charakteristika, der durchgeführten Therapie und des weiteren Erkrankungsverlaufs analysiert. Ergebnisse Insgesamt 45 Patienten mit Schädelbasismetastasen und Hirnnervenausfällen wurden erfasst. Die häufigsten Primärtumoren waren Prostatakarzinom (27 %), Mammakarzinom (22 %) und multiples Myelom (16 %). Die am häufigsten betroffenen Hirnnerven waren Nervus trigeminus (42 %), Nervus oculomotorius (33 %) und Nervus facialis (27 %). 84 % aller Patienten wiesen außerhalb der Schädelbasis liegende weitere Knochenmetastasen auf. Eine durale Infiltration oder eine Meningeosis neoplastica lagen bei je 13 % der Patienten vor. Nach Bestrahlung waren 61 % der Patienten hinsichtlich der auf die Schädelbasismetastase zurückzuführenden Symptome klinisch stabil, bei 22 % hatten sich die Symptome gebessert. Das mediane Gesamtüberleben betrug 8 Monate (Spanne: 0,4–51 Monate). Bei Patienten, die mit einer dosiseskalierten Bestrahlung behandelt wurden, bestand eine längere Überlebenszeit (16,4 Monate vs. 4,7 Monate). Dieser Effekt persistierte auch in der multivariaten Analyse unter Berücksichtigung der Faktoren Karnofsky-Index, Metastasenanzahl, Primärtumor und Bestrahlungsdosis (HR 0,37, p = 0,02). Diskussion Schädelbasismetastasen mit Hirnnervenausfällen haben ein vielgestaltiges Bild und oft eine schlechte Prognose. Um potenziell eine Überlebenszeitverbesserung zu erreichen, sind präzise Diagnostik und Therapie Voraussetzung. Prospektive kontrollierte Untersuchungen sind notwendig.
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Affiliation(s)
- J Hoppe
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - T Kalckreuth
- Department of Radiation-Oncology, University Hospital Freiburg, Freiburg, Deutschland
| | - M Metelmann
- Department of Neurology, University Hospital Leipzig, Leipzig, Deutschland
| | - J J Rumpf
- Department of Neurology, University Hospital Leipzig, Leipzig, Deutschland
| | - S Klagges
- Sächsisches Krebsregister Leipzig, Leipzig, Deutschland
| | - S Dietzsch
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - C Scherlach
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Deutschland
| | - T Kuhnt
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - R D Kortmann
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland
| | - C Seidel
- Department of Radiation-Oncology, University Hospital Leipzig, Leipzig, Deutschland. .,, Stephanstr. 9a, 04103, Leipzig, Deutschland.
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Johnston EW, Latifoltojar A, Sidhu HS, Ramachandran N, Sokolska M, Bainbridge A, Moore C, Ahmed HU, Punwani S. Multiparametric whole-body 3.0-T MRI in newly diagnosed intermediate- and high-risk prostate cancer: diagnostic accuracy and interobserver agreement for nodal and metastatic staging. Eur Radiol 2019; 29:3159-3169. [PMID: 30519933 PMCID: PMC6510859 DOI: 10.1007/s00330-018-5813-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/24/2018] [Accepted: 09/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy and interobserver concordance of whole-body (WB)-MRI, vs. 99mTc bone scintigraphy (BS) and 18fluoro-ethyl-choline (18F-choline) PET/CT for the primary staging of intermediate/high-risk prostate cancer. METHODS An institutional review board approved prospective cohort study carried out between July 2012 and November 2015, whereby 56 men prospectively underwent 3.0-T multiparametric (mp)-WB-MRI in addition to BS (all patients) ± 18F-choline PET/CT (33 patients). MRI comprised pre- and post-contrast modified Dixon (mDixon), T2-weighted (T2W) imaging, and diffusion-weighted imaging (DWI). Patients underwent follow-up mp-WB-MRI at 1 year to derive the reference standard. WB-MRIs were reviewed by two radiologists applying a 6-point scale and a locked sequential read (LSR) paradigm for the suspicion of nodal (N) and metastatic disease (M1a and M1b). RESULTS The mean sensitivity/specificity of WB-MRI for N1 disease was 1.00/0.96 respectively, compared with 1.00/0.82 for 18F-choline PET/CT. The mean sensitivity and specificity of WB-MRI, 18F-choline PET/CT, and BS were 0.90/0.88, 0.80/0.92, and 0.60/1.00 for M1b disease. ROC-AUC did not show statistically significant improvement for each component of the LSR; mean ROC-AUC 0.92, 0.94, and 0.93 (p < 0.05) for mDixon + DWI, + T2WI, and + contrast respectively. WB-MRI had an interobserver concordance (κ) of 0.79, 0.68, and 0.58 for N1, M1a, and M1b diseases respectively. CONCLUSIONS WB-MRI provides high levels of diagnostic accuracy for both nodal and metastatic bone disease, with higher levels of sensitivity than BS for metastatic disease, and similar performance to 18F-choline PET/CT. T2 and post-contrast mDixon had no significant additive value above a protocol comprising mDixon and DWI alone. KEY POINTS • A whole-body MRI protocol comprising unenhanced mDixon and diffusion-weighted imaging provides high levels of diagnostic accuracy for the primary staging of intermediate- and high-risk prostate cancer. • The diagnostic accuracy of whole-body MRI is much higher than that of bone scintigraphy, as currently recommended for clinical use. • Staging using WB-MRI, rather than bone scintigraphy, could result in better patient stratification and treatment delivery than is currently provided to patients worldwide.
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Affiliation(s)
- Edward William Johnston
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK
| | - Arash Latifoltojar
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK
| | - Harbir Singh Sidhu
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK
| | - Navin Ramachandran
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK
| | - Magdalena Sokolska
- Medical Physics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Alan Bainbridge
- Medical Physics, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Caroline Moore
- Department of Urology, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Hashim Uddin Ahmed
- Department of Urology, Imperial College London, Fulham Palace Road, Hammersmith, London, W6 8RF, UK
| | - Shonit Punwani
- UCL Centre for Medical Imaging, 2nd Floor Charles Bell House, 43 - 45 Foley Street, London, W1W 7TS, UK.
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Comparison of bone lesion distribution between prostate cancer and multiple myeloma with whole-body MRI. Diagn Interv Imaging 2019; 100:295-302. [PMID: 30704946 DOI: 10.1016/j.diii.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/20/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE To assess the distribution of bone lesions in patients with prostate cancer (PCa) and those with multiple myeloma (MM) using whole-body magnetic resonance imaging (MRI); and to assess the added value of four anatomical regions located outside the thoraco-lumbo-pelvic area to detect the presence of bone lesions in a patient-based perspective. MATERIALS AND METHODS Fifty patients (50 men; mean age, 67±10 [SD] years; range, 59-87 years) with PCa and forty-seven patients (27 women, 20 men; mean age, 62.5±9 [SD] years; range, 47-90 years) with MM were included. Three radiologists assessed bone involvement in seven anatomical areas reading all MRI sequences. RESULTS In patients with PCa, there was a cranio-caudal increasing prevalence of metastases (22% [11/50] in the humeri and cervical spine to 60% [30/50] in the pelvis). When the thoraco-lumbo-pelvic region was not involved, the prevalence of involvement of the cervical spine, proximal humeri, ribs, or proximal femurs was 0% in patients with PCa and≥4% (except for the cervical spine, 0%) in those with MM. CONCLUSION In patients with PCa, there is a cranio-caudal positive increment in the prevalences of metastases and covering the thoraco-lumbo-pelvic area is sufficient to determine the metastatic status of a patient with PCa. In patients with MM, there is added value of screening all regions, except the cervical spine, to detect additional lesions.
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Younsi N, Montravers F, Philippe C, Seddiki M, Uzan S, Izrael V, Talbot JN. CA 15-3 and Bone Scintigraphy in the follow-up of Breast Cancer. Int J Biol Markers 2018; 12:154-7. [PMID: 9582604 DOI: 10.1177/172460089701200403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
By means of the retrospective study of the clinical records of 158 women followed for breast cancer, we aimed to evaluate the consequences of a non-systematic indication for bone scan (BS) based either on CA 15-3 levels alone or a combination of tumor marker levels and clinical criteria. With the first option, the negative predictive value was 95% and 82% of the BS would have been avoided. With the second option, the negative predictive value was 97% and 59% of the BS would have been avoided. Furthermore, the preliminary results of a longitudinal study showed that those patients with normal CA 15-3 levels and positive bone scans showed a subsequent rise in CA 15-3 levels which frequently became elevated with an average delay of 15 months. Omission of systematic bone scans in the follow-up of breast cancer patients is likely to lead to a delay in the diagnosis of bone metastasis in 3% to 5%, the consequences of which have to be examined carefully.
