Bilateral iliac metastases with sunburst pattern from prostate cancer

Bone metastases from prostatic carcinoma commonly exhibit blastic characteristics with radiographically dense lesions. Occasionally they may demonstrate an unusual pattern of spiculation mimicking primary neoplasms of sarcomatous origin. The author presents a case of bone metastases from prostate carcinoma with bilateral and relatively symmetric iliac "sunburst" lesions documented on computed tomography and bone scintigraphy.     

MR imaging of skeletal metastases from medulloblastoma

The findings of MR imaging in 3 patients with bone metastases from medulloblastoma are reported. The first patient showed focal lesions of low signal intensity on T1-weighted spin echo images at a time when bone scintigraphy was negative for metastases. This patient later developed extensive osteosclerotic lesions visible on plain films. The bone marrow of the second patient showed diffuse low signal intensity on T1-weighted images. After chemotherapy the signal intensity of the bone marrow increased which correlated with a return of normal hematopoietic tissue. A response to chemotherapy was also found on MR imaging and repeat bone marrow biopsies in a third patient. A consistent finding was a low signal intensity on pre-gadolinium images, but the pattern (focal or diffuse abnormal signal intensity) was different in each patient. To our knowledge, this is the first report on MR imaging findings in bone metastases from medulloblastoma.     

Case report: metastatic adamantinoma of the Tibia—an unusual presentation

A 26-year-old female with a tibial lesion diagnosed as an adamantinoma was treated with intra-lesional curettage, bone grafting and intra-medullary nailing. Six years post-surgery, she presented with an asymptomatic primary site but with a metastatic lesion in the mid-shaft of the ipsilateral femur and lung metastases. The femoral lesion was treated with wide excision and reconstructed with an allograft and plate fixation. Pulmonary metastatectomy was carried out for the lung lesions. A follow-up CT scan of the chest at 1 year after the surgery for the metastatic lesions revealed fresh unresectable bilateral metastases. Although cases of local recurrences and pulmonary metastases in adamantinoma are reported, this case is unusual in presenting without a local recurrence but with simultaneous skeletal and pulmonary metastases.     

Bone metastasis revealing a primary prostate cancer

Spiculated reactive periosteal bone is usually found in cases of primary malignant bone tumors; rarely in secondary bone lesions. The authors report a case of bone tumor of the clavicle in a 62 year-old patient with "sunburst " periosteal reaction on radiographs. The metastatic nature of this lesion from an unknown prostate carcinoma was confirmed by immunohistochemical studies of the clavicle biopsy. Tumorectomy was performed and the patient's status is stable with a follow-up of 10 months.     

How does iliac crest bone marrow biopsy compare with imaging in the detection of bone metastases in small cell lung cancer?

Iliac crest bone marrow biopsy (BMB) has often been used as the gold standard for the detection of bone marrow metastases in small cell lung cancer (SCLC). However, it is likely to lead to numerous false-negative results. For this reason, we compared the results of bone scintigraphy (BS), magnetic resonance imaging (MRI), and BMB in 48 sequential patients affected with pathologically confirmed SCLC (47 were evaluable; mean age, 58.4 years). The three procedures were carried out within 1 week, no treatment being performed during this period. Whole-body scans and spot views were obtained in the anterior and posterior projections. For MRI, only the thoracolumbar spine, the sternum and the pelvis were scanned, using spin-echo T1-weighted sequences, resulting in an acquisition time of less than 45 min. Only five BMBs were rated as positive. In these cases, both BS and MRI were also positive. The other 42 biopsies were negative. Among them, in ten cases both BS and MRI were positive. In 21 cases, both BS and MRI were negative. In five cases MRI was positive while BS was negative. Finally, in six cases MRI was negative whilst BS was positive. In most cases in which either BS or MRI was positive, follow-up scans confirmed the initial findings. This study suggests that BMB is more invasive and less sensitive than BS or MRI in detecting bone metastases. MRI seems to be more sensitive than BS in detecting small spinal or pelvic metastases. Whole-body bone scintigraphy is more sensitive in detecting skull, costal or peripheral metastases. BS and MRI should be used in combination and may replace BMB in the detection of bone metastases in SCLC. Correspondence to: I. Perrin-Resche     

