Usefulness of 18F-fluoride PET/CT in Breast Cancer Patients with Osteosclerotic Bone Metastases

Purpose

Bone metastasis is an important factor for the treatment and prognosis of breast cancer patients. Whole-body bone scintigraphy (WBBS) can evaluate skeletal metastases, and ¹⁸F-FDG PET/CT seems to exhibit high specificity and accuracy in detecting bone metastases. However, there is a limitation of ¹⁸F-FDG PET in assessing sclerotic bone metastases because some lesions may be undetectable. Recent studies showed that ¹⁸F-fluoride PET/CT is more sensitive than WBBS in detecting bone metastases. This study aims to evaluate the usefulness of ¹⁸F-fluoride PET/CT by comparing it with WBBS and ¹⁸F-FDG PET/CT in breast cancer patients with osteosclerotic skeletal metastases.

Materials and Methods

Nine breast cancer patients with suspected bone metastases (9 females; mean age ± SD, 55.6 ± 10.0 years) underwent ^99mTc-MDP WBBS, ¹⁸F-FDG PET/CT and ¹⁸F-fluoride PET/CT. Lesion-based analysis of five regions of the skeletons (skull, vertebral column, thoracic cage, pelvic bones and long bones of extremities) and patient-based analysis were performed.

Results

¹⁸F-fluoride PET/CT, ¹⁸F-FDG PET/CT and WBBS detected 49, 20 and 25 true metastases, respectively. Sensitivity, specificity, positive predictive value and negative predictive value of ¹⁸F-fluoride PET/CT were 94.2 %, 46.3 %, 57.7 % and 91.2 %, respectively. Most true metastatic lesions on ¹⁸F-fluoride PET/CT had osteosclerotic change (45/49, 91.8 %), and only four lesions showed osteolytic change. Most lesions on ¹⁸F-FDG PET/CT also demonstrated osteosclerotic change (17/20, 85.0 %) with three osteolytic lesions. All true metastatic lesions detected on WBBS and ¹⁸F-FDG PET/CT were identified on ¹⁸F-fluoride PET/CT.

Conclusion

¹⁸F-fluoride PET/CT is superior to WBBS or ¹⁸F-FDG PET/CT in detecting osteosclerotic metastatic lesions. ¹⁸F-fluoride PET/CT might be useful in evaluating osteosclerotic metastases in breast cancer patients.     

Bone and skeletal muscle metastases from gastric adenocarcinoma: unusual radiographic, CT and scintigraphic features

Skeletal metastatic lesions arising from gastric cancer are uncommon and usually of the osteolytic type. In order to gain a better understanding of its radiological spectrum, we report two atypical cases of skeletal metastases from gastric adenocarcinoma presenting with unusual radiographic, CT and scintigraphic features. In one patient multiple ossifying skeletal muscle metastases and bone metastases with spiculated periosteal reaction occurred as a presenting manifestation of the malignant disease. The other patient developed widespread osteosclerotic metastases with a superscan pattern on bone scintigraphy. Received 18 July 1997; Revision received 14 November 1997; Accepted 9 December 1997     

The appearance of breast cancer metastases on dry bone: Implications for forensic anthropology

Breast carcinoma is a major cause of morbidity and mortality in women. The study of bone pathologies presents considerable potential in anthropology, paleopathology, forensic science and medicine. In this paper, we present and discuss metastatic lesions found in the skeletons of known individuals from the CAL Milano Cemetery Skeletal Collection, clinically diagnosed with breast cancer during life. Fourteen skeletons from a contemporary and identified collection were macroscopically studied and metastases were identified by comparison with clinical literature. As a result, bone metastases were observed in 43% of the study sample. They were located most commonly on the ribs (28.1%), pelvic girdle (19.8%), vertebrae (15.6%), skull (15.6%), scapulae (10.2%) as well as proximal segment of the femora (8.4%) and humeri (2.4%) respectively, favoring sites of high vascularization. The majority of the lesions were osteolytic, although osteoblastic and mixed metastases did occur. Osteolytic metastases appear as coalescent porosity or round to oval perforating lesions on bones with denticulated margins and pitted surrounding bone, whereas osteoblastic metastases thickened the existing trabecula (spongiosclerosis). Mixed metastases were perforating lytic lesions exposing the osteoblastic activity in the underlying trabecular bone. These results, consistent with the data from the literature, strengthen the diagnostic criteria for metastases and illustrate the aspect of bone metastases in breast carcinoma.     