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Affiliation(s)
- N Younsi
- Service de Médecine Nucléaire, Hôpital Tenon, Paris, France
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Capitanio S, Bongioanni F, Piccardo A, Campus C, Gonella R, Tixi L, Naseri M, Pennone M, Altrinetti V, Buschiazzo A, Bossert I, Fiz F, Bruno A, DeCensi A, Sambuceti G, Morbelli S. Comparisons between glucose analogue 2-deoxy-2-( 18F)fluoro-D-glucose and 18F-sodium fluoride positron emission tomography/computed tomography in breast cancer patients with bone lesions. World J Radiol 2016; 8:200-209. [PMID: 26981229 PMCID: PMC4770182 DOI: 10.4329/wjr.v8.i2.200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 10/08/2015] [Accepted: 12/11/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare 2-deoxy-2-(18F)fluoro-D-glucose(18F-FDG) and 18F-sodium (18F-NaF) positron emission tomography/computed tomography (PET/CT) accuracy in breast cancer patients with clinically/radiologically suspected or known bone metastases.
METHODS: A total of 45 consecutive patients with breast cancer and the presence or clinical/biochemical or radiological suspicion of bone metastatic disease underwent 18F-FDG and 18F-fluoride PET/CT. Imaging results were compared with histopathology when available, or clinical and radiological follow-up of at least 1 year. For each technique we calculated: Sensitivity (Se), specificity (Sp), overall accuracy, positive and negative predictive values, error rate, and Youden’s index. McNemar’s χ2 test was used to test the difference in sensitivity and specificity between the two diagnostic methods. All analyses were computed on a patient basis, and then on a lesion basis, with consideration ofthe density of independent lesions on the co-registered CT (sclerotic, lytic, mixed, no-lesions) and the divergent site of disease (skull, spine, ribs, extremities, pelvis). The impact of adding 18F-NaF PET/CT to the work-up of patients was also measured in terms of change in their management due to 18F-NaF PET/CT findings.
RESULTS: The two imaging methods of 18F-FDG and 18F-fluoride PET/CT were significantly different at the patient-based analysis: Accuracy was 86.7% and 84.4%, respectively (McNemar’s χ2 = 6.23, df = 1, P = 0.01). Overall, 244 bone lesions were detected in our analysis. The overall accuracy of the two methods was significantly different at lesion-based analysis (McNemar’s χ2 = 93.4, df = 1, P < 0.0001). In the lesion density-based and site-based analysis, 18F-FDG PET/CT provided more accurate results in the detection of CT-negative metastasis (P < 0.002) and vertebral localizations (P < 0.002); 18F-NaF PET/CT was more accurate in detecting sclerotic (P < 0.005) and rib lesions (P < 0.04). 18F-NaF PET/CT led to a change of management in 3 of the 45 patients (6.6%) by revealing findings that were not detected at 18F-FDG PET/CT.
CONCLUSION: 18F-FDG PET/CT is a reliable imaging tool in the detection of bone metastasis in most cases, with a diagnostic accuracy that is slightly, but significantly, superior to that of 18F-NaF PET/CT in the general population of breast cancer patients. However, the extremely high sensitivity of 18F-fluoride PET/CT can exploit its diagnostic potential in specific clinical settings (i.e., small CT-evident sclerotic lesions, high clinical suspicious of relapse, and negative 18F-FDG PET and conventional imaging).
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Chikarmane S, Tirumani S, Howard S, Jagannathan J, DiPiro P. Metastatic patterns of breast cancer subtypes: What radiologists should know in the era of personalized cancer medicine. Clin Radiol 2015; 70:1-10. [DOI: 10.1016/j.crad.2014.08.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 08/12/2014] [Accepted: 08/20/2014] [Indexed: 12/01/2022]
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8
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Tombal B, Lecouvet F. Diagnosis and Management of Metastatic Prostate Cancer. Prostate Cancer 2014. [DOI: 10.1002/9781118347379.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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9
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Ewing sarcoma dissemination and response to T-cell therapy in mice assessed by whole-body magnetic resonance imaging. Br J Cancer 2013; 109:658-66. [PMID: 23839490 PMCID: PMC3738111 DOI: 10.1038/bjc.2013.356] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/29/2013] [Accepted: 06/14/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Novel treatment strategies in Ewing sarcoma include targeted cellular therapies. Preclinical in vivo models are needed that reflect their activity against systemic (micro)metastatic disease. METHODS Whole-body magnetic resonance imaging (WB-MRI) was used to monitor the engraftment and dissemination of human Ewing sarcoma xenografts in mice. In this model, we evaluated the therapeutic efficacy of T cells redirected against the Ewing sarcoma-associated antigen GD2 by chimeric receptor engineering. RESULTS Of 18 mice receiving intravenous injections of VH-64 Ewing sarcoma cells, all developed disseminated tumour growth detectable by WB-MRI. All mice had lung tumours, and the majority had additional manifestations in the bone, soft tissues, and/or kidney. Sequential scans revealed in vivo growth of tumours. Diffusion-weighted whole-body imaging with background signal suppression effectively visualised Ewing sarcoma growth in extrapulmonary sites. Animals receiving GD2-targeted T-cell therapy had lower numbers of pulmonary tumours than controls, and the median volume of soft tissue tumours at first detection was lower, with a tumour growth delay over time. CONCLUSION Magnetic resonance imaging reliably visualises disseminated Ewing sarcoma growth in mice. GD2-retargeted T cells can noticeably delay tumour growth and reduce pulmonary Ewing sarcoma manifestations in this aggressive disease model.
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Selcukbiricik F, Yildiz O, Yilmaz S, Tural D, Turna H, Mandel NM, Tuzuner N, Serdengecti S, Halac M. Increasing Role of FDG-PET/CT in Detecting Bone Marrow Metastasis of Solid Tumors in Adults: An Analysis of Ten Patients. World J Oncol 2013; 3:271-279. [PMID: 29147318 PMCID: PMC5649805 DOI: 10.4021/wjon598w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 12/22/2022] Open
Abstract
Background We aimed to test the hypothesis that whether FDG-PET/CT which was ordered for various purposes can predict suspected or particularly unsuspected bone marrow metastasis (BMM) from the complete blood count and therefore can change the management of these patients. Methods In this retrospective study, the study sample consisted of 68 subsequent patients presented to our institution’s pathology department with bone marrow metastases of solid tumors. PET/CT was found to have been ordered in 10 out of 68 patients (6.8%) for various purposes. All patients gave informed consent about the PET/CT examinations and bone marrow biopsies. Result FDG-PET/CT was ordered in 10 out of 68 solid tumor patients with pathologically proven BMM. Of these 10 patients, 3 were female and 7 were male; mean age was 54.7 years. While FDG PET/CT showed bone and BMM in 4 of 10 patients (40%), the rest of the patients had BMM without bone involvement. Five patients (50%) who had probable bone marrow involvement on their FDG PET/CT scans had unsuspected complete blood counts with regard to BMM. Conclusion PET/CT has the ability to detect a substantial number of metabolically active tumor cells in the bone marrow in all of our patients which we proved by bone marrow biopsies. We think that this cohort of patients with solid tumors is hypothesis-generating with regard to detecting early bone marrow metastases by FDG PET/CT.
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Affiliation(s)
- Fatih Selcukbiricik
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Ozcan Yildiz
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Sabire Yilmaz
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Nuclear Medicine, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Deniz Tural
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Hande Turna
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Nil Molinas Mandel
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Nukhet Tuzuner
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Pathology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Suheyla Serdengecti
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Medical Oncology, Istanbul University, Kocamustafapasa, Istanbul, Turkey
| | - Metin Halac
- Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa, Istanbul, Turkey.,Department of Nuclear Medicine, Istanbul University, Kocamustafapasa, Istanbul, Turkey
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MRI of spinal bone marrow: part I, techniques and normal age-related appearances. AJR Am J Roentgenol 2012; 197:1298-308. [PMID: 22109283 DOI: 10.2214/ajr.11.7005] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This article reviews MRI protocols, including routine and nonroutine pulse sequences as well as the normal MRI appearance of spinal marrow and expected age-related changes. CONCLUSION Routine MRI of the spine provides useful evaluation of the spinal bone marrow, but nonroutine MRI pulse sequences are increasingly being used to evaluate bone marrow pathology. An understanding of MRI pulse sequences and the normal and age-related appearances of bone marrow is important for the practicing radiologist.
