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Bone Metastases (PET)
Brian L. Bones, MD; Paige Bennett, MD
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KEY FACTS

  • Imaging

    TERMINOLOGY

    • Definitions

      • Bone metastases: Primary cancer that spreads to bone
        • Common distant sites (e.g., liver, adrenal, brain, bone)
        • Radiographic types
          • Blastic/sclerotic: Characterized by excess bone formation
          • Lytic: Characterized by bone destruction
          • Mixed: Characterized by both lytic and blastic components
          • Variable: Characterized by cancers that can show purely lytic or purely blastic types
        • Primary cancers that commonly metastasize to bone include
          • Breast
          • Lung
          • Thyroid
          • Renal
          • Prostate

    IMAGING

    • General Features

      • Role of PET/CT

        • Imaging Patterns

          • Radiotracers

            • Flare Phenomenon

              DIFFERENTIAL DIAGNOSIS

                CLINICAL ISSUES

                • Presentation

                  DIAGNOSTIC CHECKLIST

                  • Image Interpretation Pearls

                    Selected References

                    1. Etchebehere E et al: Therapy assessment of bone metastatic disease in the era of 223radium. Eur J Nucl Med Mol Imaging. ePub, 2017
                    2. Evangelista L et al: New clinical indications for (18)F/(11)C-choline, new tracers for positron emission tomography and a promising hybrid device for prostate cancer staging: A systematic review of the literature. Eur Urol. 70(1):161-75, 2016
                    3. Minamimoto R et al: Prospective comparison of 99mTc-MDP scintigraphy, combined 18F-NaF and 18F-FDG PET/CT, and whole-body MR in patients with breast and prostate cancer. J Nucl Med. 56(12):1862-8, 2015
                    4. Vali R et al: Imaging of prostate cancer with PET/CT using (18)F-Fluorocholine. Am J Nucl Med Mol Imaging. 5(2):96-108, 2015
                    5. Mick CG et al: Molecular imaging in oncology: (18)F-sodium fluoride PET imaging of osseous metastatic disease. AJR Am J Roentgenol. 203(2):263-71, 2014
                    6. Schiavina R et al: The new promise of FACBC position emission tomography/computed tomography in the localization of disease relapse after radical treatment for prostate cancer: are we turning to the right radiotracer? Eur Urol. 65(1):255-6, 2014
                    7. Schuster DM et al: Anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid: physiologic uptake patterns, incidental findings, and variants that may simulate disease. J Nucl Med. 55(12):1986-92, 2014
                    8. Glendenning J et al: Imaging breast cancer bone metastases: current status and future directions. Semin Nucl Med. 43(4):317-23, 2013
                    9. Hofman MS et al: High management impact of Ga-68 DOTATATE (GaTate) PET/CT for imaging neuroendocrine and other somatostatin expressing tumours. J Med Imaging Radiat Oncol. 56(1):40-7, 2012
                    10. Yang HL et al: Diagnosis of bone metastases: a meta-analysis comparing ¹⁸FDG PET, CT, MRI and bone scintigraphy. Eur Radiol. 21(12):2604-17, 2011
                    11. Tateishi U et al: A meta-analysis of (18)F-Fluoride positron emission tomography for assessment of metastatic bone tumor. Ann Nucl Med. 24(7):523-31, 2010
                    12. Gabriel M et al: 68Ga-DOTA-Tyr3-octreotide PET for assessing response to somatostatin-receptor-mediated radionuclide therapy. J Nucl Med. 50(9):1427-34, 2009
                    13. Beheshti M et al: Detection of bone metastases in patients with prostate cancer by (18)F fluorocholine and (18)F fluoride PET-CT: a comparative study. Eur J Nucl Med Mol Imaging. J Nucl Med. 35(10):1766-74, 2008
                    14. Gabriel M et al: 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med. 48(4):508-18, 2007
                    15. Fujimoto R et al: Diagnostic accuracy of bone metastases detection in cancer patients: comparison between bone scintigraphy and whole-body FDG-PET. Ann Nucl Med. 20(6):399-408, 2006
                    Related Anatomy
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                    Related Differential Diagnoses
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                    References
                    Tables

