Keywords:
Cancer, Biological effects, Molecular imaging, MR-Functional imaging, MR-Diffusion/Perfusion, CT, Oncology, Musculoskeletal bone
Authors:
D. Dalili1, A. Gogbashian2, A. R. Padhani2; 1London/UK, 2Northwood, Middlesex/UK
DOI:
10.1594/essr2018/P-0163
Background
At a cellular level,
interactions between tumour,
bone marrow mesenchymal cells (via cytokines) results in distinct imaging phenotypes,
through promotion and/or inhibition of both osteoblastic and osteoclastic recruitment and activity.
Bone metastasis characterisation using diffusion MRI allows categorization based on the degree of cellularity.
Multiparametric imaging with CT/Fat%/BS allows metastasis appearance to be related directly to underlying biology.
We describe with examples,
7 sub-categories of bone metastasis hypothesising corresponding molecular and cellular mechanisms ( Fig. 1 )
Pattern 1 - Osteolytic,
predominantly fatty (osteoporotic myeloma variant)
Pattern 2 - Osteolytic with fibrosis and lower cellularity (rare pattern in breast cancer)
Pattern 3 - Pure osteolytic,
high cellularity (lung/renal/thyroid)
Pattern 4 - Normal,
high cellularity (haematological malignancies)
Pattern 5 - mixed osteolytic/osteoblastic (commonest 'classical' of breast/prostate) (fig 3).
Pattern 6 - Sclerosis with bone delamination
Pattern 7 - Dense osteoblastic