Utility of Tc-99m GSA whole-body scintigraphy in detecting bone metastases from hepatocellular carcinoma

Recent advances in the treatment of hepatocellular carcinoma (HCC) have prolonged patient survival. However, the number of patients with bone metastases identified during follow-up examinations has increased. Tc-99m Sn-N-pyridoxy-5-methyltryptophan (Tc-99m PMT) has been reported to accumulate at a high rate in HCC lesions and bone metastases. In the patient described here, whole-body scintigraphy showed accumulation of DTPA galactosyl human serum albumin (Tc-99m GSA) and Tc-99m PMT in bone metastases from HCC. The authors suggest that asialoglycoprotein receptors may be present in bone metastases from well-differentiated HCC. Tc-99m GSA whole-body imaging can be used to detect bone metastases from HCC and to evaluate hepatic reserve.     

Treated invasive cervical carcinoma. Utility of computed tomography in distinguishing between skeletal metastases and radiation necrosis

The bony pelvis should be carefully evaluated on computed tomography (CT) scans of the lower abdomen and pelvis performed for staging cervical cancer or for evaluating suspected recurrence. CT provides optimal imaging of the spine and pelvis, frequently providing a clinically relevant supplement to bone scan or plain film information. In a study of eight patients with skeletal metastases from cervical carcinoma and three cases of radiation osteitis, overlap existed in their imaging characteristics. Metastases were always lytic but nearby sclerotic areas from radiation were often present. Radiation osteitis may be lytic, sclerotic, or mixed, and both may avidly accumulate bone-scanning radiotracers. The absence of a soft tissue mass, slow progression, blastic elements, and sharply defined borders on CT suggest radiation necrosis. However, in some lesions within a radiation portal, biopsy or MRI may be required for final diagnosis.     

Accuracy of CT in detecting squamous carcinoma metastases in cervical lymph nodes

The accuracy of computed tomography (CT) in the assessment of nodal metastases was correlated retrospectively with the pathological examination in 28 patients with known head and neck squamous cell carcinoma, who underwent neck dissections. Three patients had bilateral neck dissections resulting in a total of 31 dissections. CT scanning correctly staged 28 of 31 neck dissections providing an accuracy of 90%, a sensitivity of 87.5% and a specificity of 100% in the detection of nodal metastases. Of the 21 true positives, underestimation of the extent of nodal disease occurred in seven cases. Regarding extracapsular nodal spread, CT resulted in an accuracy of 62%, a sensitivity of 62.5% and a specificity of 60%. All three false negatives for nodal metastases occurred in metastatic spread to the submandibular nodes. The existing criteria for assessment of nodal metastases with CT are sensitive and specific, but in the assessment of extranodal spread CT may not detect 37.5% of cases.     

Incidence of bone metastases in women with minimal and occult breast carcinoma.

A total of 42 women with proved minimal (14) or occult (28) breast carcinoma were evaluated for up to 48 months (mean = 28 months). Bone scans, radiographs, blood chemistries, enzyme levels, and operative findings demonstrated metastases only in those 6 patients (14%) who presented with symptomatic metastases from an unknown primary source. The other 36 women are free of metastases. Preoperative radionuclide bone scans may not be necessary for women with minimal and asymptomatic occult breast cancers.     

Radionuclide bone scanning in neuroblastoma: skeletal metastases and primary tumor localization of 99mTc-MDP

Of 42 radionuclide bone scans in 35 children with neuroblastoma, 21 were abnormal for the presence of skeletal metastases. Of the 21 abnormal scans, 16 were corroborated by positive bone-marrow biopsy or clinical data. The false-negative and false-positive rates for bone scanning were 4.8% and 9.5%, respectively. Calcification of the primary tumor was seen on pretreatment computed tomographic (CT) scans in 24 (89%) of 27 cases, while only 13 (48%) of 27 were detectable by plain radiographs. Uptake of technetium-99m methylene diphosphate (99mTc-MDP) by the primary tumor occurred in 20 of 27 cases, but correlation between tumor uptake and calcification was not statistically significant. All children with markedly elevated urinary vanillylmandelic acid exhibited primary tumor uptake. Survival was not affected independently by primary tumor uptake.     

