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Query: UMLS:C0153690 (bone metastases)
 6,382 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite advances in morphological imaging, some patients with lung cancer are found to have non resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. We have attempted to evaluate the utility of the fluorine-18 deoxyglucose positron emission tomography (FDG PET) for the detection of bone metastasis. One hundred and ten consecutive patients with histological diagnosis of non-small cell lung cancer (NSCLC) who underwent both FDG PET and bone scintigraphy were selected for this review. In this group, there were 43 patients with metastatic disease (stage IV). Among these, 21 (19% of total group) had one or several bone metastases confirmed by biopsy (n = 8) or radiographic techniques (n = 13). Radionuclide bone scanning correctly identified 54 out of 89 cases without osseous involvement and 19 out of 21 osseous involvements. On the other hand, FDG PET correctly identified the absence of osseous involvement in 87 out of 89 patients and the presence of bone metastasis in 19 out of 21 patients. Thus using PET there were two false-negative and two false-positive cases. PET and bone scanning had, respectively, an accuracy of 96% and 66% in the evaluation of osseous involvement in patients with NSCLC. In conclusion, our data suggest that whole-body FDG PET may be useful in detecting bone metastases in patients with known NSCLC.
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PMID:Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer. 972 72

The early detection of metastases from medullary thyroid cancer (MTC) is important because the only curative therapy consists in surgical removal of all tumour tissue. There is no single sensitive diagnostic imaging modality for the localization of all metastases in patients with MTC. Therefore, in many cases several imaging modalities (e.g. ultrasonography, magnetic resonance imaging, computerized tomography and scintigraphy using pentavalent technetium-99m dimercaptosuccinic acid, thallium-201 chloride, indium-111 pentetreotide, anti-CEA antibodies or metaiodobenzylguanidine) must be performed consecutively in patients with elevated calcitonin levels until the tumour is localized. In this prospective study, we investigated the value of fluorine-18 fluorodeoxyglucose positron emission tomography ([18F]FDG PET) in the follow-up of patients with MTC. [18F]FDG PET examinations of the neck and the chest were performed in 20 patients with elevated calcitonin levels or sonographic abnormalities in the neck. Positive [18F]FDG findings were validated by histology, computerized tomography or selective venous catheterization. [18F]FDG PET detected tumour in 13/17 patients (nine cases were validated by histology, four by computerized tomography). Five patients showed completely negative PET scans (of these cases, one was true-negative and four false-negative). One patient with [18F]FDG accumulation in pulmonary lesions from silicosis and one patient with a neck lesion that was not subjected to histological validation had to be excluded. Considering all validated localizations, [18F]FDG PET detected 12/14 tumour manifestations in the neck, 6/7 mediastinal metastases, 2/2 pulmonary metastases and 2/2 bone metastases. In two patients with elevated calcitonin levels, no diagnostic modality was able to localize a tumour. The sensitivity of [18F]FDG PET in the follow-up of MTC was 76% (95% confidence interval 53%-94%); this is encouraging. [18F]FDG PET promises to be a valuable diagnostic method, especially for the detection of lymph node metastases, surgical resection of which can result in complete remission.
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PMID:The value of fluorine-18 fluorodeoxyglucose PET in patients with medullary thyroid cancer. 1085 2

The purpose of this study was to evaluate the usefulness of positron emission tomography with 18F-2-deoxyglucose (FDG-PET) for the detection of malignant bone metastases, and to compare FDG-PET results with conventional technetium-99m methylene diophosphate (Tc-99m MDP) bone scan findings. Twenty-four patients (10 females, 14 males, ages: 39-71 years) with biopsy-proven malignancy and suspected bone metastases, underwent whole body FDG-PET and bone scan to detect bone metastases. Bone metastases were established in 39 discordant bone lesions by histopathological examination of biopsy samples, MRI/CT, and follow-up bone scan/FDG-PET findings showing progressively and extensively widespread bone lesions. A total of 98 bone lesions found on either FDG-PET or bone scan were evaluated For 39 bone lesions with discordant findings between FDG-PET and bone scan, histopathological examination, MRI/CT and follow-up bone scan/FDG-PET findings revealed 8 metastatic and 0 benign bone lesions with positive FDG-PET findings, not detected on bone scan. Eleven metastatic and 20 benign bone lesions with positive bone scan findings were not detected on FDG-PET. FDG-PET has a better specificity, but a lower sensitivity for detecting malignant bone metastases when compared with bone scan.
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PMID:Comparison and discrepancy of 18F-2-deoxyglucose positron emission tomography and Tc-99m MDP bone scan to detect bone metastases. 1092 75