Frequency and etiology of unexplained bilateral hydronephrosis in patients with breast cancer: results of a longitudinal CT study

We retrospectively reviewed the records of 153 patients with breast cancer undergoing serial abdominal computed tomography (CT). During a median follow-up of 40 months, 2 (1.4%) of 153 patients developed bilateral hydronephrosis in the absence of radiologically visible obstructing pathology. Surgery confirmed malignant infiltration of the ureters by metastatic lobular carcinoma in both patients, suggesting that new unexplained bilateral hydronephrosis on serial CT in patients with breast cancer is likely to reflect infiltrative retroperitoneal involvement of the ureters by metastatic lobular carcinoma.     

Q Fever masquerading as prostate cancer metastases

We report a case of Q fever demonstrated on (99m)Tc methylene diphosphonate bone scan and fluorodeoxyglucose (FDG) PET/CT. A 66-year-old man with newly diagnosed, low-grade prostate cancer presented with abdominal and bone pain. Bone scan revealed multiple lesions suspicious for prostate cancer metastases. Because of liver abnormalities on noncontrast CT, an FDG PET/CT was performed and demonstrated FDG-avid sclerotic bone lesions, infiltrative liver disease, and retroperitoneal adenopathy. This appearance, thought unusual for low-grade prostate cancer, prompted extensive clinical evaluation for several months. Liver and iliac bone biopsies showed noncaseating granulomas without neoplasia. Extensive serologic evaluation eventually demonstrated elevated Q fever titers.     

FDG-avid sclerotic bone metastases in breast cancer patients: a PET/CT case series

Distant metastases from breast cancer most frequently occur in the skeleton. Although 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), with or without computed tomography (CT), is superior to bone scintigraphy for the detection of osteolytic bone metastases, it has been reported that sclerotic bone metastases frequently show no or only a low degree of FDG uptake on PET and PET/CT. Since both lytic and sclerotic metastases can occur in breast cancer patients, bone scintigraphy may remain of additional value in these patients. In this case series, we describe four breast cancer patients in whom FDG PET/CT has clearly visualized sclerotic bone metastases because of increased FDG uptake. Not so much the type of metastasis (sclerotic or lytic), but possibly the characteristics of the primary tumor or treatments prior to the FDG PET/CT scan might influence the degree of FDG uptake of bone metastases. The ability to detect sclerotic bone metastases based on increased FDG uptake supports the use of FDG PET/CT as a staging procedure in breast cancer patients, but knowledge of factors determining the visibility of bone metastases with FDG PET/CT is crucial.     

Sensitivity in detecting osseous lesions depends on anatomic localization: planar bone scintigraphy versus 18F PET.

Radionuclide bone scanning (RNB) is considered to be the most practical screening technique for assessing the entire skeleton for skeletal metastases. However, RNB has been shown to be of lower sensitivity than MRI and CT in detecting osteolytic metastases. A prospective study was designed to evaluate the accuracy of planar RNB versus tomographic bone imaging with 18F-labeled NaF and PET (18F PET) in detecting osteolytic and osteoblastic metastases and its dependency on their anatomic localization. METHODS: Forty-four patients with known prostate, lung or thyroid carcinoma were examined with both planar RNB and 18F PET. A panel of reference methods including MRI of the spine, 1311 scintigraphy, conventional radiography and spiral CT was used as the gold standard. RNB and 18F PET were compared by a lesion-by-lesion analysis using a five-point score for receiver operating characteristic (ROC) curve analysis. RESULTS: 18F PET showed 96 metastases (67 of prostate carcinoma and 29 of lung or thyroid cancer), whereas RNB revealed 46 metastases (33 of prostate carcinoma and 13 of lung or thyroid cancer). All lesions found with RNB were also detected with 18F PET. Compared with 18F PET and the reference methods, RNB had a sensitivity of 82.8% in detecting malignant and benign osseous lesions in the skull, thorax and extremities and a sensitivity of 40% in the spine and pelvis. The area under the ROC curve was 0.99 for 18F PET and 0.64 for RNB. CONCLUSION: 18F PET is more sensitive than RNB in detecting osseous lesions. With RNB, sensitivity in detecting osseous metastases is highly dependent on anatomic localization of these lesions, whereas detection rates of osteoblastic and osteolytic metastases are similar. Higher detection rates and more accurate differentiation between benign and malignant lesions with 18F PET suggest the use of 18F PET when possible.     

