[Diagnostic performance of bone scintigraphy and (11)C-Choline PET/CT in the detection of bone metastases in patients with biochemical recurrence of prostate cancer]

AIM

To compare bone scan (BS) with (11)C-Choline PET/CT for the detection of bone metastases in patients with biochemical recurrence of prostate cancer (PC).

MATERIAL AND METHODS

A total of 169 patients with biochemical recurrence of PC(PSA:2.4-58 ng/ml) who were referred for both exams (0-15 days-in-between) were included. Lesion-detection-rate per patients and lesions were analyzed for both BS and (11)C-Choline PET/CT. Metastasis diagnosis was reached by: biopsy, CT/(18)F-Fluoride PET/MRI confirmation, or evidence of progression in subsequent imaging procedures.

RESULTS

A total of 91 lesions were found to be active in BS and/or (11)C-choline PET/CT (40 patients), with 78 of which were metastatic. BS detected 38 blastic, 2 lytic and 10 non-CT-evident lesions. (11)C-Choline PET/CT detected 41 blastic, 4 lytic and 29 non-CT-evident lesions. BS and (11)C-Choline PET/CT sensitivities were 65.4% and 96.1%; specificities ere 38.5 and 92.3% (χ(2) 8.27, p<0.04). Both imaging techniques were negative in 118 patients. Tracer avid lesions were found in 51 patients: with 30/51 being BS and (11)C-Choline PET/CT concordant; in 21/51 patients had discordant lesions (kappa 0.712, p=0.00). Lesions were absolutely discordant in 10/19 patients,: 5 FN BS, 2 FP BS (degenerative changes; dysplasia), 1 FN (11)C-Choline PET/CT (blastic), 1 FP (11)C-Choline PET/CT (degenerative), 1 out of field-of-view lesion with (11)C-Choline PET/CT (tibia alone). (11)C-Choline PET/CT showed extraosseous involvement in 26/51 patients with bone metastases: 9 local recurrences, 5 infra-diaphragmatic-lymph-nodes, 2 supra-diaphragmatic, 5 local and infra-diaphragmatic, 4 infra- and supra-diaphragmatic, 1 supra-diaphragmatic and lung metastases.

CONCLUSION

(11)C-Choline PET/CT yielded better sensitivity and specificity than BS for the detection of bone involvement in patients with biochemical recurrence of PC and allowed extraosseous restaging, with an impact in the clinical management of these patients.

[Roentgenologic characteristics of Gaucher's disease (author's transl)]

Gaucher's disease is a rare metabolic disorder in which there is an abnormal accumulation of cerebrosides in the reticuloendothelial system due to a deficit of beta-glucuronidase. Three patients with this disease, 8, 14, and 23 years old, were studied. The purpose of this paper is to point out some of the roentgenologic findings, such as areas of femoral osteolysis, renal venous thrombosis, and in one patient, sclerosis of the sacroiliac joint. Splenomegaly and alteration of the tubular bony structure of the distal end of the femur were present in all three cases. The roentgenologic images of the disease are discussed. The osteoarticular system is the most often affected. Osteolysis is the basic lesion with expansion of the bone marrow and sclerosis. The earliest symptom and sometimes the only one is the Erlenmeyer flask deformity or widening of the distal portion of the femur. Sometimes there is a high degree of deossification without definite osteolytic lesions. Pathologic fractures and fractures caused by pressure of the vertebral bodies are common. Aseptic femoral necrosis are often present. Other less frequent sites of osteoarticular pathology are the skull, jaws, ribs, and sacroiliac joints. Splenomegaly is the most frequent visceral lesion. Other organs sometimes affected are the liver, kidneys, heart, lymphatic system, and lungs, with nodular or basal reticular infiltrations.