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

In conclusion, it would appear from present evidence that several statements can be made. First, MRI is the most accurate method of staging the periprostatic spread of carcinoma. Both the prostate and the regional nodes can be evaluated. The role of ultrasound is, at present, unclear. Second, the utility of CT has diminished with the emergence of high-quality MRI, but in situations in which MRI scans are inconclusive (e.g., in the assessment of paraaortic node disease, in which images are degraded by peristaltic movement), CT may be useful. Third, the choice of method for the assessment of nodal disease is a more difficult question. Although MRI and CT have replaced lymphography in most centers, the latter study, especially when combined with fine-needle aspiration biopsy, still is useful. Fourth, bone metastases are best assessed with scintigraphy, which can point to areas requiring supplemental plain radiography. An MRI study of the spine, although highly sensitive, is not practical. Fifth, MRI is superior to CT myelography in assessing spinal disease. Finally, the chest radiograph is the mainstay of assessing chest involvement.
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PMID:Imaging of patients with stage D prostatic carcinoma. 199 73

There is now a wide choice of medical imaging to show both focal and diffuse pathologies in various organs. Conventional radiology with plain films, fluoroscopy and contrast medium have many advantages, being readily available with low-cost apparatus and a familiarity that almost leads to contempt. The use of plain films in chest disease and in trauma does not need emphasizing, yet there are still too many occasions when the answer obtainable from a plain radiograph has not been available. The film may have been mislaid, or the examination was not requested, or the radiograph had been misinterpreted. The converse is also quite common. Examinations are performed that add nothing to patient management, such as skull films when CT will in any case be requested or views of the internal auditory meatus and heal pad thickness in acromegaly, to quote some examples. Other issues are more complicated. Should the patient who clinically has gall-bladder disease have more than a plain film that shows gall-stones? If the answer is yes, then why request a plain film if sonography will in any case be required to 'exclude' other pathologies especially of the liver or pancreas? But then should cholecystography, CT or scintigraphy be added for confirmation? Quite clearly there will be individual circumstances to indicate further imaging after sonography but in the vast majority of patients little or no extra information will be added. Statistics on accuracy and specificity will, in the case of gall-bladder pathology, vary widely if adenomyomatosis is considered by some to be a cause of symptoms or if sonographic examinations 'after fatty meals' are performed. The arguments for or against routine contrast urography rather than sonography are similar but the possibility of contrast reactions and the need to limit ionizing radiation must be borne in mind. These diagnostic strategies are also being influenced by their cost and availability; purely pragmatic considerations are not infrequently the overriding factor. Non-invasive methods will be preferred, particularly sonography as it is far more acceptable by not being claustrophobic and totally free of any known untoward effects. There is another quite different but unrelated aspect. The imaging methods, apart from limited exceptions, cannot characterize tissues as benign or malignant, granulomatous or neoplastic; cytology or histology usually provides the answer. Sonography is most commonly used to locate the needle tip correctly for percutaneous sampling of tissues. Frequently sonography with fine needle aspiration cytology or biopsy is the least expensive, safest and most direct route to a definitive diagnosis. Abscesses can be similarly diagnosed but with needles or catheters through which the pus can be drained. The versatility and mobility of sonography has spawned other uses, particularly for the very ill and immobile, for the intensive therapy units and for the operating theatre, as well in endosonography. The appointment of more skilled sonographers to the National Health Service could make a substantial contribution to cost-effective management of hospital services. Just when contrast agents and angiography have become safe and are performed rapidly, they are being supplanted by scanning methods. They are now mainly used for interventional procedures or of pre-operative 'road maps' and may be required even less in the future as MRI angiography and Doppler techniques progress. MRI will almost certainly extent its role beyond the central nervous system (CNS) should the equipment become more freely available, especially to orthopaedics. Until then plain films, sonography or CT will have to suffice. Even in the CNS there are conditions where CT is more diagnostic, as in showing calculations in cerebral cysticercosis. Then, too, in most cases CT produces results comparable to MRI apart from areas close to bone, structures at the base of the brain, in the posterior fossa and in the spinal cord. Scintigraphy for pulmonary infarcts and bone metastases and in renal disease in children plays a prominent role and its scope has increased with new equipment and radionuclides. Radio-immunoscintigraphy in particular is likely to expand greatly not only in tumour diagnosis but also in metabolic and infective conditions. Whether the therapeutic implications will be realized is more problematic. The value of MRS and NM for metabolic studies in clinical practice is equally problematical, although the data from cerebral activity are extremely interesting. While scanning has replaced many radiographic examinations, endoscopy has had a similar effect on barium meals and to a lesser extent on barium enemas. The combined visual/sonographic endoscope is likely to accelerate this process. There is no doubt that over the last 2 decades medical imaging has changed the diagnostic process, but its influence on the outcome of disease other than infections is less certain and probably indefinable. Data concerning the comparative efficacy in terms of patient outcome for each of the imaging techniques would be of considerable interest and a great help in determining diagnostic strategies.
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PMID:Medical imaging. 206 25