The role of bone scintigraphy in osteogenic sarcoma

Hospital records of 27 children with osteogenic sarcoma were reviewed in an effort to define the usefulness of skeletal scintigraphy in the initial evaluation and follow-up of their disease. Serial bone scans as well as plain radiographs, linear tomograms, and computed tomograms were evaluated for evidence of bone or lung metastases. Eighteen patients developed lung metastases and three developed bone metastases. Seven patients demonstrated uptake of tracer in lung metastases, however, the lesions were all easily identifiable by radiographic means. All bone metastases were detected by scintigraphy, in one instance prior to radiographic abnormality. In no cases were bone metastases known to occur in the absence of lung metastases. None of the bone scans performed for routine follow-up pruposes resulted in altered therapy for the patient. We propose that skeletal scintigraphy is useful in the initial metastatic work up of osteogenic sarcoma, and may be helpful in some patients with specific indications during their follow-up, but is less valuable when there is no clinical suspicion for bone metastases.     

The value of bone scintigraphy,bone marrow scintigraphy and fast spin-echo magnetic resonance imaging in staging of patients with malignant solid tumours: a prospective study

The purpose of this prospective study was to define the value of bone scintigraphy (BS), bone marrow scintigraphy (BMS) and the new fast spin-echo (FSE) magnetic resonance imaging (MRI) sequences in screening for bone metastases in patients with solid malignant tumours. It was our particular interest to classify patients into a group with and a group without bone metastases, and not only to compare the absolute number of metastases detected by each method. Thirty-two patients were examined using technetium-99m dicarboxy propane diphosphonate bone scintigraphy, ^99mTc-labelled monoclonal anti-granulocyte antibodies for bone marrow scintigraphy and 1.5 T MRI using T1-weighted and FSE T2-weighted sequences. Against a reference standard obtained by re-evaluation of all clinical and imaging data 1 year after prospective BS, BMS and MRI had been performed, the three imaging modalities were falsely positive in two, eight and two cases and falsely negative in zero and four cases, respectively. BMS was falsely positive in eight patients because of vertebral marrow degeneration which caused photopenic defects which could not be differentiated from metastases. MRI showed these lesions to unequivocally contain fat. BMS and MRI were falsely negative in four cases because of the limited field of examination. In our study the key factor in classifying a patient as bone MI or MO was the possibility of surveying the entire skeleton, as is the case in BS, and not that MRI had a higher sensitivity compared to BS when analysis was on a lesion-by-lesion basis. BMS had the same limitations as MRI because the usual bone marrow distribution resulted in a physiologically limited field of view. We conclude that BS remains the method of choice in staging patients with solid tumours despite the fact that MRI is no longer a time-consuming method using FSE sequences. MRI has a complemantary role if special questions remain. BMS appears to have little value in the detection of bone metastases because of its poor specificity, its limited spatial resolution and its restriction to those areas of the skeleton containing haematopoietic marrow. Correspondence to: G.K. v. Schulthess     

153Sm-EDTMP治疗转移癌性骨痛

目的 探讨影响^153Sm-乙二胺四亚甲基磷酸盐（EDTMP）治疗转移癌性骨痛疗效的相关因素。方法 按国际原子能机构区域合作计划组织中国多中心研究,3年内收集^153Sm-EDTMP治疗转移癌性骨痛234例,根据治疗响应分为有效及无效2组,比较其个人情况,临床特点,原发病种,骨转移特点及治疗方法等因素,以SAS软件进行分组与多因素分析。结果 183例治疗有效,51例治疗无效,2组间在年龄、非核素治疗、^153Sm-EDTMP用量、转移灶数目、占骨骼比重、放射性摄取程度等方面无明显差别。但无效组中男性（43例,84.3%）、肺癌（34例,66.7%）、脊柱、骨盆与下肢转移的比例明显不同于有效组。多因素分析证实患者性别、肿瘤类型和转移部位与治疗效果相关。结论 ^153Sm-EDTMP治疗对肺癌、男性和下半身转移者效果可能较差。     