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12
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Shah LM, Salzman KL. Imaging of spinal metastatic disease. Int J Surg Oncol 2011; 2011:769753. [PMID: 22312523 PMCID: PMC3263660 DOI: 10.1155/2011/769753] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 08/20/2011] [Indexed: 11/18/2022] Open
Abstract
Metastases to the spine can involve the bone, epidural space, leptomeninges, and spinal cord. The spine is the third most common site for metastatic disease, following the lung and the liver. Approximately 60-70% of patients with systemic cancer will have spinal metastasis. Materials/Methods. This is a review of the imaging techniques and typical imaging appearances of spinal metastatic disease. Conclusions. Awareness of the different manifestations of spinal metastatic disease is essential as the spine is the most common site of osseous metastatic disease. Imaging modalities have complimentary roles in the evaluation of spinal metastatic disease. CT best delineates osseous integrity, while MRI is better at assessing soft tissue involvement. Physiologic properties, particularly in treated disease, can be evaluated with other imaging modalities such as FDG PET and advanced MRI sequences. Imaging plays a fundamental role in not only diagnosis but also treatment planning of spinal metastatic disease.
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Affiliation(s)
- Lubdha M. Shah
- Neuroradiology Division, Department of Radiology, School of Medicine, The University of Utah, 1A71 SOM, 50 N. Medical Drive, Salt Lake City, UT 84132, USA
| | - Karen L. Salzman
- Neuroradiology Division, Department of Radiology, School of Medicine, The University of Utah, 1A71 SOM, 50 N. Medical Drive, Salt Lake City, UT 84132, USA
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Tombal B, Lecouvet F. Modern Detection of Prostate Cancer's Bone Metastasis: Is the Bone Scan Era Over? Adv Urol 2011; 2012:893193. [PMID: 22013439 PMCID: PMC3195676 DOI: 10.1155/2012/893193] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 08/11/2011] [Indexed: 12/03/2022] Open
Abstract
Prostate cancer cells have an exquisite tropism for bone, which clinically translates into the highest rate of bone metastases amongst male cancers. Although in the latest years there has been an active development of new "bone targeted" therapies, modern diagnostic techniques for bone metastases still relies mostly on (99m)Tc bone scanning (BS) and plain X-ray. BS dramatically lacks specificity and sensitivity. Recent publications using modern imaging technologies have clearly pinpointed that BS grossly underestimates the true prevalence of bone metastasis. In addition BS does not allow tumour measurement and is, therefore, not appropriate to monitor response to therapy. This might be extremely important in patients harbouring high-risk localized disease that are eventually candidate for local therapy. Here we reviewed what are the emerging imaging strategies that are likely to supplant BS and to what extent they can be used in the clinic already.
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Affiliation(s)
- Bertrand Tombal
- Division of Urology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
| | - Frederic Lecouvet
- Division of Radiology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
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Hausmann D, Jochum S, Utikal J, Hoffmann RC, Zechmann C, Neff KW, Goerdt S, Schoenberg SO, Dinter DJ. Comparison of the diagnostic accuracy of whole-body MRI and whole-body CT in stage III/IV malignant melanoma. J Dtsch Dermatol Ges 2011; 9:212-22. [PMID: 21352483 DOI: 10.1111/j.1610-0387.2011.07614.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Malignant melanoma (MM) is dramatically increasing in light-skinned populations worldwide. Staging and regular follow-up examinations are essential. The purpose of this study was to compare the diagnostic accuracy of whole-body MRI with the standard diagnostic algorithm (whole-body CT and brain MRI) in patients with stage III/IV MM. PATIENTS AND METHODS A group of 50 consecutively admitted patients with stage III/IV MM were included in the study. Whole-body CT and brain MRI scans were performed. Additionally, all patients underwent a whole-body MRI (1.5 Tesla Magnetom Avanto, Siemens Healthcare Sector, Erlangen). The findings were compared on a lesion-by-lesion basis as part of clinical routine follow-up. RESULTS 33 patients received a follow-up CT and were evaluated. Overall, 824 lesions were detected. The sensitivity of whole-body MRI was observer-dependent. MRI was slightly less sensitive than CT according to the findings of the two most experienced observers (73.4 % vs. 78.2 %, p = 0.0744). CT was significantly more sensitive in the detection of small (1-5 mm) pulmonary nodules (2.9 % vs. 66.9 %, p < 0.0001). Yet overall, MRI was significantly more specific than CT (83.4 % vs. 50.4 %, p < 0.0001). CONCLUSIONS Whole-body MRI in compliance with standard requirements for the observers (high level of experience) should be considered as an appropriate alternative to CT without ionizing radiation, particularly for young patients with advanced MM.
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Affiliation(s)
- Daniel Hausmann
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Germany.
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Mitsuya K, Nakasu Y, Horiguchi S, Harada H, Nishimura T, Yuen S, Asakura K, Endo M. Metastatic skull tumors: MRI features and a new conventional classification. J Neurooncol 2010; 104:239-45. [PMID: 21110218 PMCID: PMC3151370 DOI: 10.1007/s11060-010-0465-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 11/08/2010] [Indexed: 11/25/2022]
Abstract
Skull metastases are malignant bone tumors which are increasing in incidence. The objectives of this study were to characterize the MR imaging features, locations, and extent of metastatic skull tumors to determine the frequency of the symptomatic disease, and to assess patient outcomes. Between September 2002 and March 2008, 175 patients undergoing routine head MR imaging were found to have metastatic skull tumors. Contrast-enhanced study with fat suppression was used in some cases when required. Classification of metastases was simplified to three yes/no questions: first, with regard to location (either in the calvarium or in the cranial base); second, with regard to distribution within the plane of the cranial bone (either “circumscribed” meaning clearly demarcated and confined to one bone, or “diffuse” and likely to spread across a suture to another bone); and third, with regard to invasion (“intraosseous” in cranial bones only, or “invasive” spreading from the skull, either out into the scalp or inward to the dura and perhaps further in). Primary sites were breast cancer (55%), lung cancer (14%), prostate cancer (6%), malignant lymphoma (5%), and others (20%). The mean time from primary diagnosis to skull metastasis diagnosis was 71 months for cases of breast cancer, 26 months for prostate cancer, 9 months for lung cancer, and 4 months for malignant lymphoma. Calvarial circumscribed intraosseous metastases were found most frequently (27%). The patients were mainly asymptomatic. However, some patients suffered from local pain or cranial nerve palsies that harmed their quality of life. Treatment, mainly for symptomatic cases, was by local or whole-skull irradiation. Metastatic skull tumors are not rare, and most are calvarial circumscribed intraosseous tumors. MR images contribute to understanding their type, location, and multiplicity, and their relationship to the brain, cranial nerves, and dural sinuses. Radiation therapy improved the QOL of patients with neurological symptoms.
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Affiliation(s)
- Koichi Mitsuya
- Division of Neurosurgery, Shizuoka Cancer Center, Sunto, Japan.
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Gutzeit A, Doert A, Froehlich JM, Eckhardt BP, Meili A, Scherr P, Schmid DT, Graf N, von Weymarn CA, Willemse EMM, Binkert CA. Comparison of diffusion-weighted whole body MRI and skeletal scintigraphy for the detection of bone metastases in patients with prostate or breast carcinoma. Skeletal Radiol 2010; 39:333-43. [PMID: 20205350 DOI: 10.1007/s00256-009-0789-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To prospectively compare the diagnostic accuracy of diffusion-weighted whole body imaging with background whole body signal suppression (DWIBS) with skeletal scintigraphy for the diagnosis and differentiation of skeletal lesions in patients suffering from prostate or breast cancer. MATERIAL AND METHODS A diagnostic cohort of 36 patients was included in skeletal scintigraphy and 1.5 T DWIBS MRI. Based on morphology and signal intensity patterns, two readers each identified and classified independently, under blinded conditions, all lesions into three groups: (1) malignant, (2) unclear if malignant or benign and (3) benign. Finally, for the definition of the gold standard all available imaging techniques and follow-up over a minimum of 6 months were considered. RESULTS Overall, 45 circumscribed bone metastases and 107 benign lesions were found. DWIBS performed significantly better in detecting malignant skeletal lesions in patients with more than 10 lesions (sensitivity: 0.97/0.91) compared to skeletal scintigraphy (sensitivity: 0.48/0.42). No statistical difference could be found between DWIBS (0.58/0.33) and skeletal scintigraphy (0.67/0.58) in the sensitivity values for malignant skeletal lesions in patients with less than 5 lesions. For benign lesions, scintigraphy scored best with a sensitivity of 0.93/0.87 compared to 0.20/0.13 for DWIBS. Interobserver agreement with Cohen's kappa coefficient was calculated as 0.784 in the case of scintigraphy and 0.663 for DWIBS. CONCLUSION With respect to staging, in prostate and breast carcinoma, the DWIBS technique is not superior to skeletal scintigraphy, but ranks equally. However, in the cases with many bone lesions, markedly more metastases could be discovered using the DWIBS technique than skeletal scintigraphy.
