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Bone scan for evaluation of the solitary lesion found incidentally on plain film or CT

¹ Nuclear Medicine Service (115), James A. Haley Veterans' Hospital, Tampa, Florida

1275

Objectives: Work-up of the solitary lesion found incidentally on plain film or CT may pose a diagnostic challenge. Increased metabolic activity on bone scan (BS) in a single lesion would, by itself, be of little diagnostic value. However, the presence of multiple abnormal sites may increase the likelihood of significant pathology. A retrospective review was done to assess the value of BS for this indication. Methods: BS was done to evaluate 44 solitary lesions noted on plain film (25) or CT (19). The 3 most common involved sites were pelvis (21), long bone (11), spine (7). 30 lesions were sclerotic (size 1-3 cm, mean 1.5 cm), 8 lucent (size 1-1.6 cm, mean 1.3 cm), 6 mixed (size 1.5-4 cm, mean 2.6 cm). There were 39 men and 5 women, age 35-86 yrs (mean 66 yrs). 22/44 (50%) patients had known cancer (prostate 14, bladder 3, breast 2, colon 2, sarcoma 1), but no known bony metastatic disease. Whole-body (and where necessary spot or SPECT (8)) Tc-99m HDP BS was performed in all patients. Results: Increased uptake was present in 18/44 (41%) lesions; 7/18 positive lesions (39%) were in patients with known cancer (prostate 5, breast 1, sarcoma 1) (table). In no case did BS identify any additional suspicious sites. Follow-up (ranging from 2-24 months) of all positive lesions did not reveal any significant associated pathology. Conclusions: In this series of patients, half with known malignancy, 41% of solitary lesions on plain film or CT demonstrated increased uptake on BS. However, BS did not identify any additional suspicious sites to increase the likelihood that the original solitary lesion represented metastatic disease. Nor did follow-up of any of the positive lesions reveal significant underlying pathology. The uncertainty introduced by a positive BS finding could lead to further unnecessary tests. BS has no role in the initial work-up of the incidental radiographic lesion; its best use may be in cases where clinically there is an increased likelihood of metastatic disease (e.g., elevated tumor marker, multiple suspicious lesions, lymphadenopathy on CT).

Correlation of Radiographic and BS Findings

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