Comparison of FDG PET and SPECT for detection of bone metastases in breast cancer

OBJECTIVE: The purpose of our study was to evaluate the efficacy of FDG PET and bone SPECT for diagnosing bone metastases in breast cancer. SUBJECTS AND METHODS: The study was a prospective series of 15 patients with breast cancer who underwent both PET and bone scanning with SPECT. Comparison was performed on a lesion-by-lesion analysis. MDCT, MRI, and the patient's clinical course were used as references. RESULTS: In the lesion-by-lesion analysis (n = 900), the sensitivity for diagnosing bone metastases was 85% for SPECT and 17% for PET, specificity was 99% for SPECT and 100% for PET, and accuracy was 96% for SPECT and 85% for PET. In the statistical analysis, bone SPECT was significantly superior to FDG PET for its sensitivity (p < 0.0001) and accuracy (p < 0.0001). No statistically significant difference was seen with regard to specificity. When classifying the bone metastases as osteoblastic or osteolytic, bone scanning classified 92% of metastases as osteoblastic and 35% of metastases as osteolytic, whereas PET classified 6% of metastases as osteoblastic and 90% of metastases as osteolytic. CONCLUSION: Bone SPECT is superior to FDG PET in detecting bone metastases in breast cancer. The sensitivity of osteoblastic lesions is limited with FDG PET. Surveillance of metastatic spread to the skeleton in breast cancer patients based on FDG PET alone is not possible.     

Comparison of18FDG-PET with99mTc-HMDP scntigraphy for the detection of bone metastases in patients with breast cancer

OBJECTIVE: Bone is one of the most common sites of metastasis in breast cancer patients. Although bone scintigraphy is widely used to detect metastatic breast cancer, the usefulness of 18FDG-PET for detecting bone metastasis has not been clearly evaluated. The purpose of this study was to compare the diagnostic accuracy of 18FDG-PET with bone scintigraphy in detecting bone metastasis in breast cancer patients. METHODS: Forty-four women aged 35 to 81 years (mean, 56 years) with breast cancer were examined in this study. Both 18FDG-PET and bone scintigraphy were performed for each patient with 0-69 day intervals (mean, 11.5 days). The results of each image interpretation were compared retrospectively. Whole-body bones were classified into 9 anatomical regions. Metastases were confirmed at 45/187 regions in 14 patients by bone biopsy or clinical follow-up including other imaging techniques for a period of at least 6 months afterwards. RESULTS: On a region basis, the sensitivity, specificity, and accuracy of 18FDG-PET were 84%, 99% and 95%, respectively. Although these results were comparable to those of bone scintigraphy, the combination of 18FDG-PET and bone scintigraphy improved the sensitivity (98%) and accuracy (97%) of detection. False negative lesions of bone scintigraphy were mostly bone marrow metastases and those of 18FDG-PET were mostly osteoblastic metastases. 18FDG-PET was superior to bone scintigraphy in the detection of osteolytic lesions (92% vs. 73%), but inferior in the detection of osteoblastic lesions (74% vs. 95%). CONCLUSIONS: This study shows that 18FDG-PET tends to be superior to bone scintigraphy in the detection of osteolytic lesions, but inferior in the detection of osteoblastic lesions. 18FDG-PET should play a complementary role in detecting bone metastasis with bone scintigraphy.     

