Metastatic lesions to bone

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.

• 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