Musculoskeletal · Case 06

Diffuse Bone Metastasis

Imaging Findings

Multiple small foci of intensely ncreased uptake in the calvarium, cervicothoracolumbar spine, bilateral anterior and posterior ribs, bilateral pelvis, proximal humeri, and proximal femurs.

Essential Facts

Bone metastases can be seen on imaging when neoplastic cells migrate from their original site to to the bone. Most cancers are able to metastasize to bone, however breast cancer, prostate cancer, and multiple myeloma are particularly likely to spread to bone.
Bone metastases are frequently seen in the spine, pelvis, and femurs. Metastases to the bone may cause pain, fracture, and weakness.
Bone scans are most useful for sclerotic lesions such as prostate cancer.

Scan Information

Bone scans with labeled phosphonates allow for the visualization of local bone metabolism, which is activated in the earlier phases of many types of malignancies. This allows for the use of bone scans to detect metastases when they are associated with marked reactive hypermetabolism of bone, seen in metastases from breast cancer, prostate cancer, neuroendocrine tumors. Contrastingly, bone scans are not useful in detecting metastases from cancers that cause bone-marrow proliferation (lymphoma). It is important to recognize that bone matrix regeneration after treatment of bone metastases can induce metabolic activation, making it possible to misinterpret the imagining as disease progression. A normal bone scan is displayed below to contrast from abnormal bone scans.

References

https://drive.google.com/drive/folders/1KsSGxRufvR3DHpqh3IzcyCQx_X1-Qs3m
Heindel, Walter, et al. “The Diagnostic Imaging of Bone Metastases.” Deutsches Arzteblatt International, Deutscher Arzte Verlag, 31 Oct. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4239579/.
Nuclear Medicine Case Review Series, by Harvey A. Ziessman, Elsevier, 2011, p. 13-14.