                    Tables

                    KEY FACTS

                    • Imaging

                      TERMINOLOGY

                      • Definitions

                        • Bone metastases: Primary cancer that spreads to bone
                          • Common distant sites (e.g., liver, adrenal, brain, bone)
                          • Radiographic types
                            • Blastic/sclerotic: Characterized by excess bone formation
                            • Lytic: Characterized by bone destruction
                            • Mixed: Characterized by both lytic and blastic components
                            • Variable: Characterized by cancers that can show purely lytic or purely blastic types
                          • Primary cancers that commonly metastasize to bone include
                            • Breast
                            • Lung
                            • Thyroid
                            • Renal
                            • Prostate

                      IMAGING

                      • General Features

                        • Role of PET/CT

                          • Imaging Patterns

                            • Radiotracers

                              • Flare Phenomenon

                                DIFFERENTIAL DIAGNOSIS

                                  CLINICAL ISSUES

                                  • Presentation

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Etchebehere E et al: Therapy assessment of bone metastatic disease in the era of 223radium. Eur J Nucl Med Mol Imaging. ePub, 2017
                                      2. Evangelista L et al: New clinical indications for (18)F/(11)C-choline, new tracers for positron emission tomography and a promising hybrid device for prostate cancer staging: A systematic review of the literature. Eur Urol. 70(1):161-75, 2016
                                      3. Minamimoto R et al: Prospective comparison of 99mTc-MDP scintigraphy, combined 18F-NaF and 18F-FDG PET/CT, and whole-body MR in patients with breast and prostate cancer. J Nucl Med. 56(12):1862-8, 2015
                                      4. Vali R et al: Imaging of prostate cancer with PET/CT using (18)F-Fluorocholine. Am J Nucl Med Mol Imaging. 5(2):96-108, 2015
                                      5. Mick CG et al: Molecular imaging in oncology: (18)F-sodium fluoride PET imaging of osseous metastatic disease. AJR Am J Roentgenol. 203(2):263-71, 2014
                                      6. Schiavina R et al: The new promise of FACBC position emission tomography/computed tomography in the localization of disease relapse after radical treatment for prostate cancer: are we turning to the right radiotracer? Eur Urol. 65(1):255-6, 2014
                                      7. Schuster DM et al: Anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid: physiologic uptake patterns, incidental findings, and variants that may simulate disease. J Nucl Med. 55(12):1986-92, 2014
                                      8. Glendenning J et al: Imaging breast cancer bone metastases: current status and future directions. Semin Nucl Med. 43(4):317-23, 2013
                                      9. Hofman MS et al: High management impact of Ga-68 DOTATATE (GaTate) PET/CT for imaging neuroendocrine and other somatostatin expressing tumours. J Med Imaging Radiat Oncol. 56(1):40-7, 2012
                                      10. Yang HL et al: Diagnosis of bone metastases: a meta-analysis comparing ¹⁸FDG PET, CT, MRI and bone scintigraphy. Eur Radiol. 21(12):2604-17, 2011
                                      11. Tateishi U et al: A meta-analysis of (18)F-Fluoride positron emission tomography for assessment of metastatic bone tumor. Ann Nucl Med. 24(7):523-31, 2010
                                      12. Gabriel M et al: 68Ga-DOTA-Tyr3-octreotide PET for assessing response to somatostatin-receptor-mediated radionuclide therapy. J Nucl Med. 50(9):1427-34, 2009
                                      13. Beheshti M et al: Detection of bone metastases in patients with prostate cancer by (18)F fluorocholine and (18)F fluoride PET-CT: a comparative study. Eur J Nucl Med Mol Imaging. J Nucl Med. 35(10):1766-74, 2008
                                      14. Gabriel M et al: 68Ga-DOTA-Tyr3-octreotide PET in neuroendocrine tumors: comparison with somatostatin receptor scintigraphy and CT. J Nucl Med. 48(4):508-18, 2007
                                      15. Fujimoto R et al: Diagnostic accuracy of bone metastases detection in cancer patients: comparison between bone scintigraphy and whole-body FDG-PET. Ann Nucl Med. 20(6):399-408, 2006