Bone Metastases: Assessment of Therapeutic Response through Radiological and Nuclear Medicine Imaging Modalities (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...
Frontiers in Medicine, 2024
Accurate detection and reliable assessment of therapeutic responses in bone metastases are imperative for guiding treatment decisions, preserving quality of life, and ultimately enhancing overall survival. Nuclear imaging has historically played a pivotal role in this realm, offering a diverse range of radiotracers and imaging modalities. While the conventional bone scan using 99m Tc marked bisphosphonates has remained widely utilized, its diagnostic performance is hindered by certain limitations. Positron emission tomography, particularly when coupled with computed tomography, provides improved spatial resolution and diagnostic performance with various pathology-specific radiotracers. This review aims to evaluate the performance of different nuclear imaging modalities in clinical practice for detecting and monitoring the therapeutic responses in bone metastases of diverse origins, addressing their limitations and implications for image interpretation.
MRI for response assessment in metastatic bone disease
2013
Background Beyond lesion detection and characterisation, and disease staging, the quantification of the tumour load and assessment of response to treatment are daily expectations in oncology. Methods Bone lesions have been considered "non-measurable" for years as opposed to lesions involving soft tissues and "solid" organs like the lungs or liver, for which response evaluation criteria are used in every day practice. This is due to the lack of sensitivity, specificity and measurement capabilities of imaging techniques available for bone assessment, i.e. skeletal scintigraphy (SS), radiographs and computed tomography (CT). Results This paper reviews the possibilities and limitations of these techniques and highlights the possibilities of positron emission tomography (PET), but mainly concentrates on magnetic resonance imaging (MRI). Conclusion Practical morphological and quantitative approaches are proposed to evaluate the treatment response of bone marrow lesions using "anatomical" MRI. Recent developments of MRI, i.e. dynamic contrast-enhanced (DCE) imaging and diffusion-weighted imaging (DWI), are also covered.
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.
Nuclear medicine communications, 2017
Although the overall incidence of bone metastasis is not known, over one-half of the people who die of cancer in the USA every year are thought to have bone involvement. In this study we have developed a method to quantify the metabolic and anatomic changes induced by different types of bone metastases in cancer patients using PET/CT images. Seventy-three cancer patients with no previous history of chemotherapy or radiotherapy who had definite bone metastases documented by PET/CT and other conventional modalities were selected for this study. PET and computed tomography (CT) images were resampled to the same pixel size. Thereafter, the bone structure was segmented using thresholding. The 50% of the maximum standardized uptake value within the bone mask was used to identify bone lesions in each slice. Using the final regions of interest defined at 70% of the maximum, the lesion characteristics including the mean Hounsfield Units were computed from the PET/CT images. The lesions were ...
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
The Established Nuclear Medicine Modalities for Imaging of Bone Metastases
Current Medical Imaging Formerly Current Medical Imaging Reviews, 2019
Background: The skeleton is one of the frequent site of metastases in advanced cancer. Prostate, breast and renal cancers mostly metastasize to bone. Discussion: Malignant tumors lead to significant morbidity and mortality. Identification of bone lesions is a crucial step in diagnosis of disease at early stage, monitoring of disease progression and evaluation of therapy. Diagnosis of cancer metastases is based on uptake of bone-targeted radioactive tracer at different bone remodeling sites. Conclusion: This manuscript summarizes already established and evolving nuclear medicine modalities (e.g. bone scan, SPECT, SPECT/CT, PET, PET/CT) for imaging of bone metastases.
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
Acta radiologica (Stockholm, Sweden : 1987), 2014
Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is commonly performed for cancer staging, as it can detect metastatic disease in multiple organ systems. However, there has been some controversy in the scientific literature when comparing FDG PET/CT and technetium-99 m-bone scintigraphy (bone scan) for the detection of skeletal metastases. To compare the accuracy of FDG PET/CT with bone scan for the detection of skeletal metastases. The study group comprised 202 adult cancer patients who underwent both FDG PET/CT and bone scan within 31 days for staging. Bone scans and FDG PET/CT were evaluated by two musculoskeletal radiologists for the presence and location of skeletal metastatic disease. Confirmation of the final diagnosis was based on the CT or magnetic resonance imaging (MRI) appearance, follow-up imaging, or histology. The sensitivity, specificity, and accuracy for detecting skeletal metastatic disease of FDG PET/CT were 97%, 98%, an...