PubMed · 1147158
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E F Lang. 1975. Editorial: Bones and beyond.. https://doi.org/10.2214/ajr.124.1.154
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Nuclear medicine provides information about bone physiology that complements anatomic imaging modalities. Following a review of the principles of bone scintigraphy, scintigraphic imaging of orthopedic problems, such as primary and secondary neoplastic disease of the skeleton, occult fracture, stress fracture, and osteomyelitis are discussed.
A surface lesion of bone may arise within the cortex, between the cortex and the periosteum, within the periosteum, or in the tissues immediately adjacent to the periosteum including tendinous and ligamentous attachments. While these lesions generally reflect the spectrum of more common intramedullary lesions and have an appearance similar to that of their intramedullary counterparts, their unusual surface origin often renders diagnosis difficult. Surface sarcomas are usually of a lower grade than that of the intramedullary tumor, and often they have a more favorable prognosis. Traumatic lesions of the bone surface are common and should be considered in the differential diagnosis of a surface lesion, especially in the young or athletic individual. An elevated peripheral white blood cell count and erythrocyte sedimentation rate may herald an infection of the bone surface.
Pain management often is difficult in patients with bone metastases. Metastatic disease represents >40% of oncologic practice, and >70% of patients with metastatic disease have uncontrolled cancer-related pain. Significant morbidity caused by pathologic fracture and spinal cord compression can result from untreated bone metastases. Representing both a manifestation of systemic disease as well as causing localized symptoms, bone metastases require a multidisciplinary therapeutic approach. Radiation therapy provides both localized and systemic treatment options in addition to chemohormonal therapies and surgery. External beam irradiation provides palliation in >70% of patients through tumor regression of a localized lesion. Systemic radiopharmaceuticals treat multifocal disease either alone or as an adjuvant to external beam irradiation. Efficient and comprehensive management of bone metastases is imperative because of the associated symptoms, prior therapies, complex underlying medical problems, and clinical presentations that often require emergent interventions. Intensification of pain may be observed with hormonal therapy and systemic radiopharmaceuticals. Symptomatic relief from antineoplastic therapies generally requires 4-12 weeks and may be related to reossification. Symptoms, occurring due to the disease and/or while awaiting response to therapy, must be aggressively managed. Persistent or recurrent pain after therapy may be due to bony instability or fracture before reossification occurs. An Interdisciplinary Bone Metastases Clinic, with representatives from Diagnostic Radiology, Medical Oncology, Nuclear Medicine, Orthopedic Surgery, Pain and Symptom Management, Physical Medicine and Rehabilitation, and Radiation Oncology, was developed that allows coordinated evaluation, treatment, and symptom management of these complex clinical presentations.