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Affiliation(s)
- Andreas Gutzeit
- Department of Radiology, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland.
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Solomou E, Kazantzi A, Romanos O, Kardamakis D. Magnetic Resonance Imaging Of Metastatic Bone Disease. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/978-1-4020-9819-2_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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Evolving concept of imaging bone marrow metastasis in the twenty-first century: critical role of FDG-PET. Eur J Nucl Med Mol Imaging 2008; 35:465-71. [PMID: 17955239 DOI: 10.1007/s00259-007-0593-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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19
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Silberstein EB. Nuclear Hematology. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Moon WJ, Lee MH, Chung EC. Diffusion-weighted imaging with sensitivity encoding (SENSE) for detecting cranial bone marrow metastases: comparison with T1-weighted images. Korean J Radiol 2007; 8:185-91. [PMID: 17554184 PMCID: PMC2627421 DOI: 10.3348/kjr.2007.8.3.185] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study was designed to determine whether diffusion-weighted imaging (DWI) with sensitivity encoding (SENSE) could detect bone marrow involvement in patients with cranial bone marrow (CBM) metastases. DWI results obtained were compared with T1-weighted imaging (T1WI) findings. Materials and Methods DWI with sensitivity encoding (SENSE; b value = 1,000) was performed consecutively in 13 patients with CBM metastases diagnosed pathologically and radiologically. CBM lesions were dichotomized according to the involved site, i.e., skull base or calvarium. Two radiologists qualitatively evaluated the relative conspicuousness of CBM lesions and image qualities in B0 and in isotropic DWI and in T1WI. According to region of interest analysis of normal and pathologic marrow for these three sequences, absolute signal difference percentages (SD%) were calculated to quantitatively analyze lesion contrast. Results All 20 lesions in 13 patients with CBM metastases revealed abnormal DWI signals in areas corresponding to T1WI abnormalities. Both skull base and calvarial lesions provided better lesion conspicuousness than T1WI and B0 images. Although the image quality of DWI was less satisfactory than that of T1WI, relatively good image qualities were obtained. Quantitatively, B0 images (SD%, 82.1 ±7.9%) showed better lesion contrast than isotropic DWI (SD%, 71.4 ±13.7%) and T1WI (SD%, 65.7 ±9.3%) images. Conclusion For scan times of less than 30 seconds, DWI with SENSE was able to detect bone marrow involvement, and was superior to T1WI in terms of lesion conspicuity. DWI with SENSE may be helpful for the detection of cranial bone/bone marrow metastases when used in conjunction with conventional MR sequences.
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Affiliation(s)
- Won-Jin Moon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, Korea
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-701, Korea
| | - Min Hee Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, Korea
| | - Eun Chul Chung
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, Korea
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Martínez del Valle Torres MD, Gutiérrez Cardo AL, Ortega Lozano SJ, Jiménez-Hoyuela García JM. Técnicas de imagen en el diagnóstico de metástasis óseas. ACTA ACUST UNITED AC 2007; 26:237-58. [PMID: 17662193 DOI: 10.1157/13107978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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22
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Puglisi F, Andreetta C, Fasola G, Cattaruzzi E, Geatti O. Bone Scan for Baseline Staging in Invasive Breast Cancer at the Time of Primary Presentation. Breast Care (Basel) 2007. [DOI: 10.1159/000111546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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23
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Schoenberger J, Fuchs E, Fertig V, Szikszai A, Maenner P, Eilles C. Clinical value of planar and tomographic dual-isotope scintigraphy using 99mTc-methylene diphosphonate and 131I in patients with thyroid cancer. Nucl Med Commun 2006; 27:865-71. [PMID: 17021426 DOI: 10.1097/01.mnm.0000239481.30910.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE (131)I whole-body scintigraphy is a highly sensitive method for the detection of differentiated thyroid tumours and metastases. However, a lack of anatomical landmarks and the physiological excretion of the tracer complicates the evaluation of the images. Therefore, we determined whether additional bone scintigraphy in combination with (131)I scintigraphy, simultaneously acquired via planar and tomographic techniques, positively contributes to the treatment plan in patients with non-conclusive (131)I images. METHODS Twenty-one patients with differentiated thyroid cancer and known metastases or unclear findings in the (131)I whole-body scan underwent dual-isotope scintigraphy (DIS) within 2-7 days after application of 5000-8000 MBq (131)I. Dual-energy planar and tomographic data were acquired simultaneously and the results compared with other imaging modalities. RESULTS In 48% of the cases (10 of 21), DIS supplied important additional information that either altered the treatment plan or staging of the patients. In 28% (six of 21), DIS provided new information that was not known before, but did not change the staging of the patients. In five cases (24%), DIS did not add any new data regarding the extent of the disease. CONCLUSIONS The simultaneous acquisition of (131)I and (99m)Tc-methylene diphosphonate provides clear landmarks and facilitates the localization of functioning metastases from differentiated thyroid cancer as well as improves the fusion with morphological images. It can be performed easily and also transferred to other isotope combinations.
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Langsteger W, Heinisch M, Fogelman I. The role of fluorodeoxyglucose, 18F-dihydroxyphenylalanine, 18F-choline, and 18F-fluoride in bone imaging with emphasis on prostate and breast. Semin Nucl Med 2006; 36:73-92. [PMID: 16356797 DOI: 10.1053/j.semnuclmed.2005.09.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Diagnostic imaging has played a major role in the evaluation of patients with bone metastases. The imaging modalities have included bone scintigraphy, computed tomography, magnetic resonance imaging, and most recently PET/CT, which can be performed with different tracers, including fluorodeoxyglucose (FDG), 18F-fluoride, 18F-choline (FCH), and 18F-DOPA (dihydroxyphenylalanine). For most tumors the sensitivity of FDG in detecting bone metastases is similar to bone scintigraphy; additionally it can be used to monitor the response to chemotherapy and hormonal therapy. 18F-Fluoride may provide a more sensitive "conventional" bone scan and is superior for FDG nonavid tumors, but, nevertheless, FDG in "early disease" often has clear advantages over 18F-fluoride. Although more data need to be obtained, it appears that FCH is highly efficient in preoperative management regarding N and M staging of prostate cancer once metastatic disease is strongly suspected or documented. For neuroendocrine tumors and in particular in medullary thyroid cancer, DOPA is similar to 18F-fluoride in providing high quality information regarding the skeleton. Nevertheless, prospective studies with large patient groups will be essential to define the exact diagnostic role of FCH and DOPA PET in different clinical settings.
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Affiliation(s)
- Werner Langsteger
- PET-CT Center Linz, Department of Nuclear Medicine and Endocrinology, St. Vincent's Hospital, Linz, Austria, and Division of Imaging, King's College, London, UK.
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Gauvain KM, Garbow JR, Song SK, Hirbe AC, Weilbaecher K. MRI detection of early bone metastases in b16 mouse melanoma models. Clin Exp Metastasis 2006; 22:403-11. [PMID: 16283483 PMCID: PMC2726655 DOI: 10.1007/s10585-005-1264-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 07/21/2005] [Indexed: 10/25/2022]
Abstract
Bone metastasis causes significant morbidity in cancer patients, including bone pain, pathologic fractures, nerve compression syndrome, and hypercalcemia. Animal models are utilized to study the pathogenesis of skeletal metastases and to evaluate potential therapeutic agents. Previously published methods for imaging bone metastasis in rodent models have focused on identifying advanced stage metastasis using simple X-rays. Here we report MRI as a method for detecting early bone metastases in mouse models in vivo. B16 mouse melanoma cells were injected into the left cardiac ventricle of C57BL/6 mice and magnetic resonance (MR) images were obtained of the left leg following the development of metastatic disease, when tumor associated bone destruction was histologically present but not visible by X-ray. T1 and T2 relaxation times of bone marrow were measured in healthy control mice and B16 melanoma tumor-bearing mice. Mean T2 values for normal marrow were 28 ms (SD 5) and for diseased bone marrow were 41 ms (SD 3). T2 relaxation time of diseased bone marrow is significantly longer than that of normal bone marrow (P < 0.0001) and can be used as a marker of early bone metastases. These studies demonstrate that MR imaging can detect bone marrow metastases in small animals prior to development of cortical bone loss identified by X-ray.
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Affiliation(s)
- Karen M Gauvain
- Department of Pediatrics, Division of Hematology/Oncology, Washington University School of Medicine, One Children's Place, Box 8116, St. Louis, MO 63110, USA.