Utility of CT in detecting postpneumonectomy carcinoma recurrence

After pneumonectomy for bronchogenic carcinoma, detection of recurrent disease in the ipsilateral hemithorax or mediastinum is often difficult. The authors discuss the utility of CT in the evaluation of 18 postpneumonectomy patients who had developed new clinical symptoms. In six patients without documented tumor recurrence, CT demonstrated a normal postpneumonectomy appearance. In the other 12, CT confirmed the clinical impression of recurrent neoplasm (10 prospectively, two retrospectively), which appeared either as enlarged mediastinal lymph nodes or as a soft-tissue mass projecting into the normal near-water-density postpneumonectomy space. In only five of these patients were plain chest radiographs suggestive of recurrence (two prospectively, three retrospectively). The accurate assessment of the presence and extent of recurrent neoplasm by CT was important in planning radiotherapy in eight patients.     

Sclerotic bone metastases from sarcomatoid renal cell carcinoma

We present a case of sarcomatoid renal cell carcinoma with multiple sclerotic skeletal metastatic lesions. Renal cell carcinoma is frequently metastatic at presentation, with a high incidence of skeletal involvement, classically described as osteolytic. However, sclerotic or osteoblastic metastatic skeletal lesions from renal cell carcinoma are rare, with only two previous reports identified in the literature, neither of which involved the sarcomatoid variant of renal cell carcinoma. In our case the sclerotic metastases were characterized by bone scan, computed tomography (CT), magnetic resonance imaging (MRI), and histologic analysis. Received: 8 April 1999 Revision requested: 27 May 1999 Revision received: 24 June 1999 Accepted: 29 June 1999     

MRI影像组学对早期口腔舌鳞状细胞癌隐匿性颈淋巴结转移的预测价值

目的:探讨基于术前常规MRI的影像组学对早期口腔舌鳞状细胞癌（OTSCC）隐匿性颈淋巴结转移的预测价值。方法:回顾性收集2015年1月至2019年12月上海交通大学医学院附属第九人民医院77例早期OTSCC患者（临床分期cT1~2N0M0）的术前MRI数据。所有患者均行原发灶切除及选择性颈淋巴结清扫术,且具有术后淋巴结...     

Radiographic manifestations of bone metastases from renal carcinoma.

From 1964 to 1974, 1,668 patients with renal carcinoma were seen at the Mayo Clinic. Bone metastases were present in 167 of these patients (only lung metastatic involvement ranked higher in frequency). More than one-third of the patients with bone metastasis from renal carcinoma had this as a presenting lesion of occult renal tumor. This group constituted 4% of all patients with renal carcinoma evaluated during the study period. While most bone lesions were in the pelvis and lower lumbar spine, any bone may be involved. All patients with bone metastases from renal carcinoma have a poor prognosis. However, some bone lesions appeared as long as 10 or more years after the initial tumor. The most common radiographic features are a lytic destructive process with indistinct margins, erosion of the cortex, and frequent expansion into the soft tissues. Pathological features are common in the long bones, and calcifications are occasionally seen. The synovial joints are not affected. A well defined sclerotic margin is a common finding after radiation treatment, although it is not a reliable indicator of the stability of the lesion.     

Preoperative embolization of bone metastases from renal cell carcinoma

The purpose of this study was to correlate the effectiveness of preoperative embolization with the blood loss and transfusion requirement during surgery for bone metastases from renal cell carcinoma. Twenty-eight preoperative embolizations in 26 patients with renal cell carcinoma metastatic to bone were retrospectively evaluated and divided into two groups: Group A included the embolizations that resulted in complete devascularization of the lesion as defined by the post-embolization arteriograms, and group B included those with an incomplete result. The two groups were compared with regard to blood loss and transfusion requirement during surgery, by unpaired two-tailed Student's t-test. Where complete embolization was effected (group A, 10 cases), there was a mean blood loss of 535 ± 390 ml. When a less than complete embolization was achieved (group B, 18 cases), the mean blood loss was 1.247 ± 1.047 ml (p = 0.049). The red blood cell transfusion in group A was 1.3 ± 1 units, whereas in group B it was 2.4 ± 1.2 (p = 0.03). Preoperative embolization of bone metastases from renal cell carcinoma with subsequent complete devascularization leads to significant reduction of blood loss during surgery. Interventional radiologists should pursue and embolize every feeder to the metastasis, because any less than complete devascularization increases the amount of blood loss and the amount of red blood cell transfusion during surgery. Received: 23 June 1998; Revised: 20 November 1998; Accepted: 24 February 1999     

