Jilin University Second Hospital Nuclear Medicine Department "Whole Body Bone Imaging" Accurate Diagnosis of "Tumor Bone Metastasis" - Issue 9

The patient, Gong Mou, female, 40 years old, came to the outpatient clinic of breast surgery of our hospital because of "back pain for about 20 days after breast cancer surgery and radiotherapy and chemotherapy". The doctor asked about the medical history and learned that the patient had a history of breast cancer and bone metastasis in our hospital (Figure 1A right). Back pain should alert the possibility of new bone metastasis. The patient was again examined by nuclear medicine department for whole-body bone imaging (Figure 1A left, Figure 1B). The results showed that compared with the previous film (2022-06-29): there was new osteolytic bone destruction in the right transverse process of T11, and new tumor bone metastasis in L2 vertebra and left iliac bone.

The left picture is the whole body bone scan during this review, and the right picture is the whole body bone scan during the initial diagnosis of bone metastasis. The red arrow indicates the location of the newly added metastatic lesions.

Examination findings: The bone morphology of the right transverse process of T11 was irregular, with local flaky soft tissue density shadows, absorption destruction of adjacent bones, and enhanced radioactive uptake; patchy low-density shadows were seen in the L2 vertebra and the left ilium, with nodular high-density shadows inside, accompanied by enhanced radioactive uptake.

Diagnostic opinion: Compared with the previous film (2022-06-29): new osteolytic bone destruction in the right transverse process of T11, new tumor bone metastasis in L2 vertebra and left iliac bone.

60%-90% of patients with advanced cancer will experience bone metastasis, which is what the common people often call "cancer flying to the bones", seriously affecting the quality of life and survival of patients, manifested as intractable pain that cannot be relieved by general drugs and gradually worsens. Some patients cannot walk and work normally. In severe cases, pathological fractures may occur, and even accompanied by adverse consequences such as depression and suicide. It is a serious complication of cancer patients in the late stage. Among all malignant tumors, breast cancer, prostate cancer, lung cancer, kidney cancer and thyroid cancer are the most common.

How do cancer patients recognize the occurrence of bone metastasis?

Based on the previous history of tumors, patients need to undergo regular follow-up examinations of primary lesions with imaging and serological markers. They need to be alert to the occurrence of bone metastasis when the following situations occur: ① Patients experience bone pain and discomfort in different parts of the body, which may manifest as local soreness, swelling, and numbness. The symptoms persist and even gradually worsen. Over time, the number of uncomfortable sites may increase, and conventional drugs are not effective; ② Fractures occur after daily physical labor or minor external injuries, and activities are limited; ③ Serological tumor markers are elevated, do not continue to decline, fluctuate, or continue to rise, and no signs of recurrence or metastasis of primary lesions or other tissue tumors are found. It should also be noted that patients with no history of tumors should also be alert to the occurrence of bone metastasis if any of the above situations occur.

Application of whole body bone imaging in tumor bone metastasis

Whole-body bone imaging is a special examination method in nuclear medicine. It uses radionuclides as imaging agents to accurately locate the site of bone destruction (Figure 2A). At the same time, CT scans are used to obtain morphological changes in specific lesions (Figure 2B), which assist in diagnosing the nature of the diseased bone and the degree of destruction. At the same time, clinicians can also use whole-body bone imaging to determine the treatment of metastatic bones (Figure 3A, B). The outstanding advantages of this examination are, on the one hand, to help clinicians discover bone metastasis in tumor patients, and on the other hand, to determine the occurrence of tumor bone metastasis through imaging characteristics, thereby prompting the clinic to find the primary lesion.

The treatment of tumors emphasizes "three earlys", namely "early detection, early diagnosis and early treatment". For patients with newly diagnosed tumors, early and timely medical intervention will greatly improve the patient's prognosis, improve the quality of life and prolong survival. Patients who have been diagnosed and treated need to pay attention to whether the disease changes throughout their life cycle. In addition to focusing on the primary lesion, they should also pay attention to whether there is metastasis to distant organs, such as bones, lungs, lymph nodes, etc. Tumors can metastasize to distant organs through blood, lymph and implantation. Early identification of metastasis can buy time for the patient's subsequent treatment and make a radical change in the prognosis of the disease. Nuclear medicine whole-body bone imaging has great advantages in identifying bone diseases, especially for screening of tumor bone metastasis. Clinicians can comprehensively evaluate the lesion from the level of anatomical structure and metabolic level, formulate treatment plans, and conduct follow-up. Therefore, for tumor patients, on the basis of meeting the condition, it is recommended to perform whole-body bone imaging at the time of initial diagnosis and for a short period of 3-6 months after treatment. Patients with stable condition can complete this examination once a year to manage the patient's condition in an all-round way.

Author: Wang Lixing

First review: Zhang Haijing

Final judge: Zhao Yinlong