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한강성심 영상의학과 이경규 1 ** 67/F C.C.: right pelvic pain for 3 months PMHx : thyroid cancer OP history 1)What is your impression? 2) A first impression and three.

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Presentation on theme: "한강성심 영상의학과 이경규 1 ** 67/F C.C.: right pelvic pain for 3 months PMHx : thyroid cancer OP history 1)What is your impression? 2) A first impression and three."— Presentation transcript:

1 한강성심 영상의학과 이경규 1 ** 67/F C.C.: right pelvic pain for 3 months PMHx : thyroid cancer OP history 1)What is your impression? 2) A first impression and three or less differential diagnoses are acceptable.

2 한강성심 영상의학과 이경규 2 ** Plain film: - an expansile, lytic lesion involving medial aspect of right iliac wing - loss of medial cortical margin & extension across right SI joint - no internal matrix mineralization and no periosteal reaction Bone scan - decreased tracer uptake in right ilium consistent with lytic lesion seen on plain film

3 한강성심 영상의학과 이경규 3 DDX : Meta vs Myeloma * Tumor uptake (-) : extremely aggressive or purely osteolytic highly aggressive anaplastic tumors, reticulum cell sarcoma, RCC, thyroid ca, histiocytosis, neuroblastoma, and multiple myeloma **

4 한강성심 영상의학과 이경규 4 ** Right iliac bone biopsy : metastatic thyroid carcinoma Diagnosis : Thyroid cancer metastasis

5 한강성심 영상의학과 이경규 5 Metastasis Bone scan evaluation

6 한강성심 영상의학과 이경규 6 Target Sites  Red Marrow  Lumbar > Thoracic > Cervical  Uncommon sites  Mandible, Patella  distal to the knee and elbow

7 한강성심 영상의학과 이경규 7 Hematogeneous Route  Venous > Arterial  Batson’s plexus  Extensive comm.  Sluggish flow  Reflux

8 한강성심 영상의학과 이경규 8 Primary / Metastasis Bone expansion Periosteal reaction Soft tissue mass Multiplicity Metastasis (10% solitary) Primary * Meta from lung ca,Thyroid ca, RCC : solitary, expansile

9 한강성심 영상의학과 이경규 9 Typical Radiologic Appearance of Metastases in Adults Primary site Appearance on Plain Radiographs Appearance on Bone scan BreastLytic,mixed or blasticIncreased isotope uptake Prostate Blastic; occasionally mixed or lytic Increased isotope uptake Lung Lytic mixed; occasionally blastic Increased isotope uptake KidneyLytic, blow-out Often decreased isotope uptake Thyroid Lytic, blow-out; sometimes normal Often decreased or normal uptake

10 한강성심 영상의학과 이경규 10 Bone scan : Application Tumor extent or localization Initial tumor staging Identify metastatic sites Monitor disease progression or therapy response

11 한강성심 영상의학과 이경규 11 Bone Metastasis 1. Multiple lesions of varing intensity,size,shape 2. Irregular distribution in axial skeleton 3. Photon deficient lesion extremely aggressive or purely osteolytic 4. Superscan pattern 5. Solitary lesion

12 한강성심 영상의학과 이경규 12 Metastasis  Uptake of tracer - dependent on blood flow and on osteoblastic activity  Malignancy  ↑ hot uptake  ↑ sensitive than plain image (3-5% vs 30-50%) Cold uptake  extremely aggressive or purely osteolytic

13 한강성심 영상의학과 이경규 13 Rib metastasis vs Benign fracture  Benign Fracture  Focal rather than linear  Decreased uptake over 3-6mon  Aligned in same location

14 한강성심 영상의학과 이경규 14 Bone scan : Caution !  Cold uptake  Insufficiency fracture  Superscan  Flare phenomenon

15 한강성심 영상의학과 이경규 15 In cancer patients, - due to metastatic disease (> 80%) may occur - aggressive or purely osteolytic tumor - disruption of blood supply to bone - significant marrow involvement, particularly in a vertebral body cause - highly aggressive anaplastic tumors, - reticulum cell sarcoma, - RCC, thyroid carcinoma, - histiocytosis, neuroblastoma, and - especially multiple myeloma ** Bone scan : Cold uptake

16 한강성심 영상의학과 이경규 16  Cold uptake  Insufficiency fracture  Superscan  Flare phenomenon Bone scan : Caution !

17 한강성심 영상의학과 이경규 17 Kyphosis Linear rib ↑ H-shaped sacral uptake Bone scan : Insufficiency Fx

18 한강성심 영상의학과 이경규 18 Bone scan : Caution !  Cold uptake  Insufficiency fracture  Superscan  Flare phenomenon

19 한강성심 영상의학과 이경규 19  Superscan ? - Poorly or non-visualization of kidney - ↑ bone to background RI ratio  cause far advanced bone metastasis - prostate, breast, lung, bladder, stomach etc metabolic condition - superscan in both axial and peripheral skeleton - Renal osteodystrophy, primary hyperparathyroidism myelofibrosis Bone scan : Superscan

20 한강성심 영상의학과 이경규 20 Superscan : Metastasis Meta - superscan Normal

21 한강성심 영상의학과 이경규 21 Superscan : renal osteodystrophy Meta - superscan Metabolic - superscan diffuse skull & mandible (+)

22 한강성심 영상의학과 이경규 22 Bone scan : Caution !  Cold uptake  Insufficiency fracture  Superscan  Flare phenomenon

23 한강성심 영상의학과 이경규 23 Bone scan : Caution !  Cold uptake  Insufficiency fracture  Superscan  Flare phenomenon transient increase in lesion activity secondary to healing under antineoplastic treatment concomitant with increased sclerosis

24 한강성심 영상의학과 이경규 24  increase in uptake intensity or appearance of new lesion within 3-6 months of staisfactory response to therapy  improvement on F/U bone scan  incidence up to 20% in breast and prostate ca  good prognostic sign in breast cancer  DDX : progression of metastatic disease Bone scan : Flare phenomenon

25 한강성심 영상의학과 이경규 25 Bone scan : Flare phenomenon Flare phenomenon < 3 month Disease progress Number & intensity ↑ of lesions beyond 6 months 3 month6monthinitial

26 한강성심 영상의학과 이경규 26 Bone scan vs MRI  MRI : superior sensitivity  Limitation of Scintigraphy - specificity  - intramedullary lesion Tumor is in marrow space only and has not elicited a reactive response in adjacent bone - aggressive or purely osteolytic lesion

27 한강성심 영상의학과 이경규 27


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