Solitary abnormalities in bone scintigrams of cancer patients are a finding causing special diagnostic problems. In a prospective study the value of MRI imaging of the bone marrow was to be ascertained when compared to recognized X-ray studies, as a method of clarifying suspect bone scintigraphy findings. 25 cancer patients presenting with a solitary suspect abnormality in bone scintigrams were examined by X-rays and MRI. In 15 patients, MRI showed that metastases were the probable cause of the hot spot. In 7 patients, radiography, the routinely used method to confirm or exclude the presence of metastases, failed to detect these metastases. In the remaining 10 patients other causes of increased activity in the bone scintigrams could be demonstrated, e.g. fracture, degenerative disease, benign tumour. The results were confirmed by biopsy, operation, autopsy or follow-up. Considering the clinical consequences of the diagnosis of bone metastases, we suggest that a bone marrow MRI of the affected region should be performed to clarify the cause of a solitary hot spot in bone scintigrams of cancer patients, especially if X-ray studies are inconclusive.
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PMID:[Magnetic resonance tomography of the bone marrow in cancer patients with a solitary area of increased uptake in the bone scintigram]. 207 88

Plain film radiography and pluridirectional tomography have been displaced by CT and MRI for imaging NPC. The latter techniques are to some extent complementary, since MRI is particularly useful for defining soft-tissue components and CT accurately delineates bone erosion. CT, however, also provides good soft-tissue definition in conjunction with contrast enhancement. Nuclear isotope scanning is valuable in detecting bone metastases. These imaging techniques are of particular value in detecting submucosal tumors not visible clinically and are also essential to accurate tumor staging.
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PMID:Radiology of nasopharyngeal carcinoma. 235 Oct 86

In the diagnosis of clinically inapparent breast cancer, mammography remains the most effective imaging modality, which is due in large part to its ability to detect microcalcifications. Of the ancillary modalities, sonography is the most useful because it readily differentiates cysts from other breast lesions. Internal mammary and axillary node imaging have been tried with varying levels of success, but false-positive and false-negative rates remain high with available techniques. Pulmonary metastases are best evaluated by chest X-ray with specificity increased by other imaging techniques. Liver and bone metastases may be screened for with isotope scans with computerized tomography, sonography, and magnetic resonance imaging, increasing the specificity of abnormal scans. CT and MRI are the most effective tools for evaluating CNS disease.
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PMID:Imaging techniques in breast cancer. 265 74

CT and MRI scanning provide valuable information in determining location and extension of middle ear and mastoid tumors and tumor-like conditions. The bone anatomy depicted by CT better delineates the involvement of the middle ear diseases. In glomus tumors, facial nerve tumors, and other cases including temporal bone metastases, the combination of CT and MR imaging is exceedingly useful in the diagnosis and management of patients.
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PMID:Tumors and tumor-like conditions of the middle ear and mastoid: role of CT and MRI. An analysis of 100 cases. 283 14

