Differential diagnosis of metastases in bone scans: chemotherapy induced bone necrosis.
OBJECTIVE
Influenced by the incorrect diagnosis of a bone metastasis caused by bone necrosis we evaluated reasons and frequency of bone necrosis in patients referred for bone scanning in follow-up of tumors.


METHODS
Bone scans performed within two years on patients with primary bone tumors or tumors metastatic to bone were reviewed in respect to the final diagnosis bone necrosis.


RESULTS
We found the cases of three young patients who presented the appearance of hot spots on bone scintigrams which were finally diagnosed as bone necrosis. In two cases the diagnosis was based on histological findings, in one case the diagnosis was made evident by follow-up. All the three patients had been treated by chemotherapy and presented no other reason for the development of bone necrosis. Enhanced tracer uptake in all sites decreased within eight weeks up to two years without therapy.


CONCLUSIONS
Single and multiple hot spots after chemotherapy may be originated by bone necrosis but mimicry metastases.
Reuland
P
P
Abt. Nuklearmedizin, Eberhard-Karls-Universität Tübingen, Deutschland.
Kaiserling
E
E
Klingebiel
T
T
Feine
U
U
Niethammer
D
D
D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D001842:Bone and Bones / Q000187:drug effects / Q000473:pathology*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009336:Necrosis; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary; D012512:Sarcoma, Ewing / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000556:secondary