Bone scintigraphy of skeletal metastasis in hepatoma patients treated by TAE.
OBJECTIVE
Skeletal metastasis in hepatocellular carcinoma patients has become clinically important as a result of advances in treatment modalities. However, the diagnostic accuracy of bone scintigraphy in hepatocellular carcinoma has been questioned.


METHODS
99mTc-MDP bone scintigraphy was performed in 63 unresectable hepatocellular carcinoma patients treated by transcatheter arterial embolization who either developed musculoskeletal pain (n = 43) or elevated serum alpha-fetoprotein levels (n = 20) during follow-up. Results were categorized as positive or negative for metastases, and their accuracy was evaluated by radiological studies, biopsy, and clinical follow-up.


RESULTS
Bone scintigraphy was positive in 22/43 (51.2%) subjects with pain and 2/20 with alpha-feto-protein elevation. Among 24 bone scintigraphy(+) patients, metastasis was confirmed in 17 and excluded in 6. Frequent sites for metastatic bone scintigraphy lesions were the spine, pelvic bone and ribs. Although 8 metastatic lesions had low or mixed uptake, most had increased uptake on bone scintigraphy. Among 39 bone scintigraphy(-) patients, metastasis was excluded in 32 and confirmed in 1. The sensitivity and specificity of bone scintigraphy in this subset of patients was 94.4% and 84.2%, respectively.


CONCLUSIONS
Transcatheter arterial embolization treated hepatocellular carcinoma patients with musculoskeletal pain have a high likelihood of bone metastasis, and bone scintigraphy is a highly reliable method for its detection.
Lee
Kyung-Han
KH
Department of Nuclear Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. khleenm@samsung.co.kr
Park
Jung Mi
JM
Yoon
Joon Kee
JK
Koh
Kwang Cheol
KC
Paik
Seung Woon
SW
Kim
Byung-Tae
BT
D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate; D000509:alpha-Fetoproteins / Q000378:metabolism
D000509:alpha-Fetoproteins; D013669:Technetium Tc 99m Medronate