Diagnostic imaging plays a major role in the evaluation of patients with skeletal tumors (1).
The majority of skeletal malignancies is represented by metastases.
The tumors that most often metastasize to bone are breast,
kidney and thyroid carcinomas and about 75% of patients with these tumors will develop at least one bone metastasis (2); breast and prostate cancer account for more than 80% of cases of metastatic bone disease and cause the greatest morbidity (3).
Primary tumors are often associated with metastatic disease...
Methods and materials
Patients with SNOMED (Systematized Nomenclature of Medicine) codes for skeletal cytology and histology biopsies from Institute of Pathology,
University Hospital of Aalborg,
from January 1,
2011 to July 31 2013,
Biopsies with no diagnostic imaging 6 months prior to when the biopsy was taken were excluded together with biopsies unsuitable for diagnosis,
autopsies from fetuses,
material from provoked abortions,
biopsies where there was no diagnostic imaging from the topography from where the biopsy was taken,
and biopsies that had inadequate image description...
Figure I exhibits the Consort Diagram,
showing that out of the 739 biopsies taken from 605 patients,
taken from 395 patients,
Table Iexhibits patient demographics and baseline information.
Table II exhibits sensitivity,
positive predictive value (PPV) and negative predictive value (NPV).FDG-PET/CT showed the best sensitivity (sensitivity 92%,
PPV 84 %,
NPV 80 %),
followed by MRI (91/83/87/88 %).
X-Ray and CT were found to have the best specificity (33/96/86/66 % and 76/89/91/71 % respectively).
Bone scintigraphy showed modest...
Our conclusion is that among modern imaging modalities,
the sensitivity for the detection of skeletal malignancies (mostly bone metastasis) was not better than 91-92 % and MRI proved to have the best combination of sensitivity and specificity (91 and 83 %) and best PPV and NPV.
The specificity of MRI and CT was below 90 % and even as low as 63% for FDG-PET/CT,
whereas it was as high as 96 % for X-Ray.
PPV was below 90 % for all modalities except CT,
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Metastatic bone disease: clinical features,
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(4) Blomqvist L,