• Journal of Chest Surgery
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• v.35 no.9
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• pp.659-663
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• 2002

The objective of this study was to assess the usefulness of bone scans in routine preoperative examinations of patients with newly diagnosed non-small cell lung carcinoma. Material and Method: We reviewed the medical records of 258 patients who were newly diagnosed with non-small cell lung cancer in our hospital between January 2000 and December 2000. More than half of the patients (132) were deemed to be inoperable due to their advanced stage based on the CT scans. The remaining 126 patients were considered potentially operable. For these patients, clinical evaluation including the presence of bone pain, serum alkaline phosphatase, and calcium levels was used as clinical predictors of bone metastasis. All patients received bone scans. Bone X-rays, MRI or bone biopsy were performed to confirm the presence of bone metastasis. The usefulness of the bone scan was evaluated by comparing its power of predicting bone metastasis to that of the clinical information. Result: In all patients, the positive and negative predictive values of bone scans for the bone metastasis were 44%, and 99%, respectively. Those of the clinical information were 38% , and 94%. However, in potentially operable patients, the negative predictive value of the clinical information was as high as 99%. Conclusion: If newly diagnosed non-small cell lung cancer patients are presented as potentially operable on the basis of CT scan with no clinical evidence of distant metastases, curative resection could be considered without performing routine bone scans because of the low probability of bone metastasis. However, if there are positive clinical findings, further evaluations, including bone scan should be followed as metastasis will be documented in more than 30% of patients.

• The Korean Journal of Nuclear Medicine
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• v.24 no.2
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• pp.299-306
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• 1990

골 신티그라피에서 신장이 희미하게 보이거나 전혀 안보이게 되는(이하 신장 영상 비출현이라 함) 원인 질환을 파악하고, 또 골 신티그라피에서 골전이가 발견된 여러 악성종양에서 신장 영상 비출현의 빈도 및 신장 영상 비출현의 소견을 보이는 여러 악성종양의 골전이 범위를 관찰하기 위하여, 서울대학교 병원에서 최근 6년간 시행한 골 신티그람 중 신장 영상 비출현의 소견을 보이는 889개를 재검토하였다. 신장영상 비출현의 원인 질환으로는 신부전이 대부분을 차지하였으나(816/889 : 91.8%), 신장 질환이 없는 경우에서는 광범위한 골전이가 가장 많았으며 (53/889 : 6.0%), 그 원발부위는 전립선암 (19/53 : 35.8%), 위암(14/53 : 26.4%), 유방암(5/53 : 9.4%), 폐암(4/53 : 7.5%) 신세포암(2/53 : 3.8%), 방광암(1/53 : 1.9%), 원발부위 미상(8/53 : 15.1%)으로 전립선암과 위암이 가장 많았다. 특히 강직성 척추염 4예, 류마토이드 관절염 3예, 성인형의 골화석증 1예에서 신장 영상 비출현의 소견을 보여 이채로왔으며, 이 밖에 원발성 부갑상선 기능항진증 및 그레이브스병이 각 1예씩 있었으며 원인을 알 수 없는 경우가 10예 있었다. 전립선암 140예중 골 신티그라피에서 골전이가 발견된 예는 108예(77.1%), 이중 신장 영상 비출현의 소견을 보이는 예는 19예(19/108, 17 6%)이었으며, 위암에서는 각각 328예, 162예(49.4%), 14예 (8.6%), 유방암에서는 각각 1754예, 730예 (41.6%), 5예(0.7%), 폐암에서는 각각 1105예, 596예(53.9%), 4예(0.7%), 방광암에서는 각각 247예, 110예(44.5%), 1예(0.9%)로 전립선암에서 신장 영상 비출현의 빈도가 가장 높았으며, 특히 위암에서 골전이 및 신장 영상 비출현의 빈도가 높아 주목되었다. 골전이 및 신장 영상 비출현의 소견을 보이는 악성종양 환자의 골 신티그람 53개중 44개 (83.0%)에서 척추 및 늑골에 미만성, 또는 다발성 침습이 관찰되었다. 또 골전이 부위를 두개골, 척추, 견대부, 늑골, 골반, 사지의 근위부 장골의 6개 부위로 나누어 분석할 경우 49개(92.5%)에서 3부위 이상에 전이가 발견되었고, 35개(66.0%)에서 4부위 이상에 전이가 발견되었으며, 5부위 이상, 6개 부위에 모두 전이가 발견된 것은 각각 20개 (37 7%), 11개(20.8%)이었다. 이상의 성적으로 보아 악성종양 환자의 골 신피그라피에서 신장 영상의 비출현은 종양의 광범위한 골전이를 간접적으로 시사하는 소견으로 생각된다. 여러 악성종양중 전립선암에서 신장 영상 비출현의 빈도가 가장 높았으며, 특히 위암에서 골전이 및 신장 영상 비출현의 빈도가 높음은 주목할 만한 것이라 하겠다.