The clinical usefulness of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) was examined in 54 patients with prostate cancer. FDG accumulation was positive in 38 of 54 the prostates (70%), 3 of 8 the lymph node metastases (38%) and 10 of 16 the bone metastases (63%), which suggested that FDG-PET is not superior to other conventional imaging methods as a tool for tumor detection. On the other hand, a quantitative value for FDG uptake in the prostate, expressed as a standardized uptake value (SUV), significantly correlated to the histological grade, clinical stage and serum PSA of the patients. A decrease of SUV was observed in all the patients who responded to endocrine treatment, and the patients with high pre-treatment SUV were shown to be at the risk for disease progression after initial treatment. The present results indicated that FDG-PET could provide us with useful prognostic information for the patients with prostate cancer by evaluating the malignant potential of the tumor.
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PMID:[Evaluation of prostate cancer using FDG-PET]. 1119 11

Malignant paraganglioma is a rare and slow growing tumour of neuroendocrine origin. At the time of diagnosis, the tumour is usually widespread, with limited therapeutic options. A variety of functional imaging studies are available for staging the disease, guiding therapy and monitoring treatment response. These include 123I-MIBG or 131I-MIBG, 111In-pentetreotide or 111In-lanreotide (somatostatin analogues), and 18F-FDG positron emission tomography. Various radionuclides, including 131I and 90Y, can be targeted to the tumour using MIBG or pentetreotide. Such targeted radionuclide therapy may provide valuable long-term palliation in such patients. We present two cases with metastatic paragangliomas who had widespread soft tissue and bone metastases. One patient was treatment naive and the second had received previous chemotherapy. The functional imaging work-up performed and the targeted radionuclide therapies considered in these patients are described. Both patients were treated with 131I-MIBG. Partial tumour response and complete symptomatic and hormonal response was achieved in one patient; in the second patient there was no change.
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PMID:Functional imaging as an aid to decision-making in metastatic paraganglioma. 1133 5

The staging procedures for small cell lung cancer do not differ appreciably from those for other forms of lung cancer. For practical purposes, the TNM stages are usually collapsed into a simple binary classification: limited disease and extensive disease. This study was performed to answer the question of whether fluorine-18 labelled 2-deoxy-2-D-glucose positron emission tomography (FDG-PET) imaging permits appropriate work-up (including both primary and follow-up staging) of patients presenting with small cell lung cancer, as compared with currently recommended staging procedures. Thirty-six FDG-PET examinations were performed in 30 patients with histologically proven small cell lung cancer. Twenty-four patients were examined for primary staging while four were imaged for therapy follow-up only. Two patients underwent both primary staging and up to four examinations for therapy follow-up. Static PET imaging was performed according to a standard protocol. Image reconstruction was based on an ordered subset expectation maximization algorithm including post-injection segmented attenuation correction. Results of FDG-PET were compared with those of the sum of other staging procedures. Identical results from FDG-PET and the sum of the other staging procedures were obtained in 23 of 36 examinations (6x limited disease, 12x extensive disease, 5x no evidence of disease). In contrast to the results of conventional staging, FDG-PET indicated extensive disease resulting in an up-staging in seven patients. In one patient in whom there was no evidence for tumour on conventional investigations following treatment, FDG-PET was suggestive of residual viability of the primary tumour. Furthermore, discordant results were observed in five patients with respect to lung, bone, liver and adrenal gland findings, although in these cases the results did not affect staging as limited or extensive disease. Moreover, FDG-PET appeared to be more sensitive for the detection of metastatic mediastinal and hilar lymph nodes and bone metastases. Finally, all findings considered suspicious for tumour involvement on the other staging procedures were also detected by FDG-PET. It is concluded that FDG-PET has potential for use as a simplified staging tool for small cell lung cancer.
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PMID:FDG-PET imaging for the staging and follow-up of small cell lung cancer. 1135 99

The exact roles of PET in the imaging management of patients with known or suspected breast cancer are still in evolution. For assessing primary lesions, it is sometimes possible with PET to detect cancers occult on standard methods. This could be useful in high-risk patient populations, but in dense breasts, background FDG uptake is often higher than in women with fatty breasts, making identification of lesions < 1 cm in size improbable with current technologies. Distinguishing malignant from benign primary breast disease would seem better addressed by biopsy. With a positive predictive value of FDG PET for cancer over 96%, any FDG-avid breast lesion is highly suspicious and merits biopsy. Although PET in theory should be useful for depicting multifocal disease before surgery, the limitations in detecting small lesions in the breast limit the contribution of PET at present. It is most likely that PET will have a greater role in depicting primary breast lesions as dedicated PET imaging devices for the breast evolve. For axillary and internal mammary nodal staging, results with FDG PET are variable. Small nodal metastases < or = 5 mm will be missed by PET, whereas larger ones are more likely to be detected. PET can depict internal mammary nodes, but the accuracy of the method in this setting is not known, nor is there consensus on how identifying internal mammary node metastases will change treatment. Based on the available data, for pT1 breast lesions, PET, if negative, is not an adequate replacement for sentinel node surgery or axillary dissection. Results from the multicenter trial will be of great interest. Clearly PET can stage metastatic disease well. Bone scans with 18F- are exquisitely sensitive for metastases, and FDG is also very good. However, FDG PET can miss some blastic metastases to bone so at present FDG is not capable of excluding the presence of bone metastases. PET seems very well suited to detecting recurrences in soft tissues and the brachial plexus region in particular. The utility of PET in planning the treatment of individual patients appears promising. Although results must be confirmed in larger studies, it appears safe to conclude that failure of a chemotherapy regimen to decrease FDG uptake promptly in a breast cancer portends poor response. This does not hold true for hormonal therapy. At present, labeled estrogens are not widely available and cannot be recommended for clinical use. Thus, PET has shown considerable promise in breast cancer imaging, but in the author's experience is best applied to solve difficult imaging questions in specific patients and is not recommended for routine evaluation of the breast cancer patient. However, in larger primary tumors, the ability to use PET for staging and to plan treatment response suggest it will be more widely used. Additional studies with newer PET imaging devices and FDG and other tracers will help us better determine the role of PET in routine clinical care of the patient with known or suspected breast cancer. Certainly, this represent a fertile area for translational research studies over the next several years with the potential to significantly alter the way breast cancer is imaged and managed.
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PMID:Current status of PET in breast cancer imaging, staging, and therapy. 1147 71

