We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.
Adenocarcinoma/diagnosis/*secondary ; Adult ; Bone Neoplasms/*diagnosis/pathology/*secondary ; Case Report ; Female ; Human ; *Osteoblasts/radiography ; *Pelvis/radiography ; Radionuclide Imaging ; Stomach Neoplasms/*diagnosis ; Tomography, X-Ray Computed

We report an unusual case of osteoblastic metastasis from gastric carcinoma. In this case, bone metastasis was the initial manifestation of the cancer. The laboratory findings revealed mild hypocalcemia and markedly elevated alkaline phosphatase levels. Plain X-ray showed mottled osteoblastic changes in the pelvis. Bone marrow and bone biopsy of the pelvis revealed metastatic adenocarcinoma with increased osteoblastic activity. An extensive search for the primary site revealed advanced gastric carcinoma, which was confirmed by endoscopic biopsy.
Adenocarcinoma/diagnosis/*secondary ; Adult ; Bone Neoplasms/*diagnosis/pathology/*secondary ; Case Report ; Female ; Human ; *Osteoblasts/radiography ; *Pelvis/radiography ; Radionuclide Imaging ; Stomach Neoplasms/*diagnosis ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the feasibility and clinical value of whole body diffusion weighted magnetic resonance imaging (WB-DWI) in detection of bone metastases.

METHODSTotally 38 patients with malignant tumors and suspected bone metastases were enrolled. All patients underwent WB-DWI and bone scintigraphy within 2 weeks. The skeletal system was divided into 13 regions: skull, sternum, clavicle, cervical spine, thoracic spine, lumbar spine, sacrum, ribs, pelvic bone, scapula, humerus, femur, and tibia/fibula. Bone metastases were assessed for both modalities in a separate consensus reading and apparent diffusion coefficient (ADC) values were calculated.

RESULTSWB-DWI identified 214 pathological lesions in 20 patients, while bone scintigraphy demonstrated 197 lesions in 20 patients. Concordance between WB-DWI and bone scintigraphy occurred in 34 of 38 patients. There was no statistical difference between these two modalities (P = 0.488). Compared with bone scintigraphy, the regions missed by WB-DWI were mainly located in skull, thoracic spine, humerus, and tibia/fibula. WB-DWI was more sensitive in the detection of metastases to the cervical spine, lumbar spine, sacrum, pelvis, ribs and femur. No statistical significance was found among the ADC values of bone metastases in different skeletal areas, and the mean ADC value was (0.75 +/- 0.10) x 10(-3) mm2/s. Furthermore, WB-DWI revealed more metastases to the lymph lodes and extraskeletal organs. Conclusion WB-DWI has high accordance with skeletal scintigraphy in detecting bone metastases, and the two modalities are complementary to each other.

Adult ; Aged ; Aged, 80 and over ; Bone Neoplasms ; diagnosis ; diagnostic imaging ; secondary ; Diffusion Magnetic Resonance Imaging ; methods ; Feasibility Studies ; Female ; Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Radionuclide Imaging ; Stomach Neoplasms ; pathology ; Whole Body Imaging ; methods ; Young Adult

OBJECTIVETo evaluate the feasibility of whole body diffusion weighted imaging (DWI) in bone metastasis detection using bone scintigraphy as comparison.

METHODSForty-five patients with malignancy history were enrolled in our study. All the patients received the whole body DWI and bone scintigraphy scan within 1 week. The magnetic resonance (MR) examination was performed on 3.0T MR scanner using embedded body coil. The images were reviewed separately by two radiologists and two nuclear medicine physicians, who were blinded to the results of the other imaging modality. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two techniques for detecting bone metastasis were analyzed.

RESULTSA total of 181 metastatic lesions in 77 regions of 34 patients were detected by whole body DWI, and 167 metastatic lesions in 76 regions of 31 patients were identified by bone scintigraphy. The patient-based sensitivity and PPV of whole body DWI and bone scintigraphy were similar (89.5% vs. 81.6%, 97.1% vs. 91.2%), whereas, the patient-based specificity and NPV of whole body DWI were obviously higher than those of bone scintigraphy (85.7% vs. 57.1%, 60.0% vs. 36.4%). Ten regions negative in scintigraphy but positive in whole body DWI, mainly located in spine, pelvis, and femur; nine regions only detected by scintigraphy, mainly located in skull, sternum, clavicle, and scapula. The region-based sensitivity and specificity of whole body DWI were slightly higher than those of bone scintigraphy (89.5% vs. 88.4%, 95.6% vs. 87.6%).

CONCLUSIONWhole body DWI reveals excellent concordance with bone scintigraphy regarding detection of bone metastasis, and the two techniques are complementary for each other.