Radiologic strategy for early detection of bone metastasis is discussed. Incidence, pathway, and radiologic manifestation of bone metastasis are briefly discussed. Bone scintigraphy is a mainstay for early detection of bone metastases, although its role as a part of staging procedure is debatable. Plain radiograph and CT scan are to be used to increase specificity of scintigraphic findings. For detection of spinal metastases CT scan is particularly useful and should be used whenever spinal metastases are suspected. MRI has become an important modality to see an extraosseous extension and marrow invasion of metastatic bone tumor.
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PMID:[Radiologic detection of metastatic bone tumors]. 317 6

The usefulness of 99mTc-MIBI scintigraphy for the detection of parathyroid lesions was evaluated in 17 patients with hyperparathyroidism. Delayed image was used to evaluate the lesions. Detectability of MIBI for parathyroid lesions was 86% (18/21). The smallest lesion detected was parathyroid hyperplasia weighted 270 mg. Ectopic parathyroid adenoma and bone metastases of parathyroid carcinoma were clearly demonstrated. Detectability of MIBI scintigraphy for the lesions including ectopic and metastatic lesions was the highest among those of ultrasonography, CT and MRI methods. MIBI scintigraphy was thought to be useful for the detection of parathyroid lesions, especially for ectopic and metastatic lesions.
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PMID:[99mTc-MIBI scintigraphy for the detection of parathyroid lesions in patients with hyperparathyroidism]. 767 65

The most effective whole-body screening test for bone metastases is the radionuclide bone scan. Conventional radiography is the best modality for characterizing metastatic lesions. Furthermore, conventional radiographs are useful for depicting impending or early pathologic fractures. The radiographic sensitivity depends on the extent, location and type of bone metastases. Therefore, normal radiographs in patients with either a positive bone scan or persistent, unexplained pain must be suspect. In these cases CT may establish the diagnosis. However, metastatic lesions in the marrow space without architectural changes in the surrounding bone can be detected only by MRI. The use of CT is also helpful in determining the local extent of bone destruction and extension into the surrounding soft tissues when planning surgery or radiotherapy.
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PMID:[Conventional imaging and computerized tomography in diagnosis of skeletal metastases]. 789 38

The records of 3,795 cases of malignant melanoma treated at the INT (Milan) from 1975 to 1992 were reviewed. Histologic confirmation was obtained in all cases. Thirty-one patients (0.82%) with solitary or multiple skeletal metastases were identified. The review of conventional films, tomograms, CT, MR and bone scintigraphy images enabled us to detect 120 single bone lesions. The X-ray features were divided into two groups according to typical and atypical skeletal lesions. Typical bone metastases are osteolytic (87.5%), with medullary origin (91.6%), and they cannot be distinguished from other osteolytic metastases on the basis of imaging criteria alone. Lesion growth causes cortical erosion and destruction (46.6%), pathologic fractures (22.5%) and soft tissue involvement (12.5%). Lytic areas usually have ill-defined margins. Clear-cut outline is an uncommon finding. Atypical skeletal metastases exhibit a mixed osteolytic-osteoblastic pattern (10%), which is hardly ever completely osteoblastic (2.5%). Other unusual metastatic patterns include intense trabecular rarefaction with no detectable single lesion (3.3%), the presence of a well-defined sclerotic rim and periosteal reaction (12.5%). Atypical growth may cause extensive cortical destruction and periosteal production resembling osteogenic osteosarcoma. The various imaging methods show that conventional radiology has relatively poor sensitivity because of anatomical reasons, while MRI is the most sensitive method to detect skeletal localizations. Treatment changes the radiologic patterns of the lesions: recalcification, sclerotic rim, periosteal reaction are common response patterns. Finally, in spite of the above limitations, conventional radiology remains the method of choice to assess lesion evolution during the follow-up.
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PMID:[The radiodiagnosis of bone metastases from melanoma]. 804 25


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