Analysis of metastatic involvement in bone using anatomical and functional information from 18F-FDG PET/CT (original) (raw)
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Radiology and oncology, 2015
The aim of the study was to retrospectively evaluate radiographic and metabolic changes in bone metastases in response to systemic therapy with (18)FDG-PET/CT and determine their roles on the evaluation of therapy response. We retrospectively evaluated radiographic and metabolic characteristics of bone metastases in 30 patients who were referred for the evaluation of response to systemic therapy with (18)FDG-PET/CT. All patients underwent integrated (18)FDG-PET/CT before and after treatment. The baseline radiographic patterns of the target lesions in responders group were lytic, sclerotic, mixed and CT negative; after treatment the radiographic patterns of all target lesions changed to a sclerotic pattern and attenuation increased (p = 0.012) and metabolic activity decreased (p = 0.012). A correlation was found between decreasing metabolic activity and increasing attenuation of the target lesions (r = -0.55) (p = 0.026). However, in nonresponders group, the baseline radiologic patte...
2009
prostate cancers in males, are most likely to spread to bones (1, 2). Bone metastases are often multiple at the time of diagnosis. The bones of the spine, pelvis, and ribs are the most commonly affected. The bones of the upper arm and upper leg also may be affected. More than 90% of metastases are found in this distribution (2, 12, 14). Although bone appears to be the most static of all the tissues in the body, it is actually very dynamic and active. Normal bone is constantly being remodeled, or broken down and rebuilt. Only 1% of the calcium in the body is available in circulation for these functions. The other 99% is locked in the bones. If blood calcium levels drop, calcium must be released from the bones through remodeling in order to maintain important physiological functions that require calcium. In the case of hypercalcemia, bone metastases cause an imbalance between bone formation and bone resorption resulting in the releasing excess calcium into the blood. As noted, tumor-induced hypercalcemia is essentially due to an increase in osteoclast-induced breakdown of the bone into the blood. During this process of bone destruction, substances such as growth factors are released that promote tumor cell growth (4, 5, and 6). Hypercalcemia of malignancy occurs in approximately 10% of patients with advanced cancers. The occurrence of hypercalcemia may rise as high as 40% in some types of cancer, including breast, lung and multiple myeloma (4, 5, 6, 7, 16, 18). Elevation of EsR, total phosphatase alkaline and tumor specific antigens such as CEA, CA 15.3 and PsA in patients with bone metastases were found to be more than in patients without bone metastases (6,11,14,15). Recently studies report about the increased efficiency of CT, MRI and PET-CT in detection of bone metastases (19, 20, 21, 22). In patients with a diagnosed primary cancer the bone pain usually is considered to be highly suggestive of bone metastases. Occasionally, patients with bone metastases may present with a pathological fractures. In addition, patients may present with complications of bone metastases such as neurological impairment due to spinal epidural compression (1, 13, 14, 17).
Clinical Oncology, 2011
Radiological and nuclear medicine imaging modalities used for assessing bone metastases treatment response include plain and digitalised radiography (XR), skeletal scintigraphy (SS), dual-energy X-ray absorptiometry (DEXA), computed tomography (CT), magnetic resonance imaging (MRI), [ 18 F] fluorodeoxyglucose positron emission tomography (FDG-PET) and PET/CT. Here we discuss the advantages and disadvantages of these assessment modalities as evident through different clinical trials. Additionally, we present the more established response criteria of the International Union Against Cancer and the World Health Organization and compare them with newer MD Anderson criteria. Even though serial XR and SS have been used to assess the therapeutic response for decades, several months are required before changes are evident. Newer techniques, such as MRI or PET, may allow an earlier evaluation of response that may be quantified through monitoring changes in signal intensity and standard uptake value, respectively. Moreover, the application of PET/CT, which can follow both morphological and metabolic changes, has yielded interesting and promising results that give a new insight into the natural history of metastatic bone disease. However, only a few studies have investigated the application of these newer techniques and further clinical trials are needed to corroborate their promising results and establish the most suitable imaging parameters and evaluation time points. Last, but not least, there is an absolute need to adopt uniform response criteria for bone metastases through an international consensus in order to better assess treatment response in terms of accuracy and objectivity.
