1 / 68

بسم اللـه الرحمن الرحيم

بسم اللـه الرحمن الرحيم. قالوا سبحانك لا علم لناإلا ما علمتنا إنك أنت العليم الحكيم. البقرة :32. صدق الله العظيم. Prof. Mervat Shafik Head of Radiology Department Cairo University. Prof. Moharram El Badawi Head of Radiology Department NCI Cairo University.

paul2
Download Presentation

بسم اللـه الرحمن الرحيم

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. بسم اللـه الرحمن الرحيم قالوا سبحانك لا علم لناإلا ما علمتنا إنك أنت العليم الحكيم البقرة :32 صدق الله العظيم

  2. Prof. Mervat Shafik Head of Radiology Department Cairo University Prof. Moharram El Badawi Head of Radiology Department NCI Cairo University Whole Body MRI Versus 99mTc-Methylene Diphosphonate Scintigraphy In Detection Of Skeletal Metastases Presented by Osama Anwer Raslan Supervised by Ass. Prof. Walid Soliman Head of Nuclear Medicine Department NCI Cairo University

  3. Metastases are by far the commonest malignant bone tumour, outnumbering many times primary bone tumours. • 99mTc-Phosphonate-based skeletal scintigraphy is the standard method for the initial staging of bone metastases • It depicts bone metastases at a relatively advanced stage of tumor infiltration when osteoblastic host reaction to tumor deposits has already occurred. • It has limited anatomic detail, sensitivity and specificity

  4. Recent advances in hardware technology, the introduction of fast MR sequences, non-invasiveness, lack of radiation and high diagnostic accuracy renewed the interest inusing WB-MRI in detection of skeletal metastases. • It was proved that, MRI was superior to scintigraphy in respect of sensitivity (92% vs. 58%) and specificity (97% vs. 85%).(Layer et al, 1994).

  5. Bone metastasis can be classified into four types, namely, osteolytic, osteoblastic, mixed, or intertrabecular type. • Carcinomas of the breast, prostate, and lung, in decreasing order, are the common sources of skeletal metastases in a general population. • Skeletal metastases predominantly affect the axial skeleton, a region rich in red marrow asit has large capillary network, a sluggish blood flow, and the suitable tissue for growth of tumour emboli.

  6. MRI of Normal Bone Marrow

  7. Normal appearance of Bone scan

  8. 99mTc-MDP uptakeis greatest the axial skeleton, with relatively less intense uptake in extremities and skull • Background activity is normally seen in soft tissues • kidneys are routinely visualized in normal subjects and should have less intensity than the adjacent lumbar spine

  9. Technique of Whole body MRI

  10. Body coverage was achieved using a maximum of four overlapping coronal body coil acquisitions. • 1st Station: From the head to upper chest • 2ndStation: Rest of chest till upper pelvis • 3rd Station: Rest of pelvis till knee • 4thStation: Knee to Toes

  11. The spine was imaged in 2 overlapped sagittal stations using the CTL coil • 1st station: cervical & upper dorsal. • 2nd station: lower dorsal till sacral

  12. Position of the upper extremities was dictated by patient’s habitus, in large patients, the arms were placed above the head, requiring an additional coronal acquisition.

  13. Total aquision time 28:00 minutes, extended to 30:50 minutes if the extra coronal station for upper limb was done • The patients in/out time ranged from 36-42 min with an average time of 39 min. • There are two options to obtain the hard copy: • Printing the images which showed the pathology: in the routine way, or after matching. The average number of films was 4 to 6 films. • Printing all the images: average of 9 films.

  14. Results

  15. Of the 23patients 15were females and 8males • Youngest was 39 years and the oldest 78 years, mean age was 53 years

  16. Regarding the 1ry , most of the patients came with breast cancer followed by bladder cancer, and prostatic carcinoma

  17. Data Analyses based on Patient-by-Patient Comparison • 3 / 23 patients were concordantly found to be totally free by both WB-MRI & BS, leaving 20 patients which was analyzed as follows: • WB-MRI: -15 / 20 had skeletal metastases, 5 had benignfindings and nopatients were found to be uncertain. • BS: -11 / 20had skeletal metastases, 2 had benign findings, and 7patients were found to be uncertainnecessitating further investigations

  18. Data Analyses based on Region-by-Region Comparison • 78 / 253regions were metastatic, 175 / 253regions were free of metastases (including regions diagnosed as benign or uncertain). • WB-MRI: • Discovered 73 / 78 metastatic regions, with a sensitivity 93.5% and PPV 100% • 180areas to be free of metastases, with 5 false negative areas, making its specificity 100% & NPV 97.2%, its accuracy 98% • BS : • Discovered 45 / 78 metastatic regions, and 2 falsely positive regions, with a sensitivity 57.6% and PPV 95.7% • 206 areas to be free of metastases, with 31 false negative areas, making its specificity 98.8% & NPV 83.4% its accuracy 86.1%

  19. WB-MRI clearly surpassed BS at spine, pelvis and both extremities, respectively. WB-MRI was slightly better at the sternum • BS was better than WB-MRI at the ribs and shoulder • Both modalities were equal at the skull

  20. Data Analyses based on Number of Lesions • Total number of lesions detected by WB-MRI (183 / 196 lesion) , with a sensitivity 93.5% , compared to 82 / 196 lesions detected by BS, with a sensitivity 41.8% • It also confirmed the higher sensitivity of WB-MRI in the spine, pelvis & extremities, in addition to the skull and shoulder. • PPV of WB-MRI 100% , & that of BS 96.4%

  21. Extraskeletal Lesions • WB-MRI elucidated 59 tumor related extraskeletal lesions, including 5 1ry detection, 1 chest wall recurrence in breast cancer, 2 cases with bilateral lung metastases not discovered before • BS only detected 2 tumor related extraskeletal lesions, which were bilateral hydronephrotic changes complicating bladder cancer • WB-MRI detected 35 tumor non related extraskeletal lesions, the most serious of which was hydronephrotic changes, plural effusions

  22. Case Presentation

  23. Case 1 53 y, male, with Papillary thyroid carcinoma complaining of sudden onset of paraplegia

  24. Impact on Management: Patient was sent for urgent surgical decompression procedure.

  25. Case 2 64 y , Male, with prostatic adenocarcinoma, complaining of generalized bone aches and multiple enlarged lymph nodes.

  26. Biopsy from cervical lymph node: Diffuse Large Cell Non-Hodgkin Lymphoma Impact on Management: Patient was diagnosed with a second primary of Lymphoma.

  27. Case 3 45 y, female , with TCC of the urinary bladder

  28. Impact on Management: Patient was diagnosed with vertebral and lung metastases, for which she received radiotherapy on the cervical and lumber spine and chemotherapy for lung metastases.

  29. Case 4 50 y, female patient, with IDC of the left breast.

  30. Impact on Management: In addition to the chemotherapy, patient was referred to the radiotherapy department for management of the spinal lesions.

  31. Case 5 Male , 78 y , with prostatic adenocarcinoma

  32. Impact on Management: Took chemotherapy for bone & lung lesion in addition to radiotherapy on symptomatic and weight baring areas

  33. Case 6 66 y, male patient, HCC, complaining of numbness of both lower limbs and low back pain.

  34. Impact on Management: Skeletal metastases were ruled out, and patient was sent for Neuro-surgical consultation

More Related