Traill Z C, Talbot D, Golding S, Gleeson F V
Department of Radiology, Churchill Hospital, Headington, Oxford, UK.
Clin Radiol. 1999 Jul;54(7):448-51. doi: 10.1016/s0009-9260(99)90830-9.
To determine the frequency of isolated, asymptomatic metastases of the peripheral skeleton in patients with breast and prostate cancer.
A retrospective review was performed of staging skeletal scintigrams. Patients with hot spots in the peripheral skeleton in the absence of convincing evidence of metastatic disease in the axial skeleton were followed-up to determine the nature of the peripheral lesion(s) based on other imaging modalities, serial imaging or biopsy, and to determine if the lesion(s) had been symptomatic at the time of the scintigram.
200 patients with histologically proven carcinomas of the breast or prostate.
Four patients (2%) had isolated metastatic involvement of the peripheral skeleton, and would, therefore, have been wrongly staged by a magnetic resonance 'marrow screen' of the axial skeleton. However, in three of these patients the lesions were painful, prompting diagnostic plain radiographs independent of the scintigraphic findings. Twelve patients (6%) had isolated scintigraphic abnormalities of the peripheral skeleton suggestive of metastatic disease but which on further investigation were shown to be benign lesions.
A limited magnetic resonance (MR) 'marrow screen' confined to the axial skeleton would not result in any significant loss of accuracy in staging patients with breast and prostate carcinoma compared with skeletal scintigraphy. Given the proven increased sensitivity of MR over skeletal scintigraphy in the detection of bone metastases, and the additional information MR provides, it is likely to provide a more accurate basis for management.
确定乳腺癌和前列腺癌患者外周骨骼孤立性无症状转移的发生率。
对分期骨骼闪烁扫描进行回顾性分析。对轴向骨骼无确凿转移疾病证据但外周骨骼有热点的患者进行随访，以根据其他成像方式、系列成像或活检确定外周病变的性质，并确定在闪烁扫描时病变是否有症状。
200例经组织学证实为乳腺癌或前列腺癌的患者。
4例患者（2%）有外周骨骼孤立性转移受累，因此，通过轴向骨骼的磁共振“骨髓筛查”会导致分期错误。然而，其中3例患者的病变有疼痛症状，促使进行独立于闪烁扫描结果的诊断性X线平片检查。12例患者（6%）有外周骨骼孤立性闪烁扫描异常，提示转移疾病，但进一步检查显示为良性病变。
与骨骼闪烁扫描相比，仅局限于轴向骨骼的有限磁共振（MR）“骨髓筛查”在乳腺癌和前列腺癌患者分期中不会导致准确性有任何显著损失。鉴于已证实MR在检测骨转移方面比骨骼闪烁扫描具有更高的敏感性，以及MR提供的额外信息，它可能为治疗提供更准确的依据。
