Singh Parneet, Agrawal Kanhaiyalal, Rahman Ashique, Singhal Tejasvini, Parida Girish Kumar, Gnanasegaran Gopinath
Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneshwar 751019, Odisha, India.
Department of Nuclear Medicine, Royal Free Hospital, London NW3 2QG, United Kingdom.
World J Radiol. 2024 Jul 28;16(7):265-273. doi: 10.4329/wjr.v16.i7.265.
Bone is one of the common sites of metastasis from prostate carcinoma. Bone scintigraphy (BS) is one of the most sensitive imaging modalities currently used for bone metastatic work-up. Skeletal metastasis in prostate carcinoma commonly involves pelvic bones but rarely involves extrapelvic-extraspinal sites.
To retrospectively analyze the BS data to determine the pattern of skeletal metastases in the prostate carcinoma.
This retrospective observational study involves patients with biopsy-proven prostate carcinoma referred for BS for staging assessment. Patients with abnormal BS were evaluated for the pattern of skeletal involvement and data were presented in descriptive format in the form of percentages.
A total of 150 patients with biopsy-proven prostate cancer who were referred for staging were included in the study. Thirteen of 150 patients (8.67%) had no abnormal uptake on planar images, ruling out metastatic disease. Twenty-four patients (16%) had heterogeneous uptake in the spine with distribution characteristic of degenerative disease and no scan pattern of metastatic disease. Thirty patients (20%) had multifocal uptake involving both pelvic and extra pelvic bones on planar images typical for skeletal metastasis and were considered metastatic. Eighty-three out of 150 patients (55.3%) had increased tracer uptake, which was indeterminate, thus, single photon emission computed tomography-computed tomography (SPECT-CT) was acquired, which showed 51 with metastatic disease, 31 benign lesions, and one indeterminate finding. Seven of 150 patients had exclusive pelvic bone uptake, which was found to be metastatic in 4/7 patients in SPECT-CT. Fifty six out of 150 patients showed exclusive extrapelvic tracer uptake, of which only 3 had vertebral metastatic disease. None of the patients with increased uptake exclusively in the extrapelvic-extraspinal location was metastatic.
The incidence of exclusive extrapelvic skeletal metastatic disease in prostate carcinoma is 2% (excluding one patient with indeterminate findings). Further, none of the patients in the current study had exclusive extrapelvic-extraspinal metastasis. Thus, exclusive extrapelvic-extraspinal focal abnormality on planar BS carries a very low probability of metastatic disease and hence, further imaging or SPECT-CT can be safely avoided in such cases.
骨骼是前列腺癌常见的转移部位之一。骨闪烁显像（BS）是目前用于骨转移检查最敏感的成像方式之一。前列腺癌的骨转移通常累及骨盆骨，但很少累及骨盆外 - 脊柱外部位。
回顾性分析BS数据，以确定前列腺癌骨转移的模式。
这项回顾性观察性研究纳入了经活检证实为前列腺癌并接受BS进行分期评估的患者。对BS异常的患者评估骨骼受累模式，并以百分比形式以描述性格式呈现数据。
本研究共纳入150例经活检证实为前列腺癌并接受分期的患者。150例患者中有13例（8.67%）在平面图像上无异常摄取，排除转移疾病。24例患者（16%）脊柱有不均匀摄取，具有退行性疾病的分布特征，无转移疾病的扫描模式。30例患者（20%）在平面图像上有多灶性摄取，累及骨盆和骨盆外骨骼，典型的骨转移表现，被认为是转移性的。150例患者中有83例（55.3%）示踪剂摄取增加，结果不确定，因此进行了单光子发射计算机断层扫描 - 计算机断层扫描（SPECT - CT），其中51例为转移性疾病，31例为良性病变，1例结果不确定。150例患者中有7例仅骨盆骨摄取，在SPECT - CT中发现4/7患者为转移性。150例患者中有56例示踪剂仅在骨盆外摄取，其中仅3例有椎体转移疾病。仅在骨盆外 - 脊柱外部位摄取增加的患者均无转移性。
前列腺癌仅骨盆外骨骼转移疾病的发生率为2%（不包括1例结果不确定的患者）。此外，本研究中没有患者有仅骨盆外 - 脊柱外转移。因此，平面BS上仅骨盆外 - 脊柱外局灶性异常发生转移疾病的概率非常低，因此，在这种情况下可以安全地避免进一步成像或SPECT - CT检查。