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Frat A, Ağildere M, Gençoğlu A, Cakir B, Akin O, Akcali Z, Aktaş A. Value of Whole-Body Turbo Short Tau Inversion Recovery Magnetic Resonance Imaging With Panoramic Table For Detecting Bone Metastases. J Comput Assist Tomogr 2006; 30:151-6. [PMID: 16365592 DOI: 10.1097/01.rct.0000189593.41198.20] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objectives of this study were to assess the efficacy and reliability of whole-body turbo short tau inversion recovery (STIR) magnetic resonance imaging (MRI) for detecting skeletal metastasis and to compare the results with those of bone scintigraphy. METHODS Twenty-six patients with primary cancer (mean age=56 years, age range: 34-75 years) were assessed for bone metastasis with whole-body MRI and bone scintigraphy. Eight bone regions in each patient were assessed (total of 208 sites) with each of these 2 techniques. A turbo STIR sequence and panoramic table were used during MRI. Whole-body MRI and scintigraphy findings were compared with biopsy or follow-up imaging results. RESULTS After at least 12 months of follow-up, 9 patients had bone metastases in a total of 31 sites. Whole-body MRI showed 29 metastases (94%) in the total 208 skeletal sites investigated in the 26 patients. Bone scintigraphy revealed metastases in 16 (52%) of the 208 sites. CONCLUSION Whole-body turbo STIR MRI is a reliable method for screening patients with suspected skeletal metastases. This technique is also advantageous in that it reveals extraskeletal organ and soft tissue metastases.
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Affiliation(s)
- Ali Frat
- Department of Radiology, Baskent University Faculty of Medicine, Bahçelievler-Ankara, Turkey.
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Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT. Bone imaging in metastatic breast cancer. J Clin Oncol 2004; 22:2942-53. [PMID: 15254062 DOI: 10.1200/jco.2004.08.181] [Citation(s) in RCA: 388] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Bone is the most common site to which breast cancer metastasizes. Imaging-by skeletal scintigraphy, plain radiography, computed tomography, or magnetic resonance imaging-is an essential part, and positron emission tomography or single-photon emission computed tomography have a potential of evaluating bone metastases, but no consensus exists as to the best modality for diagnosing the lesion and for assessing its response to treatment. Imaging bone metastases is problematic because the lesions can be osteolytic, osteoblastic, or mixed, and imaging modalities are based on either direct anatomic visualization of the bone or tumor or indirect measurements of bone or tumor metabolism. Although bone metastases can be treated, their response to treatment is considered "unmeasurable" according to existing response criteria. Therefore, the process by which oncologists and radiologists diagnose and monitor the response of bone metastases needs revision, and the current inability to assess the response of bone metastases excludes patients with breast cancer and bone disease from participating in clinical trials of new treatments for breast cancer. In this review of the MEDLINE literature, we discuss the pros and cons of each modality for diagnosing bone metastases and for assessing their response to treatment and we present a practical approach for diagnosis and assessment of bone metastasis.
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Affiliation(s)
- Tsuyoshi Hamaoka
- Breast Cancer Research Program, Department of Blood and Marrow Transplantation, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 448, Houston, TX 77030, USA
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Mentzel HJ, Kentouche K, Sauner D, Fleischmann C, Vogt S, Gottschild D, Zintl F, Kaiser WA. Comparison of whole-body STIR-MRI and 99mTc-methylene-diphosphonate scintigraphy in children with suspected multifocal bone lesions. Eur Radiol 2004; 14:2297-302. [PMID: 15243716 DOI: 10.1007/s00330-004-2390-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 04/21/2004] [Accepted: 05/24/2004] [Indexed: 10/26/2022]
Abstract
The study was performed to compare whole-body short time inversion recovery (STIR) MR imaging and (99m)Tc-methylene diphosphonate planar scintigraphy in the examination of children with suspected multifocal skeletal malignant lesions. Sixteen patients with known or suspected malignant skeletal disease underwent both whole-body STIR MR imaging and bone scintigraphy. The lesions were described and numbered according to scintigraphic evaluation criteria. Thus, 16 regions were analyzed in each patient for the comparison between the two modalities. Histology was proven in the primary malignant regions. Follow-up MRIs were registered. Scintigraphy and MRI follow-up were evaluated as gold standard. A total of 139 different lesions was observed by both modalities. Baseline whole-body MRI revealed 119 bone lesions in 256 possible sites (46.5%); scintigraphy revealed only 58 lesions (22.6%). Congruence was observed in only four patients (25%). According to the location of the lesion, correlation was observed in 39/139 lesions (28%). In all, 57.5% of the lesions were detected only by MRI and 14.5% of the lesions were detected only by scintigraphy. Whole-body MRI was more sensitive (P<0.001). Of all lesions numbered which could be separated in the initial MRI, whole-body MRI detected 178 lesions in the patients. The results suggest that whole-body MRI using a STIR sequence is an effective radiation free method for examination of children with suspected multifocal bone lesions. MRI showed more lesions than conventional (99m)Tc-methylene diphosphonate scintigraphy. Therefore, whole-body MRI may be feasible as a screening modality for metastatic and skip lesions in osteosarcoma, PNET, Ewing sarcoma and Langerhans cell histiocytosis in children.
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Affiliation(s)
- Hans-J Mentzel
- Institute of Diagnostic and Interventional Radiology, University of Jena, Jena, Germany.
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Hetzel M, Arslandemir C, König HH, Buck AK, Nüssle K, Glatting G, Gabelmann A, Hetzel J, Hombach V, Schirrmeister H. F-18 NaF PET for detection of bone metastases in lung cancer: accuracy, cost-effectiveness, and impact on patient management. J Bone Miner Res 2003; 18:2206-14. [PMID: 14672356 DOI: 10.1359/jbmr.2003.18.12.2206] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED As bone metastases might be present in lung cancer despite a normal bone scan, we examined various alternatives prospectively. Positron emission tomography using F-18 sodium fluoride (PET) and single photon emission tomography (SPECT) were more sensitive than a planar bone scan. PET was more accurate with a shorter examination time than SPECT but had higher incremental costs. INTRODUCTION Previous studies have shown that vertebral bone metastases not seen on planar bone scans may be present on F-18 fluoride positron emission tomography (PET) scan or single photon emission computed tomography (SPECT). The purpose of this study was to measure the accuracy, clinical value and cost-effectiveness of tomographic bone imaging. MATERIALS AND METHODS A total of 103 patients with initial diagnosis of lung cancer was prospectively examined with planar bone scintigraphy (BS), SPECT of the vertebral column and PET using F-18 sodium fluoride (F-18 PET). Receiver operating characteristic (ROC) curve analysis was used for determination of the diagnostic accuracy. A decision-analysis model and the national charge schedule of the German Hospital Association were used for determination of the cost-effectiveness. RESULTS Thirteen of 33 patients with bone metastases were false negative on BS, 4 on SPECT, and 2 on F-18 PET. The area under the ROC curve was 0.771 for BS, 0.875 for SPECT, and 0.989 for F-18 PET (p < 0.05). As a result of SPECT and F-18 PET imaging, clinical management was changed in 8 (7.8%) and 10 (9.7%) patients. Compared with BS, the costs per additional correctly diagnosed patient were 1272 Euro with SPECT and 2861 Euro with F-18 PET. The threshold for the costs of F-18 PET being more cost-effective than SPECT was 345 EUR. CONCLUSION Routine performance of tomographic bone imaging improves the therapeutic strategy because of detection of otherwise missed metastases. F-18 PET is more effective than SPECT but is associated with higher incremental costs.
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Affiliation(s)
- Martin Hetzel
- Department of Internal Medicine II, University of Ulm, Ulm, Germany.
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Cereceda LE, Flechon A, Droz JP. Management of Vertebral Metastases in Prostate Cancer: A Retrospective Analysis in 119 Patients. ACTA ACUST UNITED AC 2003; 2:34-40. [PMID: 15046682 DOI: 10.3816/cgc.2003.n.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The objectives of this study were to define clinical problems and treatment strategies in vertebral metastases of prostate cancer. The clinical files of 634 patients with prostate cancer seen in a comprehensive cancer center during a 4-year period were retrospectively reviewed. One hundred nineteen patients (18.8%) had 212 significant episodes of osseous spinal metastases. Pain was nearly universal (93%), and motor and bladder impairment occurred in 25% and 3.1% of patients, respectively. Bone scan and magnetic resonance imaging (MRI) were performed in 197 and 64 episodes, respectively. Fifteen episodes of spinal cord compression were treated surgically. Other treatments included hormonal therapy (163 episodes), chemotherapy (70 episodes), and radiation therapy (103 episodes). Osteolytic lesions were observed alone and in combination with osteoblastic pattern in 18% and 26% of episodes, respectively. Bone scan was the most effective screening procedure of vertebral involvement, and MRI effectively showed epidural involvement. Overall treatment led to improvements in pain and motor impairment in 77% and 50% of patients, respectively. However, clinical episodes were recurrent (1.78 episodes per patient; range, 1-8). Median survival after vertebral metastasis episode was 14 months compared with only 4 months after surgery for spinal cord compression. Vertebral metastases strongly alter quality of life in patients with prostate cancer. Pain and neurologic complications are the major problems. Careful early screening with bone scan and MRI may help to define better treatment strategy. However, further prospective studies of clinical management are needed to determine the optimal timing of radiation therapy, medical treatments, and surgery.