全数字化乳腺摄影、三维定位在乳腺癌诊断中的应用

目的:探讨全数字化乳腺X线摄影、数字化三维立体定位术在乳腺癌普查、早期诊断中的应用价值.方法:回顾性分析行全数字化乳腺X线摄影检查1890例,全部病例均经全数字化X线摄影常规摄取CC位(头尾位)、MLO位(内外斜位)片.对常规摄片提示有可疑乳腺癌征象,而临床触诊阴性者行数字化三维立体定位,病灶导丝标记切检.结果:检出并手术、病理证实乳腺癌59例.临床触诊阳性(可触及肿块)者51例,病理类型为浸润性导管癌33例,浸润性小叶癌8例,黏液腺癌6例,髓样癌4例.临床触诊阴性(未触及肿块)者8例,病理类型为导管原位癌3例,导管浸润癌3例,小叶原位癌2例,在定位导丝下行病灶切除,切除标本摄片均确认属目标病灶.结论:全数字化乳腺X线摄影能较清晰显示乳腺癌的直接和间接X线征象,结合数字化三维立体定位,病灶导丝标记切检术,对早期乳腺癌及亚临床期(临床触诊阴性)乳腺癌有重要的诊断价值.     

Expanding osteolytic bone metastases from carcinoma of the breast: An unusual appearance

Two cases of carcinoma of the breast are reported with the unusual radiographic finding of expansile osteolytic bone metastases. It is stressed that when an osteolytic expansile bone lesion is seen in patients with known breast cancer, the most likely cause is a metastasis from the carcinoma of the breast.     

Comparison of [<Superscript>68</Superscript>Ga]Ga-PSMA-11 PET/CT with [<Superscript>18</Superscript>F]NaF PET/CT in the evaluation of bone metastases in metastatic prostate cancer patients prior to radionuclide therapy

Aim

The purpose of this study was to investigate the diagnostic performance of ⁶⁸Ga-PSMA-11 PET/CT in the evaluation of bone metastases in metastatic prostate cancer (PC) patients scheduled for radionuclide therapy in comparison to [¹⁸F]sodium fluoride (¹⁸F-NaF) PET/CT.

Methods

Sixteen metastatic PC patients with known skeletal metastases, who underwent both ⁶⁸Ga-PSMA-11 PET/CT and ¹⁸F-NaF PET/CT for assessment of metastatic burden prior to radionuclide therapy, were analysed retrospectively. The performance of both tracers was calculated on a lesion-based comparison. Intensity of tracer accumulation of pathologic bone lesions on ¹⁸F-NaF PET and ⁶⁸Ga-PSMA-11 PET was measured with maximum standardized uptake values (SUV_max) and compared to background activity of normal bone. In addition, SUV_max values of PET-positive bone lesions were analysed with respect to morphologic characteristics on CT. Bone metastases were either confirmed by CT or follow-up PET scan.

Results

In contrast to 468 PET-positive lesions suggestive of bone metastases on ¹⁸F-NaF PET, only 351 of the lesions were also judged positive on ⁶⁸Ga-PSMA-11 PET (75.0%). Intensity of tracer accumulation of pathologic skeletal lesions was significantly higher on ¹⁸F-NaF PET compared to ⁶⁸Ga-PSMA-11 PET, showing a median SUV_max of 27.0 and 6.0, respectively (p?<?0.001). Background activity of normal bone was lower on ⁶⁸Ga-PSMA-11 PET, with a median SUV_max of 1.0 in comparison to 2.7 on ¹⁸F-NaF PET; however, tumour to background ratio was significantly higher on ¹⁸F-NaF PET (9.8 versus 5.9 on ⁶⁸Ga-PSMA-11 PET; p?=?0.042). Based on morphologic lesion characterisation on CT, ¹⁸F-NaF PET revealed median SUV_max values of 23.6 for osteosclerotic, 35.0 for osteolytic, and 19.0 for lesions not visible on CT, whereas on ⁶⁸Ga-PSMA-11 PET median SUV_max values of 5.0 in osteosclerotic, 29.5 in osteolytic, and 7.5 in lesions not seen on CT were measured. Intensity of tracer accumulation between¹⁸F-NaF PET and ⁶⁸Ga-PSMA-11 PET was significantly higher in osteosclerotic (p?<?0.001) and lesions not visible on CT (p?=?0.012).

