Knochenmarkszintigraphie mit Radiokolloiden bei Skelettmetastasen

Abstract

The sensitivity and specificity of bone marrow scintigraphy in demonstrating skeletal metastases was examined in 40 patients with focal metastases. Radiology and MDP scintigraphy were used as reference methods. Sensitivity depends on the region of the skeleton. False negatives are the rule in parts of the skeleton containing little bone marrow. In relation to the entire bone marrow content, sensitivity is 0.64. The high proportion of false negatives (36%) in the presence of confirmed metastases and the incomplete demonstration of the bone marrow makes marrow scintigraphy unsuitable as a screening method. Occasionally lesions confined to the marrow can be demonstrated when radiographs and bone scintigrams are still negative. In advanced cases, marrow scintigraphy can demonstrate the extent of destruction of the bone marrow. Demonstration of displacement or of an 'empty bone' is evidence of invasion of the bone marrow in patients with tumours. In patients with reduced haematopoiesis of unknown origin or unidentified diffuse skeletal uptake, bone marrow scintigraphy may provide valuable information.

Recent advances in bone marrow scanning

“…Marrow scanning is traditionally believed to be of little use for evaluating patients with suspected metastases (Datz and Taylor 1985;Fritz et al 1986). Thus, Fritz et al reported a sensitivity of 64% of bone marrow scans in 36 patients with solid carcinomas and in 4 pa- Fig.…”

“…Thus, Fritz et al reported a sensitivity of 64% of bone marrow scans in 36 patients with solid carcinomas and in 4 pa- Fig. a Normal bone scan with clear defect on the immunomarrow scan in lung cancer (b) tients with Hodgkin's disease or NHL (Fritz et al 1986). a Normal bone scan with clear defect on the immunomarrow scan in lung cancer (b) tients with Hodgkin's disease or NHL (Fritz et al 1986).…”

Bone Marrow Immunoscintigraphy versus Conventional Bone Scintigraphy in the Diagnosis of Skeletal Métastasés in Urogenital Malignancies

“…Especially bone métas tasés in prostatic cancer were studied with both conven tional bone scintigraphy and nanocolloid bone marrow scintigraphy leading to equivocal results. While some studies indicated that bone marrow scintigraphy may be more specific than bone scintigraphy in detecting skeletal métastasés (81 vs. 73%) [11], sensitivity seemed to be decreased compared to conventional bone scintigraphy in patients with prostatic cancer (83 vs. 86%) [11,12], Simi lar results were obtained for different metastatic tumours including breast cancer, lung cancer and cancer of the thy roid gland, with bone marrow imaging reaching a 64-77% sensitivity in detecting métastasés of the skeleton [13][14][15], More recently, bone marrow immunoscintigraphy using anti-NCA-95 MAbs has proved to be superior to bone marrow scintigraphy using serum albumin nanocolloids in detecting bone marrow métastasés of lymphoma, breast carcinoma and small-cell bronchogenic carcinoma [2], In this study, bone scintigraphy was abnormal in 17 out of 30 patients compared to 24 patients with abnormal bone marrow scans and bone marrow immunoscans. Compared to bone marrow scans using serum albumin nanocolloids, additonal 28 marrow lesions were detected by bone marrow immunoscintigraphy; 80% of these addi tional lesions were confirmed as tumours by marrow biopsy or radiologic examinations like plain film radiog raphy, computed tomography or magnetic resonance imaging.…”

Nachweis des Skelettbefalls maligner Erkrankungen durch Immunszintigraphie des Knochenmarks

“…Im Gegensatz zu den Befunden der vorgelegten Studie berichteten mehrere Autoren beim Prostatakarzinom, Mammakarzinom und anderen soliden Primärtumoren über eine höhere Sensitivität der Skelettszintigraphie im Vergleich zur konventionellen Mikrokolloid-Szintigraphie (10,11). Hotzeet al (15) sowie Sacchi et al (37) und Otsuka et al (27) berichteten, daß die Knochenmarkszintigraphie gelegentlich hilfreich zur Differenzierung benigner von malignen, im Skelettszintigramm nachweisbaren Herdbefunden war, und schlössen, daß beide szintigraphischen Methoden einander in ihrem Informationsgehalt ergänzen.…”