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Affiliation(s)
- Luis E Cereceda
- Oncology Service, Hospital de La Fuerza Aerea de Chile, Santiago, Chile
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Altehoefer C, Ghanem N, Högerle S, Moser E, Langer M. Comparative detectability of bone metastases and impact on therapy of magnetic resonance imaging and bone scintigraphy in patients with breast cancer. Eur J Radiol 2001; 40:16-23. [PMID: 11673003 DOI: 10.1016/s0720-048x(01)00313-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE to evaluate the comparative impact of magnetic resonance imaging and bone scintigraphy in bone metastases of breast cancer. METHODS AND PATIENTS in 81 patients with histologically proven breast cancer magnetic resonance imaging of the axial skeleton and whole-body bone scintigraphy had been performed. Images were retrospectively reviewed and compared for detection of metastases, extent of metastatic disease and therapeutic implications according to the patients' records. RESULTS about 54/81 (67%) patients revealed bone metastases. In 7/54 (13%) patients with bone metastases, scintigraphy was false negative. In one patient a solitary sternal metastases was seen. In 26/53 [49%] patients with spinal metastases, magnetic resonance imaging showed more extensive disease. Local radiotherapy or surgery was indicated in ten patients with metastases not evident in bone scintigraphy, in 20 patients with positive results by both imaging modalities and in six patients with metastases of pelvis imaged by bone scintigraphy only. CONCLUSION magnetic resonance imaging of the axial skeleton and pelvis appears superior for staging as only one patient had metastases merely outside the axial skeleton and local therapy was indicated even in spinal regions negative in bone scintigraphy.
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Affiliation(s)
- C Altehoefer
- Department of Diagnostic Radiology, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
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Daldrup-Link HE, Franzius C, Link TM, Laukamp D, Sciuk J, Jürgens H, Schober O, Rummeny EJ. Whole-body MR imaging for detection of bone metastases in children and young adults: comparison with skeletal scintigraphy and FDG PET. AJR Am J Roentgenol 2001; 177:229-36. [PMID: 11418435 DOI: 10.2214/ajr.177.1.1770229] [Citation(s) in RCA: 277] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the diagnostic accuracy of whole-body MR imaging, skeletal scintigraphy, and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for the detection of bone metastases in children. SUBJECTS AND METHODS Thirty-nine children and young adults who were 2--19 years old and who had Ewing's sarcoma, osteosarcoma, lymphoma, rhabdomyosarcoma, melanoma, and Langerhans' cell histiocytosis underwent whole-body spin-echo MR imaging, skeletal scintigraphy, and FDG PET for the initial staging of bone marrow metastases. The number and location of bone and bone marrow lesions diagnosed with each imaging modality were correlated with biopsy and clinical follow-up as the standard of reference. RESULTS Twenty-one patients exhibited 51 bone metastases. Sensitivities for the detection of bone metastases were 90% for FDG PET, 82% for whole-body MR imaging, and 71% for skeletal scintigraphy; these data were significantly different (p < 0.05). False-negative lesions were different for the three imaging modalities, mainly depending on lesion location. Most false-positive lesions were diagnosed using FDG PET. CONCLUSION Whole-body MR imaging has a higher sensitivity than skeletal scintigraphy for the detection of bone marrow metastases but a lower sensitivity than FDG PET.
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Affiliation(s)
- H E Daldrup-Link
- Department of Clinical Radiology, University Hospital of Münster, 48129 Münster, Germany
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Schirrmeister H, Buck A, Guhlmann A, Reske SN. Anatomical distribution and sclerotic activity of bone metastases from thyroid cancer assessed with F-18 sodium fluoride positron emission tomography. Thyroid 2001; 11:677-83. [PMID: 11484897 DOI: 10.1089/105072501750362754] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Currently, bone scintigraphy (BS) is considered to lack sensitivity in detecting bone metastases (BM) from thyroid cancer. We evaluated the anatomical distribution and metabolic behavior of BM as well as the accuracy of BS with and without combination of whole-body iodine scintigraphy (WBI) in detecting metastatic bone disease in thyroid carcinoma. F-18 positron emission tomography (PET), x-ray, BS, and WBI were performed in 35 patients with known or suspected bone metastases from papillary (9 patients) or follicular (26 patients) thyroid carcinoma. Twenty-two metastases were previously known in 14 patients. The indication was staging in 21 patients with high risk for BM, elevated thyroglobulin (Tg)-levels or evaluation of exact extent of BM (14 patients). In addition, results of WBI (35 patients), X-ray (35 patients) F-18 PET (35 patients), MRI of the spine (13 patients), and FDG-PET (15 patients) as well as the clinical course (1.5-4 years) were correlated. BM were detected in 18 patients. Solitary, bifocal, or multiple lesions were present in 9, 2, and 7 patients, respectively. The anatomical distribution of BM (n = 43) was as follows: spine, 42%; skull, 2%; thorax, 16%; femur, 9%; pelvis, 26%; humerus and clavicle, 5%. Sensitivity of BS in interpreting patients as positive or negative for having BM was 64%-85% (specificity, 95%-81%). The combination of BS and WBI was 100% sensitive in detecting metastatic bone disease. One patient had a single BM that was positive at BS but negative on WBI. All metastases were osteolytic on x-ray and two-thirds presented a missing or very limited osteosclerotic bone reaction on F-18 PET. Our data confirm the limited sensitivity of planar BS in detecting BM from thyroid cancer. The combination of BS and WBI, however, was highly accurate. Compared to other malignancies, the distribution pattern of BM presented a lower percentage of vertebral metastases and more patients with single metastases. Those findings in combination with a missing or only slight osteosclerotic bone reaction explain the limited sensitivity of planar BS alone.
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White PM, Boyd J, Beattie TF, Hurst M, Hendry GM. Magnetic resonance imaging as the primary imaging modality in children presenting with acute non-traumatic hip pain. Emerg Med J 2001; 18:25-9. [PMID: 11310457 PMCID: PMC1725511 DOI: 10.1136/emj.18.1.25] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The role of magnetic resonance imaging (MRI) in children presenting with acute non-traumatic hip pain was evaluated prospectively. Hip MRI was performed in addition to standard investigations (arthrosonography +/- hip radiographs) in 50 children presenting to the accident and emergency department of a paediatric hospital. MRI was performed on an open 0.23T system and comprised gradient echo T1 weighted coronal, fast spin echo T2 weighted coronal and inversion recovery spin echo (IRSE) axial sequences. Diagnostic quality MRI examinations were obtained in 94% of children. The IRSE sequence was the most reliable at determining underlying disorder (p<0.002). Interobserver agreement on the MRI examinations was very good with unweighted kappa value of 0.89, 95% confidence intervals 0.79, 0.99. Sensitivity of MRI was 0.79 (0.68, 0.90, specificity 1.00 (0.89, 1.00), accuracy 0.81 (0.70, 0.92), PPV 1.00 (0.89, 1), NPV 0.36 (0.25, 0.47). Sensitivity of standard imaging was 0.70 (0.54-0.86), specificity 0.57 (0.41, 0.73), accuracy 0.72 (0.56, 0.88), PPV 0.91 (0.75, 1.00), NPV 0.24 (0.08, 0.40). MRI correctly identified all seven children with serious underlying disorder whereas conventional imaging correctly diagnosed only two. Pelvic musculoskeletal infection was associated with the combination of marked alteration in signal in tissues adjacent to a symptomatic hip and an erythrocyte sedimentation rate of >20 mm 1st h (p<0.0001). In conclusion, MRI is a practical, well accepted and accurate non-invasive imaging technique in children presenting with acute non-traumatic hip pain. Combined with inflammatory markers MRI can be used to determine those children who require aggressive management. Where it is available, MRI is the imaging modality of choice in this condition.
