The value of radio-imaging methods in the diagnosis of chest wall metastases.

The aim of the study was to reveal the value of radio-imaging methods in the diagnostic assessment of chest wall metastases. We retrospectively reviewed 48 cases of chest wall metastases examined clinically, radiologically, by ultrasound, CT-scan and MRI. All cases were histologically assessed by surgical biopsies. Plain chest radiography (X-ray) was in all cases a prerequisite for any evaluation of the chest wall being of great value in demonstration of the displaced rib fractures, localized bony destruction and the detection of most soft tissue lesions. The ultrasound examination (US) allowed real time analysis and thus the functional imaging of the chest wall metastases with special interest in vascular impairment being limited by relatively small field of view with more difficulties in anatomical orientation. With involvement of bone marrow and spinal cord, MRI became the most sensitive and the most specific imaging method, successfully diagnosing intramedullar lesions in three cases. In the detection of chest wall infiltration by primary malignancies from the lung, pleura, pericardium, breast and spinal cord we preferred the CT-scan, which revealed the presence of the lesions in 29 cases with typically obtuse angles against the adjacent chest wall and pleura. In the imaging evaluation of malignant lymphoma the CT-scan demonstrated chest wall extension in five cases. CT-scan and MRI revealed chest wall localization for distant metastases in 14 cases. The imaging methods clearly showed the number, the extent, the anatomic reports and the aggressive characteristics of chest wall metastases being of great value in the decision of adequate therapy.