N-MID、β-CTx与肿瘤骨转移骨显像对比分析

目的:对比分析肿瘤骨转移核素骨显像与骨代谢标志物N-MID、β-CTx的临床应用价值。方法:依据骨显像将恶性肿瘤患者分为无骨转移组和骨转移组,采用Soloway分级将骨转移组病例分为4级,分析N-MID、β-CTx的变化情况。结果:骨转移组β-CTx约为0.42 ng/ml,明显高于对照组0.27 ng/ml(P<0.01);各级骨转移组β-CTx水平分别为:对照组0.24±0.17 ng/ml,1级骨转移组0.31±0.11 ng/ml,2级骨转移组0.56±0.19 ng/ml,3级骨转移组0.81±0.13 ng/ml,4级骨转移组1.10±0.22 ng/ml,β-CTx随骨转移级别增加逐渐升高,仅对照组和1级骨转移组、1级和2级骨转移组间无明显差异(P>0.05),其余各组两两比较均有显著性差异(P<0.01)。骨转移组N-MID水平约18.70 ng/ml,高于对照组14.31ng/ml,但无统计学差异(P>0.05),随骨转移级别增加,N-MID水平有逐渐上升的趋势,但各组间比较无明显差异(P均>0.05)。结论:β-CTx可以应用于骨转移的辅助诊断和2级以上骨转移程度监测,N-MID对肿瘤骨转移的诊断价值和骨转移程度的监测价值不明显。     

Osteoblastic response as a healing reaction to chemotherapy mimicking progressive disease in patients with small cell lung cancer

The osteoblastic response (OR) phenomenon as a healing reaction during effective chemotherapy—defined by the appearance of new osteoblastic bone lesions while disease response in other tumor sites was well documented—has previously been described for breast and prostate cancer. The purpose of this study was to investigate this phenomenon that could erroneously be interpreted as progressive disease in patients with small cell lung cancer (SCLC) and to establish guidelines for interpretation of follow-up computed tomography (CT) examinations in this situation. Twenty-four patients with newly diagnosed SCLC and bone metastases were retrospectively included in this study. The characteristics of bone lesions in CT examinations were correlated with bone scintigraphy and magnetic resonance imaging, if available. In target lesions the CT density quantified in Hounsfield units (HU) was evaluated at baseline and during follow-up. New osteoblastic lesions occurred during follow-up in 17 of 24 patients. OR was proven in 4 patients and considered most likely in 11 patients; mean density increase in target lesions was 153 HU. The study indicates that osteoblastic response as a healing reaction seems to occur in the majority of patients with SCLC and bone metastases and should not be misinterpreted as progressive disease.     

骨转移瘤漏误诊的影像学分析

目的借鉴漏误诊病例的经验教训,提高对本病的影像诊断水平。方法回顾性分析18例经手术病理证实的影像漏误诊骨转移瘤。结果骨转移瘤病例以多发,溶骨为主。影像检查漏误诊分别为：X线8例,CT2例。结论X线、CT是检查骨转移瘤重要手段,但有一定限度,条件许可时应尽早做MRI检查,并做必要的鉴别诊断。     

髓母细胞瘤骨转移的MRI诊断及临床治疗

目的：探讨髓母细胞瘤骨转移的MRI诊断及临床治疗。方法：回顾性分析髓母细胞瘤术后骨转移病例4例,分别行脊柱、髋关节或股骨MRI扫描,根据MRI检查结果运用常规分割法放射治疗。结果：4例中脊柱转移2例,髂骨及股骨颈转移1例,股骨下段转移1例,均表现为骨质内块状T1WI低信号、T2WI高信号影;经局部放射治疗疼痛症状均得到明显缓解。结论：髓母细胞瘤可以发生骨转移,MRI检查能够明确转移的范围和数目,其主要治疗手段是局部放射治疗。     

Extracranial metastases of meningioma

We report two unusual cases of intracranial meningioma with extracranial metastases to bone. The diagnosis was made by fine needle aspiration biopsy in both cases and confirmed by open biopsy in one. The lungs were spared in both. A review of the literature is included.     