Portal scanning for liver metastases in colorectal carcinoma

In a prospective study over 2 years, 14 patients suffering from colorectal cancer had radionuclide liver scans performed via the portal route. Technetium-99m-labelled macro-aggregates of human serum albumen were injected via the cannulated umbilical vein, distributed through the portal system of the liver and their presence recorded by a gamma camera. Of 11 patients with clinically normal livers and no metastases found at laparotomy, five had abnormal portal scans, two of these dying from multiple liver metastases during follow-up. None of the patients with normal portal scans died with liver metastases within the 2-year study period.     

Nasopharyngeal carcinoma: pattern of skeletal metastases

The records of 153 nasopharyngeal carcinoma patients with skeletal metastases were reviewed. The skeletal system was the most common site of distant metastases. The patients who developed skeletal metastases were significantly younger than those without skeletal metastases, although there was no difference between sexes. The pattern of skeletal involvement conforms to the general pattern, the spine and pelvis being the common sites. The first region of involvement was lumbar spine (28.4%), then dorsal spine (27.7%), sacrum and pelvis (16.3%), femur (9.9%), rib and sternum (7.8%), humerus (5.0%), cervical spine (3.5%) and skull vault (1.4%). Radiologically, the lesions were lytic in 66.0%, mixed lytic and sclerotic in 12.8% and sclerotic in 21.2%. The time to development of symptomatic skeletal metastases of mixed or sclerotic nature was significantly longer than lytic lesions, and patients with mixed or sclerotic metastases also had better survival.     

Osteoblastic metastases from breast carcinoma with false-negative bone scan

 The authors report a case of metastatic breast carcinoma that on investigation was shown to have a negative bone scan in spite of multiple densely sclerotic metastases on radiography and CT and a positive bone biopsy. The literature is reviewed with regard to the subject of negative bone scans in this situation.     

Transcatheter arterial embolization for bone metastases from hepatocellular carcinoma

The objective of this study was to determine which of the following three methods is the most effective for the treatment of bone metastases from hepatocellular carcinoma (HCC): transcatheter arterial embolization (TAE); combination of TAE and external radiotherapy; or external radiotherapy alone. Thirty-nine metastatic bone lesions from HCC in 33 patients were retrospectively reviewed. Each lesion underwent either TAE alone (group A, n = 11), TAE followed by radiotherapy (group B, n = 17), or radiotherapy alone (group C, n = 11). They were evaluated on the following subjects: pain relief; improvement of daily activities; and complications. Each treatment was effective for pain relief (89-94%) and improvement of daily activities (73-82%). The mean time interval from the beginning of each treatment to the onset of initial pain relief was 4.7 days in group A, 4.8 days in group B, and 15 days in group C. Recurrence of the pain after the initial pain relief was noted in 75% in group A, 20% in group B, and 88% in group C. Pyrexia and local pain commonly occurred after TAE. In conclusion, TAE is effective in relieving pain immediately and in improving the patients' daily activities. The combination of TAE and radiotherapy is recommended for permanent pain relief.     

Unicentric osteosarcoma of bone with subsequent skeletal metastases

Five cases of unicentric osteosarcoma with subsequent skeletal metastases are reviewed. Skeletal metastases may occur prior to pulmonary metastases in such patients. Initial and periodic bone scanning is therefore justified since early detection of distant bone lesions may have important therapeutic implications. A classification of multiple site osteosarcoma based upon clinical, pathologic, and radiologic characteristics is proposed.