Söderlund V
Department of Radiology, Karolinska Hospital and Sophiahemmet, Stockholm, Sweden.
Eur Radiol. 1996;6(5):587-95. doi: 10.1007/BF00187654.
The clinical management of patients with skeletal metastases puts new demands on imaging. The radiological imaging in screening for skeletal metastases entails detection, metastatic site description and radiologically guided biopsy for morphological typing and diagnosis. Regarding sensitivity and the ease in performing surveys of the whole skeleton, radionuclide bone scintigraphy still is the first choice in routine follow-up of asymptomatic patients with metastatic disease of the skeleton. A negative scan has to be re-evaluated with other findings, with emphasis on the possibility of a false-negative result. Screening for metastases in patients with local symptoms or pain is best accomplished by a combination of radiography and MRI. Water-weighted sequences are superior in sensitivity and in detection of metastases. Standard spin-echo sequences on the other hand are superior in metastatic site description and in detection of intraspinal metastases. MRI is helpful in differentiating between malignant disease, infection, benign vertebral collapse, insufficiency fracture after radiation therapy, degenerative vertebral disease and benign skeletal lesions. About 30% of patients with known cancer have benign causes of radiographic abnormalities. Most of these are related to degenerative diseases and are often easily diagnosed. However, due to overlap in MRI characteristics, bone biopsy sometimes is essential for differentiating between malignant and nonmalignant lesions. Performing bone biopsy and aspiration cytology by radiologist and cytologist in co-operation has proven highly accurate in diagnosing bone lesions. The procedure involves low risk to the patient and provides a morphological diagnosis. Once a suspected metastatic lesion is detected, irrespective of modality, the morphological diagnosis determines the appropriate work-up imaging with respect to the therapy alternatives. The integration of multimodality imaging in the assessment of skeletal metastases is complex and requires multidiciplinary co-operation in order to optimize screening and medical clinical care with respect to the prognosis and life quality of patients with bone metastatic disease.
骨骼转移瘤患者的临床管理对影像学提出了新的要求。骨骼转移瘤筛查中的放射影像学检查需要进行检测、描述转移部位，并在放射学引导下进行活检以进行形态学分型和诊断。就敏感性和对整个骨骼进行检查的便捷性而言，放射性核素骨显像仍是骨骼转移性疾病无症状患者常规随访的首选方法。阴性扫描结果必须结合其他检查结果进行重新评估，尤其要注意假阴性结果的可能性。对于有局部症状或疼痛的患者，转移瘤的筛查最好通过X线摄影和MRI联合进行。水加权序列在转移瘤的敏感性和检测方面更具优势。另一方面，标准自旋回波序列在转移部位描述和脊髓内转移瘤检测方面更具优势。MRI有助于鉴别恶性疾病、感染、良性椎体塌陷、放疗后骨质疏松性骨折、退行性椎体疾病和良性骨骼病变。约30%已知患有癌症的患者存在影像学异常的良性病因。其中大多数与退行性疾病有关，通常易于诊断。然而，由于MRI特征存在重叠，有时骨活检对于区分恶性和非恶性病变至关重要。由放射科医生和细胞病理学家合作进行骨活检和细针穿刺抽吸活检，在诊断骨病变方面已被证明具有很高的准确性。该操作对患者风险较低，并能提供形态学诊断。一旦检测到疑似转移瘤病变，无论采用何种检查方式，形态学诊断都能确定针对治疗方案的合适的后续影像学检查。在骨骼转移瘤评估中整合多模态影像学检查较为复杂，需要多学科合作，以便在骨转移性疾病患者的预后和生活质量方面优化筛查和医疗临床护理。
