Differentiation of Rib Fractures from Metastases by Bone Scanning

Harbert, John C.; George, Francis H.; Kerner, Michael L.

doi:10.1097/00003072-198108000-00005

Cited by 27 publications

(9 citation statements)

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“…Tc-99m Bone Scan Whole Body. Nuclear medicine bone scans are sensitive but not specific for detection of rib fracture [30]. Bone scans are most commonly used for detection of osseous involvement in systemic processes (eg, metastatic disease) and may result in false-positive diagnosis of malignancy in a patient with rib fractures, although the pattern of tracer uptake can often help differentiate the two processes [30].…”

Section: Discussion Of Procedures By Variant Variant 1: Suspected Ribmentioning

confidence: 99%

“…Nuclear medicine bone scans are sensitive but not specific for detection of rib fracture [30]. Bone scans are most commonly used for detection of osseous involvement in systemic processes (eg, metastatic disease) and may result in false-positive diagnosis of malignancy in a patient with rib fractures, although the pattern of tracer uptake can often help differentiate the two processes [30]. Bone scans have limited use in distinguishing acute and subacute or chronic rib fractures as they will usually be positive within 24 hours after an injury, but the return to normal can be slow (79% by 1 year, 93% by 2 years, and 100% in 3 years) [31].…”

Section: Discussion Of Procedures By Variant Variant 1: Suspected Ribmentioning

confidence: 99%

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ACR Appropriateness Criteria® Rib Fractures

Imaging¹,

Henry

Donnelly

et al. 2019

Journal of the American College of Radiology

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Rib fractures are the most common thoracic injury after minor blunt trauma. Although rib fractures can produce significant morbidity, the diagnosis of injuries to underlying organs is arguably more important as these complications are likely to have the most significant clinical impact. Isolated rib fractures have a relatively low morbidity and mortality and treatment is generally conservative. As such, evaluation with standard chest radiographs is usually sufficient for the diagnosis of rib fractures, and further imaging is generally not appropriate as there is little data that undiagnosed isolated rib fractures after minor blunt trauma affect management or outcomes. Cardiopulmonary resuscitation frequently results in anterior rib fractures and chest radiographs are usually appropriate (and sufficient) as the initial imaging modality in these patients. In patients with suspected pathologic fractures, chest CT or Tc-99m bone scans are usually appropriate and complementary modalities to chest radiography based on the clinical scenario.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.Disclaimer: The ACR Committee on Appropriateness Criteria and its expert panels have developed criteria for determining appropriate imaging examinations for diagnosis and treatment of specified medical condition(s). These criteria are intended to guide radiologists, radiation oncologists, and referring physicians in making decisions regarding radiologic imaging and treatment. Generally, the complexity and severity of a patient's clinical condition should dictate the selection of appropriate imaging procedures or treatments. Only those examinations generally used for evaluation of the patient's condition are ranked. Other imaging studies necessary to evaluate other co-existent diseases or other medical consequences of this condition are not considered in this document. The availability of equipment or personnel may influence the selection of appropriate imaging procedures or treatments. Imaging techniques classified as investigational by the FDA have not been considered in developing these criteria; however, study of new equipment and applications should be encouraged. The ultimate decision regarding the appropriateness of any specific radiologic examination or treatment must be made by the referring physician and radiologist in light of all the circumstances presented in a...

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Section: Discussion Of Procedures By Variant Variant 1: Suspected Ribmentioning

confidence: 99%

Section: Discussion Of Procedures By Variant Variant 1: Suspected Ribmentioning

confidence: 99%

ACR Appropriateness Criteria® Rib Fractures

Imaging¹,

Henry

Donnelly

et al. 2019

Journal of the American College of Radiology

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“…Malheureusement, la spécificité de cet examen est moins élevée, se pose souvent le problème du diagnostic différentiel entre les métastases et les pathologies bénignes qui entraînent un remaniement osseux, et ce surtout lorsque les foyers d'hyperfixation ostéoblastiques sont uniques et/ou situés au niveau de régions anatomiques particulières (par exemple à proximité des articulations) [18][19][20][21][22][23]. Dans ces cas, l'apport de la TEM-TDM (ou SPECT-CT) s'avère très utile.…”

Section: Discussion : Rôle De La Scintigraphie Osseuse Dans Le Bilan unclassified

“…L'un des principaux problèmes de la scintigraphie osseuse est celui de pouvoir différencier les aspects de pathologie dégénérative bénigne et les aspects de pathologie oncologique (tous ces aspects se traduisant sur l'image statique par une hyperfixation du traceur osseux), surtout pour ce qui concerne les foyers d'hyperfixation uniques [18,21,23,24].…”

Section: Discussion : Rôle De La Scintigraphie Osseuse Dans Le Bilan unclassified