Annals of Nuclear Medicine, 2006
18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has become widely available and an important oncological technique. To evaluate the influence of PET on detection of bone metastasis, we compared the diagnostic accuracy of PET and conventional bone scintigraphy (BS) in a variety of cancer patients. Methods: Consecutive ninety-five patients with various cancers, who received both PET and BS within one month, were retrospectively analyzed. A whole-body PET (from face to upper thigh) and a standard whole body BS were performed and these images were interpreted by two experienced nuclear medicine physicians with and without patient information using monitor diagnosis. Each image interpretation was performed according to 8 separate areas (skull, vertebra, upper limbs, sternum and clavicles, scapula, ribs, pelvis, and lower limbs) using a 5-point-scale (0: definitely negative, 1: probably negative, 2: equivocal, 3: probably positive, 4: definitely positive for bone metastasis). Results: Twenty-one of 95 patients (22.1%) with 43 of 760 areas (5.7%) of bone metastases were finally confirmed. In untreated patients, 12 of 14 bone metastasis positive patients were detected by PET, while 9 of 14 were detected by BS. Three cases showed true positive in PET and false negative in BS due to osteolytic type bone metastases. In untreated cases, PET with and without clinical information showed better sensitivity than BS in patient-based diagnosis. For the purpose of treatment effect evaluation, PET showed better results because of its ability in the evaluation of rapid response of tumor cells to chemotherapy. Out of 10 cases of multiple-area metastases, 9 cases included vertebrae. There was only one solitary lesion located outside of FOV of PET scan in the femur, but with clinical information that was no problem for PET diagnosis. Conclusion: Diagnostic accuracy of bone metastasis was comparable in PET and BS in the present study. In a usual clinical condition, limited FOV (from face to upper thigh) of PET scan may not be a major drawback in the detection of bone metastases because of the relatively low risk of solitary bone metastasis in skull bone and lower limbs.
Radiology, 2008
1 From the Department of Nuclear Medicine (UT, CG, HWDY, HAM) and Division of Breast Medical Oncology (SD, MC), University of Texas MD Anderson Cancer Center, Unit 1263, 1515 Holcombe Blvd, Houston, TX 77030. Received March 27, 2007; revision requested May 25; revision ...
Nuclear Medicine Communications, 2010
Tamer Ö zü lker, Aysun Kü ç ü kö z Uzun, Filiz Ö zü lker and Tevfik Ö zpaç acı Purpose We tried to assess the efficacy of fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography (PET/CT) (18 F-FDG-PET/CT) scan in detecting bone metastases in cancer patients and to compare the results with bone scan (BS) findings. Materials and methods Seventy patients with a variety of neoplastic diseases, who had undergone both 18 F-FDG-PET/CT and BS and were eventually diagnosed as having metastatic bone disease, were enrolled in this study. The confirmation of the final diagnosis of bone metastasis was made by histopathological findings or clinical follow-up for 11 months, on average, including magnetic resonance imaging, 18 F-FDG-PET/CT or BS findings, showing progression of the lesions or their disappearance after therapy. Results 18 F-FDG-PET/CT imaging detected bone involvement in 68 out of 70 patients with a sensitivity of 97.1%. In contrast, BS showed the presence of metastases in 60 patients (85.7%). PET/CT detected 666 out of 721 metastatic lesions correctly (92.3%), whereas BS detected 506 lesions totally (70.1%). PET/CT revealed organ metastases in 24 patients and in seven patients with unknown primary; PET/CT also depicted primary tumor. Conclusion 18 F-FDG-PET/CT is more sensitive than BS in detecting bone metastasis in patients with neoplastic diseases. 18 F-FDG-PET/CT has the advantage of detecting unknown primary cancers and visceral metastases besides bone metastases. Nucl Med Commun
PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact
European Journal of Nuclear Medicine and Molecular Imaging, 2010
