Imaging
Metastatic lesions to bone
- Preliminary Diagnosis: Metastatic lesions to bone
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I. What imaging technique is first-line for this diagnosis
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II. Describe the advantages and disadvantages of this technique for diagnosis of metastatic lesions to bone.
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III. What are the contraindications for the first-line imaging technique?
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IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of metastatic lesions to bone.
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VI. What are the contraindications for the alternative imaging techniques?
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
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