Currently, bone scintigraphy (BS) is considered to lack sensitivity in detecting bone metastases (BM) from thyroid cancer. We evaluated the anatomical distribution and metabolic behavior of BM as well as the accuracy of BS with and without combination of whole-body iodine scintigraphy (WBI) in detecting metastatic bone disease in thyroid carcinoma. F-18 positron emission tomography (PET), x-ray, BS, and WBI were performed in 35 patients with known or suspected bone metastases from papillary (9 patients) or follicular (26 patients) thyroid carcinoma. Twenty-two metastases were previously known in 14 patients. The indication was staging in 21 patients with high risk for BM, elevated thyroglobulin (Tg)-levels or evaluation of exact extent of BM (14 patients). In addition, results of WBI (35 patients), X-ray (35 patients) F-18 PET (35 patients), MRI of the spine (13 patients), and FDG-PET (15 patients) as well as the clinical course (1.5-4 years) were correlated. BM were detected in 18 patients. Solitary, bifocal, or multiple lesions were present in 9, 2, and 7 patients, respectively. The anatomical distribution of BM (n = 43) was as follows: spine, 42%; skull, 2%; thorax, 16%; femur, 9%; pelvis, 26%; humerus and clavicle, 5%. Sensitivity of BS in interpreting patients as positive or negative for having BM was 64%-85% (specificity, 95%-81%). The combination of BS and WBI was 100% sensitive in detecting metastatic bone disease. One patient had a single BM that was positive at BS but negative on WBI. All metastases were osteolytic on x-ray and two-thirds presented a missing or very limited osteosclerotic bone reaction on F-18 PET. Our data confirm the limited sensitivity of planar BS in detecting BM from thyroid cancer. The combination of BS and WBI, however, was highly accurate. Compared to other malignancies, the distribution pattern of BM presented a lower percentage of vertebral metastases and more patients with single metastases. Those findings in combination with a missing or only slight osteosclerotic bone reaction explain the limited sensitivity of planar BS alone.
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PMID:Anatomical distribution and sclerotic activity of bone metastases from thyroid cancer assessed with F-18 sodium fluoride positron emission tomography. 1148 97

The aim of the study was to evaluate sensitivity and specificity of positron emission tomography (PET) and 18F-fluorodesoxyglucose (18F-FDG) in breast cancer diagnosis and to assess tumor dissemination. Sixty two patients were examined: 10 without mammary disease, 10 with fibrous cystic mastopathy, and 42 with breast cancer, which was hystologically verified. PET scanning was recorded in the "Whole body" mode 70-90 min later administration of 370-420 MBq 18F-FDG. It was shown that PET has a high diagnostic accuracy in breast cancer detection. There were no False-positive cases in our investigations. PET scanning in the "Whole body" mode was allowed to assess dissemination of tumor process with high accuracy. Metastatic involvement of local lymph nodes was detected in 82.8% cases and bone metastases--86% in cases.
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PMID:[Clinical experience with positron emission tomography with 2-fluorine, 18F-2-deoxy-d-glucose used for the diagnosis of malignant breast neoplasms]. 1185 29

A case of carcinomatous monoarthritis involving the left knee due to colonic adenocarcinoma is described. Large recurrent synovial effusion, that will be later hematic, lytic lesion of the bones and chondrolysis were noted. Knee positron emitting tomography scan using FDG (FDG-PET) revealed a diffuse increased uptake in soft tissues assumed to be synovium, the hypertrophy of which was identified by ultrasonography. Whole body PET scan showed extensive lymph node, visceral and bone metastases, suggesting that the increase in the synovium could also be of metastatic origin. The final diagnosis of synovial carcinomatosis secondary to the known colonic adenocarcinoma was confirmed by histological analysis of biopsies obtained by arthroscopy. A review of the literature is realised. To our knowledge, this is the first synovial metastasis studied by FDG-PET.
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PMID:[Synovial metastases from colonic cancer presenting as arthritis of the knee. Characterization by 18FDG PET scan]. 1223 24


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