Bone Metastasis from Primary Hepatocellular Carcinoma: Characteristics of Soft Tissue Formation

Kim, Sangwon; Chun, Mison; Wang, Heejung; Cho, Sungwon; Oh, Young‐Taek; Kang, Shin-Wook; Yang, Juno

doi:10.4143/crt.2007.39.3.104

Cited by 35 publications

(33 citation statements)

References 11 publications

(6 reference statements)

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“…Fukutomi et al reported that 24 out of 29 lesions (83%) showed osteolysis with expansile soft tissue formation [5]. Kim et al reported 54% of HCC cases showed soft tissue formation [28], and our study showed 55% of HCC cases showed soft tissue formation on patient-based analysis. Despite the relatively low incidence of bone metastasis, soft tissue formation requiring emergency treatment is frequently observed in HCC, and imaging studies to assess soft tissue formation can be of great clinical importance.…”

Section: Discussionsupporting

confidence: 57%

Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CT and 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

Seo

Choi

Kim

et al. 2011

Nucl Med Mol Imaging

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Purpose Bone metastasis from hepatocellular carcinoma (HCC) can present with soft tissue formation, resulting in oncologic emergency. Contrast-enhanced FDG PET/CT and bone scintigraphy were compared to evaluate characteristics of bone metastases with or without soft tissue formation from HCC. Methods Of 4,151 patients with HCC, 263 patients had bone metastases. Eighty-five patients with bone metastasis from HCC underwent contrast-enhanced FDG PET/CT. Fifty-four of the enrolled subjects had recent 99m Tc-HDP bone scintigraphy available for comparison. Metastatic bone lesions were identified with visual inspection on FDG PET/CT, and maximum standardized uptake value (SUV max ) was used for the quantitative analysis. Confirmation of bone metastasis was based on histopathology, combined imaging modalities, or serial follow-up studies. Results Forty-seven patients (55%) presented with soft tissue formation, while the remaining 38 patients presented without soft tissue formation. Frequent sites of bone metastases from HCC were the spine (39%), pelvis (19%), and rib cage (14%). The soft-tissue-formation group had more frequent bone pain (77 vs. 37%, p<0.0001), higher SUV max (6.02 vs. 3.52, p<0.007), and higher incidence of photon defect in bone scintigraphy (75 vs. 0%) compared to the non-soft-tissue-formation group. FDG PET/CT had higher detection rate for bone metastasis than bone scintigraphy both in lesion-based analysis (98 vs. 53%, p=0.0015) and in patient-based analysis (100 vs. 80%, p<0 .001). Conclusions Bone metastasis from HCC showed a high incidence of soft tissue formation requiring emergency treatment. Although the characteristic findings for soft tissue formation such as photon defect in bone scintigraphy are helpful in detection, overall detectability of bone metastasis is higher in FDG PET/CT. Contrast-enhanced PET/CT will be useful in finding and delineating softtissue-forming bone metastasis from HCC.

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Section: Discussionsupporting

confidence: 57%

Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CT and 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

Seo

Choi

Kim

et al. 2011

Nucl Med Mol Imaging

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“…Pelvic bone was the least common site of skeletal metastases, it was found in only 5 patients in contrary to previous studies which reported that pelvic bones including the hip joints was the 2nd most common site of bony metastases from HCC (14,20,25).…”

Section: Discussioncontrasting

confidence: 63%

The many, atypical presentations of musculoskeletal hepatocellular carcinoma (HCC) metastases

Elian

Gawad

2014

The Egyptian Journal of Radiology and Nuclear Medicine

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Purpose: To demonstrate many uncommon, non-classical clinical presentations of HCC that have been gathered from an endemic region in the Nile Basin. Patients and methods: We will highlight cases of high quality MDCT performed for various clinical symptoms not classically associated with advanced or metastatic HCC and the role of image-guided biopsy in diagnoses. These include: (a) gradual progressive weakness of lower limbs; (b) Retrosternal pain not responding to medications; (c) severe right hip pain; (d) progressive cheek swelling. These symptoms further corresponded to musculoskeletal abnormalities, not typically associated with HCC, including: (a) lumbar spinal cord compression by expansile vertebral body lesion; (b) direct invasion of chest wall; (c) large expansile metastasis of right acetabulum; (d) expansible rib lesions with rib destruction, (e) painful cheek swelling. Results: In numerous patients with a range of non-specific musculoskeletal complaints and various clinical presentations, the final diagnosis was HCC. The clinical presentation was dependent on uncommon skeletal deposits which were often expansile with the local effect of compression as underlying cause for the odd presentation. The important role of MDCT and Histopathological assessment in making correct diagnosis will be stressed. Conclusion: HCC can often grow silently and may present late with odd non-classic clinical presentation.

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“…If a bone scan revealed definite or possible findings of bone metastasis, the lesions were re-evaluated by CT, MRI, or PET-CT, and followed-up at 3-month intervals. On these additional images, definite metastatic findings on bone scans were characterized as soft tissue formation that lysed the bone framework without evidence of other diseases [17]. Lesions were finally defined as truly metastatic if an initial chest CT or bone scans revealed definite features of metastases or the size and number of initial lesion(s) increased during follow-up.…”

Section: Identification and Confirmation Of Extra-hepatic Metastasesmentioning

confidence: 99%

Role of the routine use of chest computed tomography and bone scan in staging workup of hepatocellular carcinoma

Jin

Lee

et al. 2012

Journal of Hepatology

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Bone Metastasis from Primary Hepatocellular Carcinoma: Characteristics of Soft Tissue Formation

Cited by 35 publications

References 11 publications

Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CT and 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

Evaluation of Bone Metastasis from Hepatocellular Carcinoma Using 18F-FDG PET/CT and 99mTc-HDP Bone Scintigraphy: Characteristics of Soft Tissue Formation

The many, atypical presentations of musculoskeletal hepatocellular carcinoma (HCC) metastases

Role of the routine use of chest computed tomography and bone scan in staging workup of hepatocellular carcinoma

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