Aged ; Bone Neoplasms ; diagnosis ; pathology ; secondary ; Diffusion Magnetic Resonance Imaging ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Radionuclide Imaging ; Sensitivity and Specificity ; Whole Body Imaging ; instrumentation ; methods

Positron emission tomography combined with computed tomography (PET/CT) has been receiving increasing attention during the recent years for making the diagnosis, for determining the staging and for the follow-up of various malignancies. The PET/CT findings of 58 breast cancer patients (age range: 34-79 years old, mean age: 50 years) were retrospectively compared with the PET or CT scans alone. PET/CT was found to be better than PET or CT alone for detecting small tumors or multiple metastases, for accurately localizing lymph node metastasis and for monitoring the response to chemotherapy in breast cancer patients.
Adult ; Aged ; Bone Neoplasms/*diagnosis/pathology/secondary ; Breast/pathology/radionuclide imaging ; Breast Neoplasms/*diagnosis/pathology/radionuclide imaging ; Carcinoma, Ductal, Breast/diagnosis/pathology ; Carcinoma, Intraductal, Noninfiltrating/*diagnosis/pathology/radionuclide imaging ; Contrast Media/administration & dosage ; Female ; Humans ; Lymphatic Metastasis ; Mammography/methods ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis/pathology ; Neoplasm Staging/methods ; Positron-Emission Tomography/*methods ; Radiographic Image Enhancement/methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods ; Ultrasonography, Mammary

Bone is a common site of metastasis in patients with hepatocellular carcinoma (HCC). We report a rare case of rib metastasis from HCC treated by transcatheter arterial chemoembolization (TACE). A 55-year-old man with liver cirrhosis presented with right lower chest pain. The diagnosis was an HCC with a bone metastasis in the right eighth rib. Intra-arterial injections of doxorubicin mixed with Lipiodol and Gelfoam particles were instituted through the right eighth intercostal artery. Computed tomography and a Tc99-labeled scan performed 2 months after the third TACE revealed no viable HCC in the right eighth rib.
Bone Neoplasms/radiography/secondary/*therapy ; Carcinoma, Hepatocellular/diagnosis/secondary/*therapy ; *Chemoembolization, Therapeutic ; Doxorubicin/administration & dosage ; Gelatin Sponge, Absorbable/administration & dosage ; Hepatic Artery/pathology ; Humans ; Injections, Intra-Arterial ; Iodized Oil/administration & dosage ; Liver Cirrhosis/diagnosis/pathology ; Liver Neoplasms/diagnosis/pathology/*therapy ; Male ; Middle Aged ; *Ribs/radiography/radionuclide imaging ; Tomography, X-Ray Computed

Bone scan (BS) and serum alkaline phosphatase (ALP) concentration are used to detect bone metastasis in malignancy, although whole-body fluoro-D-glucose positron emission tomography computed tomography (FDG PET/CT) is being used increasingly. But BS is still used for the detection of metastatic bone lesion. So we compared the usefulness of PET/CT, BS, and serum ALP in detecting bone metastases in patients with newly diagnosed lung cancer. The medical record database was queried to identify all patients with a new diagnosis of lung cancer between January 2004 and December 2005, who had a PET/CT, BS, and serum ALP before treatment. We retrospectively reviewed all patients' records and radiological reports. One hundred eighty-two patients met the inclusion criteria. Bone metastases were confirmed in 30 patients. The sensitivity values were 93.3% for PET/CT, 93.3% for BS, 26.7% for serum ALP concentration, and 26.7% for BS complemented with serum ALP concentration. The respective specificity values were 94.1%, 44.1%, 94.1%, and 97.3%. The kappa statistic suggested a poor agreement among the three modalities. FDG PET/CT and BS had similar sensitivity, but PET/CT had better specificity and accuracy than BS. PET/CT is more useful than BS for evaluating bone metastasis. However, in the advanced stage, because of its high specificity, BS complemented with serum ALP is a cost-effective modality to avoid having to use PET/CT.
Aged ; Alkaline Phosphatase/*blood ; Bone Neoplasms/diagnosis/radionuclide imaging/*secondary ; Carcinoma, Non-Small-Cell Lung/diagnosis/pathology ; Carcinoma, Small Cell/diagnosis/pathology ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Lung Neoplasms/*diagnosis/pathology ; Male ; Medical Records ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography ; Radiopharmaceuticals/*diagnostic use ; Retrospective Studies ; Sensitivity and Specificity ; Technetium Tc 99m Medronate/*diagnostic use ; Tomography, X-Ray Computed ; Whole Body Imaging/methods