Bone pain palliation with strontium-89 in breast cancer patients with bone metastases and refractory bone pain

Fifteen patients with breast cancer and skeletal metastases who had bone pain refractory to opioid analgesics and who were not eligible for or had not responded to local field radiotherapy, were treated with strontium-89. All patients had received previous treatment with chemotherapy and radiotherapy for bone metastases. Severity of bone pain, sleeping pattern, mobility and dependency on analgesics were evaluated before and 4, 8 and 12 weeks after⁸⁹Sr administration. Patients received 2 MBq/kg (118–148 MBq) of⁸⁹Sr by i.v. injection. Pain relief and a reduction in analgesic requirements were observed in 7 of the 15 (47%) patients, with a reduction in the severity score from 34% to 71%. Duration of the response varied from 3 to 7 months. A decrease in peripheral blood cell count was observed in 11 patients: a 15%–66% reduction in white cell count and a 14%–75% reduction in platelet count were detected at 12 weeks after treatment in these patients. We conclude that⁸⁹Sr is effective (47% response rate) for bone pain palliation in patients with bone metastases from breast cancer. Dependency on opioid analgesics may be reduced in patients with refractory bone pain.     

转移性骨肿瘤放射治疗临床分析

目的分析79例转移性骨肿瘤放射治疗止痛效果及中位生存期。方法采用6MV和15MV X线照射转移性骨肿瘤79例共141处病灶。常规分割组18例，照射DT40—50Gy／20—25次共4—5周；大分割组61例，照射DT30-36Gy／10-12次共2-2．5周。结果（1）总的中位生存期为3．81个月。中位生存期单纯骨转移者8．05个月，原发灶已控制者4．29个月，分别显著高于合并内脏转移者的3．10个月（P〈0．05）和原发灶未控或不明者的3．31个月（P〈0．05）；中位生存期单发和多发骨转移者差异无统计学意义（P〉0．05）。（2）放射止痛总的有效率为92．90％，常规分割组止痛效果优于大分割组（x^2=12．99，P=0．005），而止痛效果与原发灶是否得到控制、转移是单发还是多发均无关系。（3）放射止痛起效的快慢与单次剂量成正比（x^2=9．55，P=0．002）。结论放射治疗可作为转移性骨肿瘤的一种主要止痛手段。     

核素骨显像与MRI检测脊柱转移瘤的对比研究

目的：比较核素骨显像与MRI对脊柱转移瘤的诊断价值。方法；对76例经病理证实为恶性肿瘤的患者进行骨显像与MRI检查，比较骨显像与MRI对脊柱部位病变的检查情况。结果：骨显像、MRI对脊柱转移瘤的阳性病例及阳性病灶数的检出率拉近，阳性病例检出率为68／81和61／81，阳性病灶检出率为167／536和156／536。二者我椎转移为好发段，MRI对胸椎病灶的检出率优于骨显像，检出率分别为83／237和64／237；二者对腰椎的检出率无差别，骨显像对颈椎、骶椎的检出率优于MRI（颈椎分别为15／63和6／63，骶椎分别为23／78和10／78）。对多发病灶的检出MRI优于骨显像，检出率分别为143／237和116／237。结论：在显示脊柱肿瘤骨转移方面，总体的敏感性二者接近，在具体部位二者各有优势，在多发病灶上MRI优于骨，骨显像因其简单易行，仍为肿瘤患者病情初始评价的选择，在其对临床问题解释不够充分时，则应采用MRI作为补充。     

转移性骨肿瘤漏误诊原因的影像学分析

目的 分析转移性骨肿瘤漏、误诊的原因,提高对该病影像诊断水平。材料与方法 回顾分析资料完整的转移性骨肿瘤１０５例,其原发肿瘤主要为肺癌、前列腺癌、消化道癌及乳等。所有病例均摄Ｘ线平片,其中ＣＴ检查３１例,ＭＲ检查２１例,ＥＣＴ检查３４例。结果 骨转移瘤以多发、溶骨型为主。初次影像检查漏、误诊分别为：Ｘ线平片３５例,ＣＴ５例,ＭＲ及ＥＣＴ各１例。结论 影像检查首选ＥＣＴ和Ｘ线平片,有条件时最好作ＣＴ     

99Tcm-BW250/183骨髓免疫显像诊断恶性肿瘤骨转移的临床价值

目的 探讨99Tc^m-抗粒细胞单抗BW250／183骨髓免疫显像诊断恶性肿瘤骨转移的临床价值。方法 14例有恶性肿瘤骨转移的患者接受了99Tcm-BW250/183骨髓免疫显像和99Tcm-亚甲基二膦酸盐（MDP）骨显像,对比分析两种检查结果,并与X线和（或）MRI比较。结果 骨髓免疫显像在4例骨转移患者中新发现骨显像未发现的病变部位8个,6例骨转移患者存在外周骨髓扩张;骨髓免疫显像和骨显像诊断骨转移的灵敏度分别为90％和100％,特异性分别为100％和25％,准确性分别为92．9％和78．5％。结论 99Tcm-BW250/183骨髓免疫显像诊断恶性肿瘤骨转移有较高的灵敏度和特异性,对于骨骼孤立病灶的良恶性鉴别有重要的临床价值。     