Conclusion

In comparison to ⁶⁸Ga-PSMA-11 PET/CT, ¹⁸F-NaF PET/CT detects a higher number of pathologic bone lesions in advanced stage PC patients scheduled for radionuclide therapy. Our data suggest that ⁶⁸Ga-PSMA-11 PET should be combined with ¹⁸F-NaF PET in PC patients with skeletal metastases for restaging prior to initiation or modification of therapy.

     

^18F-FDG PET／CT诊断恶性肿瘤骨转移的应用价值

目的评价^18F-脱氧葡萄糖（FDG）PET／CT检测恶性肿瘤骨转移的应用价值。方法回顾性分析经^18F-FDG PET／CT诊断的689例恶性肿瘤患者的资料,按颈椎、胸椎、腰椎、骶尾椎、骨盆、肩胛骨和锁骨、长骨、胸骨、肋骨及颅骨将机体骨骼分为10个区域,记录每个区域的骨转移情况。根据同机CT进一步区分转移灶的病变性质（破骨性或成骨性）,比较同机CT、^18F-FDG PET及^18F-FDG PET／CT诊断骨转移的灵敏度、特异性及准确性。计算阳性病灶的最大标准摄取值（SUVmax）。患者不同性别间年龄差异采用χ^2检验,诊断率的比较采用MeNemar检验。结果共有91例患者442个区域被确定有骨转移,PET／CT诊断骨转移患者的灵敏度、特异性和准确性分别为94．5％（86／91）、97．8％（585／598）和97．4％（671／689）,高于同机CT的79．1％（72／91）,91．8％（549／598）和90．1％（621／689）（χ^2=20．049,148．890,168．792,P：0．000）;PET／CT诊断病灶骨转移的灵敏度、特异性和准确性分别为95．0％（420／442）,97．2％（455／468）和96．2％（875／919）,高于同机CT的81．0％（358／442）,90．4％（423／468）和85．8％（781／910）（χ^2=98．673,125．691,220．375,P=0．000）。同机CT共诊断出99个成骨性和197个破骨性病变。PET真阳性病灶SUVmax为6．7±3．0,假阳性病灶SUVmax为3．7±1．3（χ^2=463．120,P=0．000）;成骨性病变SUVmax为4．9±2．0,破骨性病变SUVmax为7．4±3．1（χ^2=327．175,P：0．000）。结论同机CT和^18F-FDG PET图像的结合提高了PET／CT诊断恶性肿瘤骨转移的能力;同机CT能精确定位病变,并可区分转移病灶的成骨或破骨性质。     

Intraosseous osteolytic lesions. Diagnostic, differential diagnosis and therapy (author's transl)

Any pathological damage occurring in a bone will produce either an osteolytic or osteosclerotic lesion which can be seen in the macroscopic specimen as well as in the roentgenogram. Various bone lesions may lead to local destructions of the bone. An osteoma or osteoplastic osteosarcoma produces an osteosclerotic lesion showing a dense mass in the roentgenogram; a chondroblastoma or an osteoclastoma, on the other had, induces an osteolytic focal lesion. This paper presents examples of different osteolytic lesions of the humerus. An osteolytic lesion seen in the roentgenogram may be either produced by an underlying non-ossifying fibroma of the bone, by fibrous dysplasia, osteomyelitis or Ewing's sarcoma. Differential diagnostic considerations based on the radiological picture include eosinophilic bone granuloma, juvenile or aneurysmal bone cyst, multiple myeloma or bone metastases. Serious differential diagnostic problems may be involved in case of osteolytic lesions occurring in the humerus. Cases of this type involving complications have been reported and include the presence of an teleangiectatic osteosarcoma as well as that of a hemangiosarcoma of the bone.     