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Affiliation(s)
- P M White
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh, UK
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Janni W, Gastroph S, Hepp F, Kentenich C, Rjosk D, Schindlbeck C, Dimpfl T, Sommer H, Braun S. Prognostic significance of an increased number of micrometastatic tumor cells in the bone marrow of patients with first recurrence of breast carcinoma. Cancer 2000; 88:2252-9. [PMID: 10820346 DOI: 10.1002/(sici)1097-0142(20000515)88:10<2252::aid-cncr8>3.0.co;2-q] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Using cytokeratin (CK) as a histogenetic marker of epithelial tumor cells in the bone marrow of patients with primary breast carcinoma, a subgroup of patients with decreased survival can be identified. This study was designed to evaluate the frequency and prognostic relevance of such cells in patients with recurrent breast carcinoma. METHODS Bone marrow aspirates from 65 patients were analyzed immunocytochemically for the presence of CK positive cells. A quantitative immunoassay with monoclonal anti-CK antibody A45-B/B3 was used and 2 x 10(6) bone marrow cells per patient were evaluated. For prognostic evaluation the authors calculated a cutoff value of micrometastatic tumor cells by analogy to classification and regression tree (CART) analysis. Patients were monitored prospectively for a median of 37 months (range, 11-63 months). RESULTS Bone marrow micrometastases were present in 5 of 32 patients (16%) with locoregional recurrence and in 24 of 33 patients (73%) with distant recurrence. The bone marrow status yielded no prognostic indication for patients with locoregional recurrence. In contrast, a cutoff value of 2.5 tumor cells per 1 million bone marrow cells analyzed (2.5 x 10(-6) tumor cells) correlated with a significantly different prognosis for women with distant disease. Patients with metastatic disease and a micrometastatic tumor load of > 2.5 x 10(-6) tumor cells survived for a mean of 6 months (95% confidence interval [95% CI], 2.0-9.1) compared with 17 months (95% CI, 11.6-22.0) for patients with < or = 2.5 x 10(-6) tumor cells (P < 0.0001). Multivariate analysis, allowing for hormone receptor status, disease free interval prior to recurrence, manifestation site of metastases, age, and micrometastases in bone marrow, revealed that bone marrow involvement was an independent risk factor, with a hazard ratio of 7.4 (95% CI, 1.6-13.3) for disease-related death. CONCLUSIONS An increased number of micrometastases identified in the bone marrow of patients with metastatic breast carcinoma represents an independent prognostic factor that may influence future therapeutic strategies for patients with metastatic breast carcinoma.
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Affiliation(s)
- W Janni
- I. Frauenklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universtiitaet, Munich, Germany
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Schirrmeister H, Guhlmann A, Kotzerke J, Santjohanser C, Kühn T, Kreienberg R, Messer P, Nüssle K, Elsner K, Glatting G, Träger H, Neumaier B, Diederichs C, Reske SN. Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography. J Clin Oncol 1999; 17:2381-9. [PMID: 10561300 DOI: 10.1200/jco.1999.17.8.2381] [Citation(s) in RCA: 167] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Previous studies have shown that bone metastases are revealed by magnetic resonance imaging (MRI) or bone marrow scintigraphy several months before they are visible by conventional bone scintigraphy (BS). We present a new approach for detecting bone metastases in patients with breast cancer. We compared findings obtained with fluoride ion (F-18) and positron emission tomography (PET) with those obtained with conventional BS. PATIENTS AND METHODS Thirty-four breast cancer patients were prospectively examined using F-18-PET and conventional BS. F-18-PET and BS were performed within 3 weeks of each other. Metastatic bone disease was previously known to be present in six patients and was suspected (bone pain or increasing levels of tumor markers, Ca(2+), alkaline phosphatase) in 28 patients. Both imaging modalities were compared by patient-by-patient analysis and lesion-by-lesion analysis, using a five-point scale for receiver operating characteristic (ROC) curve analysis. A panel of reference methods was used, including MRI (28 patients), planar x-ray (17 patients), and spiral computed tomography (four patients). RESULTS With F-18-PET, 64 bone metastases were detected in 17 patients. Only 29 metastases were detected in 11 patients with BS. As a result of F-18-PET imaging, clinical management was changed in four patients (11.7%). For F-18-PET, the area under the ROC curve was 0.99 on a lesion basis (for BS, it was 0.74; P <.05) and 1.00 on a patient basis (for BS, it was 0.82; P <.05). CONCLUSION F-18-PET demonstrates a very early bone reaction when small bone marrow metastases are present, allowing accurate detection of breast cancer bone metastases. This accurate detection has a significant effect on clinical management, compared with the effect on management brought about by detection with conventional BS.
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Affiliation(s)
- H Schirrmeister
- Departments of Nuclear Medicine, Gynecology, Radiation Oncology, and Diagnostic Radiology, University Hospital, Ulm, Germany
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Freedman GM, Negendank WG, Hudes GR, Shaer AH, Hanks GE. Preliminary results of a bone marrow magnetic resonance imaging protocol for patients with high-risk prostate cancer. Urology 1999; 54:118-23. [PMID: 10414737 DOI: 10.1016/s0090-4295(99)00090-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To compare the accuracy of a bone marrow magnetic resonance imaging (MRI) protocol in patients at high risk of metastatic disease with radioisotopic bone scans, the standard method for detection of bony metastases in patients with prostate cancer. METHODS The study group consisted of 19 men with prostate cancer who underwent a bone marrow MRI between November 1993 and February 1996. This protocol images the marrow of the thoracolumbar spine, sacrum, pelvis, and femurs. Indications for MRI included an equivocal bone scan and/or staging of locally advanced or recurrent disease. The findings on MRI and bone scan were compared and the results correlated with the subsequent clinical patient outcome. RESULTS The bone marrow MRI protocol detected metastatic disease in 1 (7%) of 13 patients with negative bone scans. Four patients had an indeterminate bone scan: 2 had true-positive MRIs, 1 a true-negative MRI, and 1 a false-positive MRI on the basis of subsequent clinical follow-up. Two patients with positive bone scans had true-positive MRIs. CONCLUSIONS Although not recommended for routine staging, MRI was useful in this study for clarifying an equivocal bone scan. The bone marrow MRI protocol images a high yield volume of the bony skeleton and is fast and economical compared with obtaining many focused MRI scans of these areas separately. These preliminary data suggest that further investigation of its clinical utility for staging locally advanced or recurrent disease is justified.
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Affiliation(s)
- G M Freedman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
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Earnest F, Ryu JH, Miller GM, Luetmer PH, Forstrom LA, Burnett OL, Rowland CM, Swensen SJ, Midthun DE. Suspected non-small cell lung cancer: incidence of occult brain and skeletal metastases and effectiveness of imaging for detection--pilot study. Radiology 1999; 211:137-45. [PMID: 10189463 DOI: 10.1148/radiology.211.1.r99ap34137] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To estimate the incidence of occult metastases to the brain and skeleton in patients suspected of having non-small cell lung cancer (NSCLC) (stage higher than T1Nomo) with surgically resectable disease, to assess the accuracy of screening magnetic resonance (MR) imaging and radionuclide bone scanning for help in identifying occult metastases, and to determine the effectiveness of a high dose of MR contrast material. MATERIALS AND METHODS Twenty-nine patients suspected of having NSCLC localized to the lung or to the lung and regional nodes underwent preoperative MR imaging with contrast material enhancement and radionuclide bone scanning for detection of brain or skeletal metastases. Patients were followed up for 12 months to determine the incidence of clinical metastatic disease. RESULTS Eight (28%) patients had occult metastatic disease to the brain or skeleton. Brain metastases were identified on MR images in five of six patients. Bone metastases were identified on MR images in four of five patients and on bone scans in three of five patients. MR imaging was no more accurate than bone scanning for skeletal evaluation. A high dose of MR contrast material allowed detection of more metastases and of small lesions. CONCLUSION Contrast-enhanced MR imaging of the brain is indicated for the exclusion of brain metastases in patients with clinically operable known or possible NSCLC and a large (> 3-cm) lung mass. Skeletal imaging may be indicated if an isolated brain metastasis is detected.
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Affiliation(s)
- F Earnest
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905, USA
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White PM, Adamson DJ, Howard GC, Wright AR. Imaging of the thorax in the management of germ cell testicular tumours. Clin Radiol 1999; 54:207-11. [PMID: 10210337 DOI: 10.1016/s0009-9260(99)91152-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM To evaluate role of chest computed tomography (CTC) and chest radiography (CXR) in management of patients with testicular germ cell tumours (GCT). PATIENTS AND METHODS An analysis was undertaken of staging and re-assessment CTC and CXR examinations performed on patients with GCT over a 4.5-year period. Data were obtained on clinical presentation, tumour histology, tumour marker levels and clinical course. Consensus review interpretation was combined with these data to obtain a 'standard of reference'. Sensitivity, specificity and predictive values were derived by comparison of original imaging reports to 'standard of reference'. RESULTS Six hundred and twenty-three CTC examinations on 207 patients with GCT were included. Intrathoracic metastases were identified in 1% of seminoma patients compared with 20% of non-seminoma (NSGCT) patients. CTC was more accurate than CXR in the detection of intrathoracic metastases at 0.97, 0.96-0.98 (95% CI) compared with 0.91, 0.89-0.93. The agreement between imaging techniques and the standard of reference (determined by Kappa statistic) was respectively 0.96 for CTC and 0.65 for CXR. In GCT patients undergoing re-assessment with both CXR and CTC, CXR never detected unknown intrathoracic metastatic disease. Abdominopelvic lymphadenopathy was associated with intrathoracic metastases (P < 0.001), however re-assessment CTC did identify intrathoracic metastases in 27 cases without concurrent abdominopelvic disease. CXR was negative in 19 of these. CONCLUSION Routine interval CXRs are unnecessary in NSGCT patients undergoing regular re-assessment CTC due to the low additional yield and limited effect on management. Re-assessment should still include CTC. In low risk, pure seminoma patients (abdominal CT and marker negative) re-assessment CTC can be safely avoided. Baseline CTC is advocated with CXR alone for re-assessment.
