The high incidence of skeletal metastases in cancer patients warrants careful detection with imaging and follow-up. Efforts are needed to manage pain associated with skeletal metastases as part of overall patient management.
Methods
This article reviews the current methods of diagnostic imaging in the evaluation of skeletal metastases and image-guided treatment of bone metastases for the palliation of pain based primarily on the assessment of imaging and interventional radiologic literature.
Results
Approaches to diagnostic imaging of skeletal metastases are summarized. Skeletal scintigraphy provides high sensitivity for detecting skeletal metastases, but targeted computed tomography (CT) or magnetic resonance imaging (MRI) may be needed to increase specificity. Newer imaging modalities, such as positron emission tomography (PET)/CT, improve detection of both lytic and blastic metastases. Minimally invasive percutaneous ablative treatment techniques, including radiofrequency ablation, microwave ablation, and cryoablation, are examined. They provide alternative approaches to radiation therapy to effectively palliate pain of bone metastases. Preliminary results of MR-guided focused ultrasound surgery (MRgFUS) demonstrate its effectiveness in palliating pain from skeletal metastases.
Conclusions
Skeletal scintigraphy is the most common imaging modality for detecting skeletal metastases. Additional imaging may be required based on the type of tumor, the disease state, or treatment options. External-beam radiation therapy remains the mainstay for palliation of pain from bone metastases. Alternative minimally invasive and noninvasive image-guided treatment options can provide effective pain palliation.
References
1.
Even-SapirE.. Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities.J Nucl Med.2005; 46(8): 1356–1367.
2.
ResnickD.L.. Skeletal metastases. In: ResnickD.L., ed. Diagnosis of Bone and Joint Disorders.4th ed.Philadelphia, PA: WB Saunders Co; 2002: 4274–4351.
3.
HamaokaT., MadewellJ.E., PodoloffD.A.. Bone imaging in metastatic breast cancer.J Clin Oncol.2004; 22(14): 2942–2953.
4.
RybakL.D., RosenthalD.I.. Radiological imaging for the diagnosis of bone metastases.Q J Nucl Med.2001; 45(1): 53–64.
5.
RosenthalD.I.. Radiologic diagnosis of bone metastases.Cancer.1997; 80(8 suppl): 1595–1607.
6.
CostelloeC.M., RohrenE.M., MadewellJ.E.. Imaging bone metastases in breast cancer: techniques and recommendations for diagnosis.Lancet Oncol.2009; 10(6): 606–614.
ChangM.C., ChenJ.H., LiangJ.A.. Meta-analysis comparison of F-18 fluorodeoxyglucose-positron emission tomography and bone scintigraphy in the detection of bone metastasis in patients with lung cancer.Acad Radiol.2012; 19(3): 349–357.
9.
DootR.K., MuziM., PetersonL.M.. Kinetic analysis of 18F-fluoride PET images of breast cancer bone metastases.J Nucl Med.2010; 51(4): 521–527.
GrantF.D., FaheyF.H., PackardA.B.. Skeletal PET with 18F-fluoride: applying new technology to an old tracer.J Nucl Med.2008; 49(1): 68–78.
12.
BeheshtiM., ValiR., WaldenbergerP.. Detection of bone metastases in patients with prostate cancer by 18F fluorocholine and 18F fluoride PET-CT: a comparative study.Eur J Nucl Med Mol Imaging.2008; 35(10): 1766–1774.
13.
SchmidtG.P., ReiserM.F., Baur-MelnykA.. Whole-body imaging of the musculoskeletal system: the value of MR imaging.Skeletal Radiol.2007; 36(12): 1109–1119.
14.
KohD.M., CollinsD.J.. Diffusion-weighted MRI in the body: applications and challenges in oncology.AJR Am J Roentgenol.2007; 188(6): 1622–1635.
15.
KhooM.M., TylerP.A., SaifuddinA.. Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review.Skeletal Radiol.2011; 40(6): 665–681.
16.
BeheshtiM., ValiR., WaldenbergerP.. The use of F-18 choline PET in the assessment of bone metastases in prostate cancer: correlation with morphological changes on CT.Mol Imaging Biol.2010; 12(1): 98–107.
17.
ColemanR.E.. Clinical features of metastatic bone disease and risk of skeletal morbidity.Clin Cancer Res.2006; 12(20 Pt 2): 6243s–6249s.
18.
NielsenO.S., MunroA.J., TannockI.F.. Bone metastases: pathophysiology and management policy.J Clin Oncol.1991; 9(3): 509–524.
19.
WongR.K., WiffenP.. Should bisphosphonates be used to provide pain relief for patients with painful bone metastases? A systematic review for the cochrane collaboration.Int J Radiat Oncol Biol Phys.2002; 54: 2(suppl): 307–308.
20.
LutzS., BerkL., ChangE.. Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline.Int J Radiat Oncol Biol Phys.2011; 79(4): 965–976.
21.
van der LindenY.M., LokJ.J., SteenlandE.. Single fraction radiotherapy is efficacious: a further analysis of the Dutch Bone Metastasis Study controlling for the influence of retreatment.Int J Radiat Oncol Biol Phys.2004; 59(2): 528–537.
22.
HartsellW.F., ScottC.B., BrunerD.W.. Randomized trial of short-versus long-course radiotherapy for palliation of painful bone metastases.J Natl Cancer Inst.2005; 97(11): 798–804.
23.
RosenthalD.I., AlexanderA., RosenbergA.E.. Ablation of oste-oid osteomas with a percutaneously placed electrode: a new procedure.Radiology.1992; 183(1): 29–33.
24.
DupuyD.E., LiuD., HartfeilD.. Percutaneous radiofrequency ablation of painful osseous metastases: a multicenter American College of Radiology Imaging Network trial.Cancer.2010; 116(4): 989–997.
25.
ThanosL., MylonaS., GalaniP.. Radiofrequency ablation of osseous metastases for the palliation of pain.Skeletal Radiol.2008; 37(3): 189–194.
26.
GoetzM.P., CallstromM.R., CharboneauJ.W.. Percutaneous image-guided radiofrequency ablation of painful metastases involving bone: a multicenter study.J Clin Oncol.2004; 22(2): 300–306.
LubnerM.G., BraceC.L., HinshawJ.L.. Microwave tumor ablation: mechanism of action, clinical results, and devices.J Vasc Interv Radiol.2010; 21(8 suppl): S192–S203.
31.
SimonC.J., DupuyD.E.. Image-guided ablative techniques in pelvic malignancies: radiofrequency ablation, cryoablation, microwave ablation.Surg Oncol Clin N Am.2005; 14(2): 419–431.
32.
CarrafielloG., LaganàD., PellegrinoC.. Percutaneous imaging-guided ablation therapies in the treatment of symptomatic bone metastases: preliminary experience.Radiol Med.2009; 114(4): 608–625.
CataneR., BeckA., InbarY.. MR-guided focused ultrasound surgery (MRgFUS) for the palliation of pain in patients with bone metastases: preliminary clinical experience.Ann Oncol.2007; 18(1): 163–167.
40.
SmithN.B., TemkinJ.M., ShapiroF.. Thermal effects of focused ultrasound energy on bone tissue.Ultrasound Med Biol.2001; 27(10): 1427–1433.
GianfeliceD., GuptaC., KucharczykW.. Palliative treatment of painful bone metastases with MR imaging-guided focused ultrasound.Radiology.2008; 249(1): 355–363.
43.
LibermanB., GianfeliceD., InbarY.. Pain palliation in patients with bone metastases using MR-guided focused ultrasound surgery: a multicenter study.Ann Surg Oncol.2009; 16(1): 140–146.