87例肺癌患者核素骨显像结果分析

目的：通过对87例肺癌患者放射性核素全身骨显像结果进行分析，探讨肺癌骨转移的特点和规律。方法：回顾性分析了经临床病理证实的87例肺癌患者的全身骨显像表现。结果：肺癌骨转移率为63．2％，发生骨转移最常见的部位为肋骨，其次为脊椎骨、盆骨、四肢骨、肩胛骨、颅骨和胸锁骨。在不同病理类型的肺癌中，腺癌和鳞癌较其它类型更易发生骨转移。结论：肺癌骨转移比较常见，所以肺癌患者应常规作全身核素骨扫描，以帮助临床制订正确的治疗方案。     

全身MRI与核素骨扫描对骨转移瘤诊断价值的对照研究

目的 评价全身MRI对骨转移瘤的诊断价值.方法 对30例经病理证实的恶性肿瘤患者在2周内分别进行伞身MRI及核素骨显像(BS),采取临床资料同常规MRI、CT等多种影像资料结合分析,辅以必要的随访复查为"金标准",分别以30例患者和270个部位为单位进行分析.使用McNemar检验比较两者对骨转移瘤诊断的敏感度、特异度.结果 30例患者中,"金标准"诊断27例患者存在骨转移,全身MRI检出25例,2例假阴性,无假阳性患者;BS检出27例阳性患者,其中2例为假阳性.以病例为单位,两者的敏感度均为92.6%(25/27),特异度分别为100%(3/3)及33.3%(1/3).ROC曲线下面积分别为0.9630及0.6296,差异无统计学意义(P>0.05).以病灶部位为单位统计显示全身MRI的敏感度、特异度分别为90.8%(108/119)、98.0%(148/151),高于骨扫描的70.6%(84/119)、90.7%(137/151)(P值均<0.01).全身MRI的ROC曲线下面积为0.9438,大于BS的0.8066(P<0.01).全身MRI同时发现3例患者存在脑转移,4例患者存在肺转移,4例患者存在肝转移.结论 全身MRI对骨转移瘤的综合诊断能力较Bs好,具有一定的临床应用价值.

Abstract：

Objective The aim of the study was to evaluate the reliability of whole-body MRI(WBMRI)in detecting osseous metastases.Methods Thirty patients verified with malignant tumor by histology were enrolled.All the patients underwent WB-MRI and bone scintigraphy(BS)with a two week interval.Clinical information,conventional MRI and CT images,and follow-up data were collected as gold standard for the diagnosis of bone metastases.The data of 30 patients and 270 segments as study unit respectively were analyzed.The sensitivity and specificity between WB-MRI and BS were compared with McNemar test.Resuits Bone metastases were confirmed in 27 of 30 patients by gold standard.Twenty-five patients with bone metastases were detected by WB-MRI and no false-positive cases.Twenty-seven patients with bone metastases were Nund by BS but having two false-positive oases.With patients as study unit,the diagnostic sensitivity of WB-MRI and BS were both 92.6%(25/27)and the specificity were 100%(3/3)and 33.3%(1/3),respectively.The area under ROC curve of WB-MRI and BS were 0.9630 and 0.6296,respectively(P>0.05).With segments as study unit,119 bone metastases segments were confirmed.The diagnostic sensitivity of WB-MRI and BS were 90.8%(108/119)and 70.6%(84/119)(P<0.01),while the specificity were 98.0%(148/151)and 90.7%(137/151),respectively(P<0.01).The area under ROC curve of WB-MRI and BS were 0.9438 and 0.8066.The former was obviously higher than the latter(P<0.01).Meauwhile.by WB-MRI,3 cases coexisting with brain metastases,4 cases with lung metastases,and 4 cases with hepatic metastases were found.Conclusion WB-MRI was a good tool for screening osseous metastases.