Elgazzar A H, Kazem N
Department of Nuclear Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait.
Gulf J Oncolog. 2009 Jan(5):9-21.
The diagnosis of presence, location and load of metastatic, bone involvement has important implication on patient management and prognosis. This requires collection of data obtained using different imaging modalities. Bone scintigraphy is a highly sensitive and cost-effective screening modality. However, to overcome its lower specificity and its limitation in evaluation of vertebral metastases, CT, PET or MRI can be utilized to verify the nature of suspicious lesions. Expansion of SPECT/ CT may fine tune the highly sensitive bone scintigraphy. PET has an emerging and leading role in many tumors, occasionally obviating the need for bone scintigraphy, particularly in evaluation of response to therapy. PET and whole body MRI offers a potentially important tool to provide the earliest clue of bone marrow metastasis. The value of F-18 PET as a sensitive bone imaging tool needs to be further evaluated on a larger scale in different setting including treated and untreated cancer patients and to evaluate also whether potentially better resolution would lead to more benign lesions detection mimicking metastasis such as fractures, inflammatory, infection, and degenerative involvement of bone. The added value of PET-CT is also to be further examined with this regard.
转移性骨受累的存在、位置和负荷的诊断对患者的管理和预后具有重要意义。这需要收集使用不同成像方式获得的数据。骨闪烁扫描是一种高度敏感且具有成本效益的筛查方式。然而，为了克服其较低的特异性以及在评估椎体转移方面的局限性，可以利用CT、PET或MRI来验证可疑病变的性质。SPECT/CT的扩展可能会对高度敏感的骨闪烁扫描进行微调。PET在许多肿瘤中发挥着新兴且主导的作用，偶尔可无需进行骨闪烁扫描，尤其是在评估治疗反应时。PET和全身MRI提供了一个潜在的重要工具，可提供骨髓转移的最早线索。F-18 PET作为一种敏感的骨成像工具的价值需要在包括接受治疗和未接受治疗的癌症患者在内的不同环境中进行更大规模的进一步评估，并且还要评估更高的分辨率是否会导致检测出更多类似转移的良性病变，如骨折、炎症、感染和骨的退行性病变。在这方面，PET-CT的附加值也有待进一步研究。
