Metastatic Bone Disease Case Study 01
NUCLEAR MEDICINE BONE SCAN FINDINGS: The bone scan revealed abnormal activity in the L2 vertebral body that could have been metastatic disease or a post-traumatic fracture. There was minimal focal activity in the left 7th rib, which was also suspicious for metastatic disease versus trauma (Fig. 1).
An MRI of the lumbar spine was suspicious for possible bone marrow metastases, and an FDG PET scan was ordered for restaging prior to treatment planning (MRI images are not shown).
NUCLEAR MEDICINE PET SCAN
FDG PET FINDINGS: No abnormalities were seen.
NUCLEAR MEDICINE 18F NaF BONE PET SCAN
18F NaF PET FINDINGS: The 18F NaF PET bone scan revealed abnormal uptake consistent with metastatic disease in the vertebral body of the L2 vertebra. Additional foci were noted in vertebral bodies L3, L5, the superior end plate of L4, and the right transverse process of L3; all consistent with metastatic bone disease that was not visualized in the FDG PET scan. Innumerable lesions were identified in the pelvis that were appreciated only in retrospect on a prior CT scan. Focal uptake in the left 7th rib and right glenoid were consistent with metastatic disease. Additional focus of activity was seen in the proximal metaphysis of the right femur that was faintly visualized, if at all, on the bone scan.
Dr. David Haseley and Dr. Gustavo Mercier, Seattle Nuclear Medicine, Seattle, WA, USA
* Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.