Preliminary Diagnosis: Metastatic lesions to bone

I. What imaging technique is first-line for this diagnosis

  • The first-line imaging modality is plain radiography.

II. Describe the advantages and disadvantages of this technique for diagnosis of metastatic lesions to bone.

  • Plain radiography is a highly portable imaging modality.

  • Plain radiography exposes patients to minimal ionizing radiation.

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  • Plain radiography offers exquisite visualization of the surrounding osseous structures.

  • Plain radiography is moderately sensitive and specific in detailing any suspicious sclerotic and lytic osseous lesions.

  • Plain radiography is limited in detailing the surrounding soft tissues, osseous structures, and vasculature.

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to plain radiography exist.

IV. What alternative imaging techniques are available?

  • Alternative imaging techniques include CT imaging without contrast of the area of concern and nuclear medicine technetium 99 m MDP whole body scintigraphic imaging.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of metastatic lesions to bone.

CT
Advantages

  • Highly sensitive and specific in detailing any suspicious abnormal areas of increased sclerosis and lucency for osseous metastatic foci

  • Better characterizes the surrounding soft tissues, vasculature, and osseous structures

  • May help guide percutaneous biopsy

Disadvantages

  • Exposes patients to ionizing radiation

  • Less portable than plain radiography

Nuclear Medicine
Advantages

  • Highly sensitive and moderately to highly specific in detecting osseous metastatic lesions

Disadvantages

  • Less adept in detailing the surrounding soft tissues, osseous structures, and vasculature

  • Exposes patients to ionizing radiation

  • May be subject to artifact from technical imaging complications

  • False positives may be noted in patients with an underlying infection or inflammatory process

VI. What are the contraindications for the alternative imaging techniques?

  • CT imaging may be contraindicated in pregnant patients

  • Nuclear medicine Technetium 99 m MDP imaging may be contraindicated in pregnant patients and patients breastfeeding

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