“…L'atteinte des membres est un facteur de mauvais pronostic. L'hyperfixation isolée, en particulier vertébrale, reste toujours d'interprétation délicate ; une tomoscintigraphie couplée au scanner (TEMP-TDM, Figs 3, 4) complétant les clichés corps entier, un examen des clichés radiologiques, un interrogatoire soigneux sur les antécédents rhumatologiques et traumatiques ainsi que la connaissance de l'état clinique du patient permettent souvent d'aboutir au diagnostic de façon non invasive [18][19][20][21][22][23][24][25]. Si toutefois cette approche s'avère infructueuse, une biopsie peut devenir nécessaire.…”

Section: Discussion : Rôle De La Scintigraphie Osseuse Dans Le Bilan unclassified

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Radiopharmaceuticals and bone metastases: Which molecules for which patients and which indications?

et al. 2015

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Le principe des explorations scintigraphiques est de déterminer, et le plus souvent de représenter sous forme d'images, la biodistribution d'un radiopharmaceutique au sein de l'organisme. L'imagerie hybride, anatomique et fonctionnelle, augmente la sensibilité et la spécificité des examens scintigraphiques, et ce notamment dans les cas difficiles où l'analyse séparée des deux examens ne permet de trancher avec certitude quant à la nature et la signification des anomalies. La scintigraphie osseuse aux diphosphonates technétiés est l'examen radio-isotopique classique dans l'étude de la pathologie osseuse. Dans certains cas néan-moins, la tomographie par émission de positons (TEP) au FDG est plus sensible dans la détection de métastases ostéo-lytiques. La radiothérapie métabolique consiste en l'administration d'un radioélément en source non scellée, dont les rayonnements vont détruire les cellules qui ont accumulé sélectivement ce produit. La prise en charge de la douleur osseuse constitue un problème majeur, notamment en cas de cancer mammaire ou prostatique où la présence de méta-stases peut demeurer compatible avec une survie de longue durée. Dans ce cadre, la radiothérapie métabolique permet de diminuer les douleurs secondaires aux métastases osseuses, en association ou non à des médicaments antalgiques.Mots clés Scintigraphie osseuse · TEP/TDM au FDG · Radiothérapie métabolique · Métastases osseuses hyperalgiques · Palliation antalgique osseuse Abstract Nuclear medicine investigations are able to represent the biodistribution of a radiopharmaceutical within the body as images. The hybrid, anatomical and functional imaging increases the sensitivity and specificity of scintigraphic examinations, particularly in difficult cases where two separate analyses do not allow to decide the nature and significance of the abnormalities. Bone scintigraphy with technetium diphosphonates is the classic radioisotope examination in the study of bone pathology. In some cases, however, FDG-PET is more sensitive in detecting osteolytic metastases. The administration of a radionuclide in unsealed source whose radiation will destroy cells that have selectively accumulated product is called radiometabolic therapy. The management of bone pain is a major problem, particularly in cases of breast or prostate cancer where the presence of metastases can remain compatible with long-term survival of cancer patients. In this context, the radiometabolic therapy reduces the pain secondary to bone metastases, in association or not with analgesics.

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Efficacy of bone and liver scanning in breast cancer patients treated with adjuvant chemotherapy

Arnstein

Harbert

Byrne

1984

Cancer

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One hundred nineteen patients who underwent mastectomy and received adjuvant chemotherapy for breast carcinoma were studied retrospectively. Of these, 102 patients had serial bone scans and 101 patients serial liver scans during a mean follow‐up of 59 months. All had negative scans prior to chemotherapy. Twenty‐three of 102 patients converted to positive bone scans during follow‐up. These 23 patients converted a mean of 29.5 months after surgery. At conversion, 5 of 21 patients had bone pain, and none had elevated alkaline phosphatase. Thirteen of 101 patients developed positive liver scans a mean of 31.5 months after surgery. The liver scan was the first indicator of liver involvement in only 3 of 13 converters. In no case was the liver scan the first indication of metastatic disease. The incidence of bone scan conversion (22%) did not differ significantly from previously reported series of patients not receiving adjuvant therapy, but the mean time to conversion was prolonged (29.5 versus 18.0 months). In addition, none (0/21) of the bone scan converters had elevated alkaline phosphatase at the time of conversion. It is concluded that the interval from initial evaluation to bone scan conversion may be prolonged by adjuvant chemotherapy of breast cancer. It is recommended that patients have bone scans twice yearly for at least 3 to 4 years after surgery. This study emphasizes the singular importance of bone scanning in breast cancer patients who have adjuvant chemotherapy, as the scan may be the only indicator of bone involvement. Liver scans do not appear useful for screening patients without other evidence for metastatic liver involvement.

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Differentiation of Rib Fractures from Metastases by Bone Scanning

Cited by 27 publications

References 0 publications

ACR Appropriateness Criteria® Rib Fractures

ACR Appropriateness Criteria® Rib Fractures

Radiopharmaceuticals and bone metastases: Which molecules for which patients and which indications?

Efficacy of bone and liver scanning in breast cancer patients treated with adjuvant chemotherapy

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