Purpose In a minority of cases a definite diagnosis and stage grouping in cancer patients is not possible based on the imaging information of PET/CT. We report our experience with percutaneous PET/CT-guided bone biopsies to histologically verify the aetiology of hypermetabolic bone lesions. Methods We retrospectively reviewed the data of 20 consecutive patients who underwent multimodal imageguided bone biopsies using a dedicated PET/CT system in a step-by-step technique. Technical and clinical success rates of PET/CT-guided biopsies were evaluated. Questionnaires were sent to the referring physicians to assess the impact of biopsies on patient management and to check the clinical need for PET/CT-guided biopsies. Results Clinical indications for biopsy were to histologically verify the aetiology of metabolically active bone lesions without a morphological correlate confirming the suspicion of metastases in 15 patients, to determine the origin of suspected metastases in 3 patients and to evaluate
Journal of Clinical Oncology, 2007
TO THE EDITOR: We read with great interest the article by Liu et al 1 in which the authors compared the efficacy of [ 18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) and skeletal scintigraphy in evaluating skeletal metastasis from nasopharyngeal carcinoma at initial diagnosis. We congratulate the authors for a well-designed and timely study in the context of modern practice of oncology. We concur with their findings and wish to share our views on this very important subject. With widespread application of FDG-PET imaging in the day to day practice of medicine, it is now clear that FDG-PET detects metastasis very early on during the course of disease when it is confined to the bone marrow. In contrast, skeletal scintigraphy reflects indirect evidence for disease as a result of reactive bone formation after long standing red marrow involvement. Cancer cells are lodged in the red marrow as the initial site for skeletal metastasis. This accounts for the usual pattern of distribution of metastatic lesions where regions with high concentration of red marrow are the most common locations for the spread of cancer cells. Therefore, most commonly, the axial skeleton is the most common structure for early metastatic disease. In contrast, the extremities, which mainly contain the yellow or fatty marrow, are spared. Interestingly, in children, skeletal involvement does not infrequently include both appendicular and axial bones. The conclusion reached by these authors that FDG-PET imaging is significantly more sensitive and accurate than bone scan further corroborates the findings with similar approach in several other malignancies like lung or breast carcinomas. 2-4 These results emphasize that bone marrow is the primary site for the initial metastasis and should be the main focus for assessing skeletal disease. Hence, we believe, it is imperative that in the twenty-first century we should start emphasizing the concept of bone marrow and not the bone as the primary location for cancer spread. Although there was one rib lesion that was proven to be metastatic and detected by bone scan and missed by FDG-PET, most (more than 95%) solitary lesions in the rib are benign. We must point out that fractures that are more than 2 to 3 months old will be negative on PET and positive on bone scintigraphy 5 which complicates treatment for most patients with cancer. Also tomographic images provided by PET allow detailed delineation of the abnormal areas while planar images with scintigraphy have very poor spatial resolution, and therefore, are insensitive for detecting early disease. In addition, response to therapy can be best assessed by disease activity in the marrow space which is the primary location for metastatic lesions. Evidence for response based on bone scintigraphy is slow because reactive new bone formation secondary to the bone marrow lesion lasts for an extended period of time after successful treatment. The description in this letter and related literature which emphasizes the superiority of FDG-PET over bone scintigraphy is primarily applicable to malignant disorders that are aggressive in nature, such as lung cancer, melanoma, and breast cancer. The osteolytic lesions (including multiple myeloma) which are commonly missed by bone scintigraphy because of the lack of osteoblastic reaction will be readily detected by FDG-PET. In contrast, osteoblastic metastasis from slow growing tumors, such as prostate 7 and thyroid cancer, should be assessed with agents such as radiolabeled amino acids and other novel tracers 8 for accurate assessment of the extent of the disease. Also, the role of bone scintigraphy with [ 18 F]fluoride and PET needs to be further assessed and compared with that of FDG-PET with further well-designed studies. 9