全数字化乳腺摄影对乳腺癌的诊断价值

目的探讨全数字化乳腺摄影对乳腺癌,尤其未扪及肿块的乳癌的诊断价值。方法搜集2005年3月至9月门诊、住院及体检作全数字化乳腺摄影检查1290例,从中发现并经手术、病理证实乳腺癌50例,其中,临床扪及肿块42例,未扪及肿块8例。所有病例常规摄双侧乳腺CC位(头尾位)、MLO位(内外斜位),必要时局部点压摄片。对未扪及肿块者,行术前定位。使用医生工作站高分辨竖屏显示器观察图像。结果42例临床扪及肿块的乳癌中,主要X线表现有单纯肿块22例,肿块伴钙化18例,结构紊乱2例;病理类型为浸润性导管癌30例,髓样癌6例,黏液腺癌4例,浸润性小叶癌2例。8例未扪及肿块的乳癌中,分别表现为单纯钙化5例,小结节影伴钙化2例,局部结构紊乱1例;病理类型为导管原位癌3例,导管浸润癌3例,小叶原位癌2例。结论全数字化乳腺摄影能较清晰显示乳腺癌的直接及间接X线征象,对乳腺癌尤其是未扪及肿块的乳癌具有重要的诊断价值。     

Diagnostic imaging of bone metastases

PURPOSE: To present an "algorithm" for detection and diagnosis of skeletal metastases, which may be applied differently in symptomatic and asymptomatic cancer patients. MATERIAL AND METHODS: February to March 1999 we randomly selected and retrospectively reviewed the clinical charts of 100 cancer patients (70 women and 30 men; mean age: 63 years, range: 55-87). All the patients had been staged according to TNM criteria and had undergone conventional radiography and bone scan; when findings were equivocal, CT and MRI had been performed too. RESULTS: The primary lesions responsible for bone metastases were sited in the: breast (51 cases), colon (30 cases: 17 men and 13 women), lung (7 cases: 6 men and 1 woman), stomach (4 cases: 2 men and 2 women), skin (4 cases: 3 men and 1 woman), kidney (2 men), pleura (1 woman), and finally liver (1 men). The most frequent radiographic pattern was the lytic type (52%), followed by osteosclerotic, mixed, lytic vs. mixed and osteosclerotic vs lytic patterns. The patients were divided into two groups: group A patients were asymptomatic and group B patients had local symptoms and/or pain. DISCUSSION: Skeletal metastases are the most common malignant bone tumors: the spine and the pelvis are the most frequent sites of metastasis, because of the presence of high amounts of red (hematopoietic active) bone marrow. Pain is the main symptom, even though many bone metastases are asymptomatic. Pathological fractures are the most severe consequences. With the algorithm for detection and diagnosis of skeletal metastases two different diagnostic courses are available for asymptomatic and symptomatic patients. Bone scintigraphy remains the technique of choice in asymptomatic patients in whom skeletal metastases are suspected. However this technique, though very sensitive, is poorly specific, and thus a negative bone scan finding is double-checked with another physical examination: if the findings remain negative, the diagnostic workup is over. On the contrary, in patients with a positive bone scan or with local symptoms and pain, radiography and CT are used for screening of metastatic lesions: results may be negative (for low sensitivity of conventional radiology) or questionable (in which case bone biopsy is necessary), or else symptoms may be due to different causes than metastatic lesions (i.e., osteoarthritis). Before bone biopsy is made, MRI must be performed, because it is the only technique that allows to distinguish between bone marrow components. The limitation of MRI is the poor specificity of its findings, which may provide misleading findings.     

SPECT/低剂量CT融合显像技术在肺癌骨转移诊断中的应用

目的探讨SPECT/低剂量CT融合显像在肺癌骨转移诊断中的应用价值。方法选取59例肺癌疑似骨转移患者行99m Tc-MDP全身骨显像及SPECT/低剂量CT融合显像,以随访结果或活检病理学检查结果为诊断标准,比较两种检查方式诊断骨转移的灵敏度,特异度,准确率,阴性、阳性预测值,并分析肺癌骨转移影像学表现。结果1)59例肺癌患者疑似骨转移病灶146处,经随访确诊肺癌骨转移病灶115处,其中发生于脊椎51处,占44.35%,胸廓30处,26.09%,骨盆16处,占13.91%,四肢11处,占9.56%,颅骨7处,占6.09%;2)SPECT/低剂量CT融合显像诊断肺癌骨转移灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为:99.13%、93.55%、98.28%、93.55%、97.95%,均高于SPECT全身显像的97.39%、67.74%、91.80%、87.5%、91.10%,其中特异度、阳性预测值及准确率差异有统计学意义(Fisher=10.144、5.688、7.101,P<0.05);3)鳞癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为42.86%、28.57%、14.29%、7.14%、7.14%;溶骨性、成骨性骨破坏分别为75.00%、25.00%;腺癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为46.34%、26.83%、13.41%、7.32%、6.10%;溶骨性、成骨性骨破坏分别为68.29%、30.49%,鳞癌、腺癌骨转移部位及骨破坏类型差异无统计学意义(P>0.05)。结论SPECT/低剂量CT融合显像在鉴别诊断肺癌骨转移方面具有良好临床价值,肺腺癌骨转移发生率较高。     