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Affiliation(s)
- P M White
- Department of Radiology, Western General Hospital, Edinburgh, UK
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Steinborn MM, Heuck AF, Tiling R, Bruegel M, Gauger L, Reiser MF. Whole-body bone marrow MRI in patients with metastatic disease to the skeletal system. J Comput Assist Tomogr 1999; 23:123-9. [PMID: 10050822 DOI: 10.1097/00004728-199901000-00026] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the diagnostic potential of a whole-body bone marrow MR protocol in the detection of bone metastases. METHOD Whole-body bone marrow MRI was performed in 18 patients with known malignant tumors and suspected bone metastases. The imaging protocol consisted of fast T1-weighted and STIR sequences applied in different anatomical positions covering the whole skeleton. MRI findings indicating bone metastases were compared with findings from bone scintigraphy. Metastatic lesions were confirmed by follow-up MR examinations, bone scintigraphy, radiography, or CT. RESULTS A total number of 216 lesions were detected with MRI in comparison with 159 lesions detected with bone scintigraphy. Follow-up examinations confirmed 105 lesions. MRI detected 96 (91.4%) of the confirmed lesions, whereas bone scintigraphy detected 89 (84.8%). The entire examination, including patient positioning and changing of imaging coils, required 45 min of room time. CONCLUSION Whole-body bone marrow MRI as used in this study is an effective method for evaluating the entire skeletal system in patients with suspected metastatic disease.
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Affiliation(s)
- M M Steinborn
- Department of Radiology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany
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Wakasugi S, Teshima H, Nakamura H, Hashizume T, Maeda T, Hiraoka A, Hasegawa Y, Masaoka T. Tc-99m MIBI localization in bone marrow: a marker of bone marrow malignancy. Clin Nucl Med 1998; 23:664-71. [PMID: 9790040 DOI: 10.1097/00003072-199810000-00004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To determine the potential of Tc-99m MIBI for detecting bone marrow malignancy, MIBI imaging of the femur was evaluated. There was no detectable MIBI activity in 125 of 141 (89%) control patients. Clearly demonstrated focal or tubular MIBI activity indicating intramedullary accumulation was demonstrated in 44 of 45 (98%) patients with proven marrow malignancy: 9 patients with multiple myeloma, 10 patients with malignant lymphoma, 11 patients with acute leukemia, 1 patient with chronic leukemia, and 14 patients with skeletal metastases. No abnormal MIBI activity was observed in the femur in 19 of 22 (86%) patients who had no evidence of malignant involvement in the femoral marrow, in 3 patients with solitary plasmacytomas of the spine, sternum or iliac bone, or in 16 patients with malignant lymphoma. In 12 of 24 patients with acute leukemia in complete remission, no abnormal MIBI accumulation was shown in the femur, but in 12 patients, abnormal accumulation indicating residual leukemic activity was demonstrated. MIBI imaging correlated extremely well with MRI studies; 26 of 28 patients with focal or tubular increased MIBI activity in the femur showed decreased signal on T1-weighted images and a high signal on short inversion recovery images, and 11 patients with no abnormal activity showed a high signal on T1 images. MIBI imaging of the femoral bone marrow may be a new modality for detecting marrow malignancy.
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Affiliation(s)
- S Wakasugi
- Department of Nuclear Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan
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Rinne D, Baum RP, Hör G, Kaufmann R. Primary staging and follow-up of high risk melanoma patients with whole-body 18F-fluorodeoxyglucose positron emission tomography: results of a prospective study of 100 patients. Cancer 1998; 82:1664-71. [PMID: 9576286 DOI: 10.1002/(sici)1097-0142(19980501)82:9<1664::aid-cncr11>3.0.co;2-2] [Citation(s) in RCA: 152] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Positron emission tomography (PET) has been retrospectively reported to be a sensitive method for detecting malignant melanoma metastases. METHODS One hundred consecutive patients with high risk melanoma (tumor thickness > 1.5 mm) were prospectively evaluated (52 at primary diagnosis, comprising Group A, and 48 during follow-up, comprising Group B) by whole-body PET and conventional diagnostics (CD). RESULTS In Group A, the sensitivity of PET was 100% and the specificity was 94%, whereas CD did not identify any of the 9 lymph node metastases and demonstrated a lower specificity (80%). In Group B, 121 lesions were detected, 111 by PET and 69 by conventional imaging. On the basis of patients, the sensitivity, specificity, and accuracy of PET were 100%, 95.5%, and 97.9%, respectively (91.8%, 94.4%, and 92.1%, respectively, on the basis of single metastases). Prospectively, CD did not identify all patients with progression (sensitivity, 84.6%) and detected significantly fewer metastases (sensitivity, 57.5%) with much lower specificity (68.2% on the basis of patients, 45% on the basis of single lesions); therefore, the accuracy of CD was 77.1% on the basis of patients and only 55.7% on the basis of single metastases. Results also depended on specific sites: while PET yielded a higher sensitivity in detecting cervical metastases (100% vs. 66.6%) and abdominal metastases (100% vs. 26.6%), computed tomography proved to be superior in detecting small lung metastases (87% vs. 69.6%). CONCLUSIONS PET is a highly sensitive and specific technique for melanoma staging. With the exception of the brain, one single whole-body 18F-fluorodeoxyglucose-PET scan could replace the standard battery of imaging tests currently performed on high risk melanoma patients.
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Affiliation(s)
- D Rinne
- Department of Dermatology, University of Frankfurt Medical Center, Germany
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Abstract
Nuclear medicine provides information about bone physiology that complements anatomic imaging modalities. Following a review of the principles of bone scintigraphy, scintigraphic imaging of orthopedic problems, such as primary and secondary neoplastic disease of the skeleton, occult fracture, stress fracture, and osteomyelitis are discussed.
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Affiliation(s)
- K J Donohoe
- Department of Radiology, Division of Nuclear Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA
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Krasnow AZ, Hellman RS, Timins ME, Collier BD, Anderson T, Isitman AT. Diagnostic bone scanning in oncology. Semin Nucl Med 1997; 27:107-41. [PMID: 9144855 DOI: 10.1016/s0001-2998(97)80043-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Over the last several decades bone scanning has been used extensively in the evaluation of oncology patients to detect bone involvement. It can provide information about disease location, prognosis, and the effect of therapy. Bone scanning offers the advantages of whole body evaluation and the detection of lesions earlier than other techniques. However, as newer diagnostic tools become available, indications for bone scanning must be revised and the results combined with these other tests in order to provide optimum patient care. Advances in instrumentation and the subsequent improvement in image quality have allowed nuclear medicine physicians to provide more accurate bone scan interpretations. By optimizing image acquisition, it is often possible to determine lesion characteristics, which are more likely to represent malignancy. Knowledge of disease pathophysiology and other specific properties of the patient's primary tumor, along with subsequent correlation of scan abnormalities to patient history, physical examination, previous studies, and other radiological examinations, is essential for determining lesion significance. The differential diagnosis of a scan abnormality should also include consideration of both false normal and abnormal causes. The final interpretation should be clearly communicated to the clinician with appropriate recommendations for further evaluation. Only through careful attention to the patient, the clinician, and appropriate study acquisition parameters will bone scanning maintain its place in the evaluation of oncology patients.
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Affiliation(s)
- A Z Krasnow
- Department of Radiology, Medical College of Wisconsin, Milwaukee 53226, USA
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Austin-Seymour M, Chen GT, Rosenman J, Michalski J, Lindsley K, Goitein M. Tumor and target delineation: current research and future challenges. Int J Radiat Oncol Biol Phys 1995; 33:1041-52. [PMID: 7493830 DOI: 10.1016/0360-3016(95)00215-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the past decade, significant progress has been made in the imaging of tumors, three dimensional (3D) treatment planning, and radiation treatment delivery. At this time one of the greatest challenges for conformal radiation therapy is the accurate delineation of tumor and target volumes. The physician encounters many uncertainties in the process of defining both tumor and target. The sources of these uncertainties are discussed, as well as the issues requiring study to reduce these uncertainties.
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