Primary and metastatic lobular carcinoma of the breast

Invasive lobular carcinoma of the breast is the second most common type of primary breast cancer, accounting for 8-14% of cases, but is often difficult to diagnose early. It typically shows a diffuse pattern of infiltration within the breast, resulting in a variety of often subtle radiological appearances. A similar infiltrative pattern is seen in its metastatic form, with involvement of the gastrointestinal tract, peritoneum, retroperitoneum, bone marrow, meninges and uterus occurring more frequently than with the more common infiltrating ductal carcinoma of the breast. This pictorial essay illustrates the spectrum of radiological appearances which may be encountered with both primary and secondary lobular carcinoma.     

Bone metastasis of hepatocarcinoma. Review of the literature, radiologic pictures and personal caseload]

Prognosis of patients affected with hepatocellular carcinoma (HCC) has been improved by the modern imaging techniques allowing an early diagnosis and by the value of the therapeutic protocols employed. Staging has also become more and more important. Bone metastases from HCC are reportedly rare. The authors observed a 5.5% incidence in 90 cases of hepatocarcinoma. The metastases were demonstrated by radiography, CT, and nuclear scintigraphy, in patients with skeletal pain. The plain film appearance of skeletal metastases from HCC was osteolytic in all cases; no surrounding sclerosis was seen. CT scans demonstrated the destructive nature of these lesions, which were associated with bulky soft-tissue masses. Metastases exhibited increased radiotracer (99mTc-MDP) uptake at bone scintigraphy. The authors believe that bone scintigraphy should be included in the staging protocols of the HCCs which need a potentially curative therapy.     

骨转移瘤18F—FDGPET／CT影像学表现分析

目的分析骨转移瘤的18F-脱氧葡萄糖（FDG）PET／CT影像学表现。方法140例18F—FDGPET／CT检查病例,按病灶的4种CT形态（成骨改变、溶骨改变、混合改变及无改变）分组,探讨肿瘤骨转移灶代谢表现与形态表现之间的关系,进一步治疗情况与转移灶代谢表现的关系。采用SPSS10．0软件,行Mann—Whitney检验及x2检验。结果140例患者分未治疗组78例（55．7％）,治疗（化疗及内分泌）组62例（44．3％）。共检出病灶1658个,CT示成骨病灶415个（25．0％）,溶骨病灶567个（34．2％）,混合病灶177个（10．7％）,无改变病灶499个（30．1％）。对未治疗组1045个病灶平均标准摄取值（SUVmax。）行Mann—Whitney检验,混合病灶、溶骨病灶SUVmax高于成骨病灶、无改变病灶（SUVmax。中位值分别为5．7,5．2,4．8及4．6,Z=-4．680,-6．067,-2．237,-4．635,P均〈0．05）;治疗组与未治疗组行,检验,未治疗组以溶骨性改变（39．6％）为多,治疗组以成骨性改变（35．9％）为多,组间病灶组成明显不同（x2=67．8,P〈0．05）,治疗组代谢水平明显低于未治疗组（SUVmax中位值分别为4．9及4．6,Z=-4．315,P〈0．05）。结论骨转移病灶形态表现不同,其代谢表现差异明显,溶骨病灶的SUVmax。明显大于无溶骨病灶;化疗及内分泌治疗能通过对病灶转归的改变影响病灶形态及相应代谢表现。