• The Korean Journal of Nuclear Medicine
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• v.25 no.2
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• pp.211-218
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• 1991

1983년 1월부터 1991년 2월까지 서울대학교 병원에서 진단된 위 암환자를 대상으로 시행한 359예의 골스캔을 후향적으로 재검토하여 골전이 빈도와 양상을 관찰하였으며 환자들의 의무기록을 검토하여 위암의 임상상과 비교하였다. 그 결과는 다음과 같았다. 1) 359예의 골스캔 중에서 골전이에 부합되는 이상소견은 167예(46.5%)이었다. 2) 관찰된 167예의 이상소견 빈도는 척추(66%)에 가장 많이 관찰되었고, 늑골(58%), 골반부(43%), 대퇴골(31%), 두개골(22%)순이었다. 3) 척추전이에서 흉추(65.6%)와 요추(64.5%)의 전이빈도는 거의 비슷하였고, 경추(23.6%)는 낮았다. 4) 골전이 빈도는 임상적 병기 3기 환자에서 진단후 1년 이내에 급격히 증가되었고 그 이후는 증가되지 않았다. 5) 골전이는 임상적 병기가 증가됨에 따라 증가되었으나, 조직학적 세포형태와는 무관하였다. 6) 혈청 alkaline phosphatase 치와 골스캔 상의 골전이 유무와 통제적으로 유의 한 상관관계가 관찰되었다. 이상의 결과로 위암환자의 상당 수에서 골전이가 진단되었으며 위 암환자, 특히 진행암 환자에서 골전이에 대한 주기적인 추적 검사가 필요할 것으로 생각된다.

• The Korean Journal of Nuclear Medicine
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• v.22 no.2
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• pp.215-220
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• 1988

폐암은 비록 그 예후가 나쁜 것으로 되어 있으나, 각 환자에서의 정확한 병기결정은 치료방침과 예후결정에 중요하다. $^{99m}Tc-MDP$를 이용한 골스캔은 단순 방사선학적 검사보다 골전이의 조기진단에 예민하므로, 병기결정에 유용하다고 인정되어 왔다. 저자들은 최근 2년간 조직학적으로 확진된 폐암 환자중 치료전의 골스캔을 구할 수 있었던 202예를 대상으로 후향적 분석을 하였다. 1) 전체적인 골스캔의 골전이 양성율은 43%(87/202)였으며, 비소세포폐암에서 44%(60/135), 소세포폐암에서 40%(27/67)로 나타났다. 2) 비소세포폐암 중에는 선암이 61%(19/31)의 가장높은 골전이 양성율을 보였고, 비소세포폐암의 임상적 stage II에사 29%, stage II에서 50%의 골전이 양성율을 보였다. 3) 87예의 골전이 양성중에서 고립성인 경우가 18예였으며, 다발성 69예의 골분포양상는 늑골이 가장 빈번했으며 요추, 대퇴골, 흉추 그리고 골반 순서로 나타났다. 4) 골통증이 있었던 환자 67예중 골스캔상 골전이가 양성인 경우가 57예, 골통증이 없었던 107예증 골전이 양성인 경우가 17예였고, 혈청 alkaline phosphatase가 증가되었던 65예중 47예에서 골스캔 양성이었고, 그 수치가 정상이었던 137예중 40예서 골스캔상 전이 소견을 보였다. 5) 전체적으로 증가추세에 있는 폐암 환자에 있어서 치료전의 골 스캔은 병기결정에 많은 도움을 줄 수 있는 유용한 검사라 하겠다.

• The Journal of the Korean bone and joint tumor society
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• v.7 no.4
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• pp.133-138
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• 2001

Purpose : To analyze the clinical behaviors and survivorship of metastatic bone tumors. Materials and Methods : One hundred and ninty-eight metastatic bone tumors had been diagnosed from January 1982 to December 1998. Age and sex distribution, primary cancer types. metastatic sites, duration from diagnosed of primary tumors to bony metastases and survivorship were analysed. Results : Mean age was 57(24~86) years old. Lung(32.3%) and breast(16.2%) cancers were two most common primary foci. The spines was the most common site of metastases especially lumbar region(38%). Survivorship analysis was done in one hundred and fifteen patients who had been followed up. The mean survival period was 15.3 months. The survivorship of hepatoma(7.1 Mons), lung(8.72 Mons) and renal cell(4.8 Mons)cancers was relatively shorter and breast cancer(54.1 Mons) longest. Conclusion : The mean age of metastatic bone tumors of this study was older than the past reports. The axial skeletons especially spine was predominant metastatic site. The survivorship of metastatic bone tumor decreased sharply as time goes by, so early diagnosis is clue for longer survival after bony metastases.

• The Journal of Korean Institute of Communications and Information Sciences
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• v.38C no.10
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• pp.887-895
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• 2013

Metastatic bone cancer, the cancer which occurred in the various organs and progressively spread to bone, is one of the complications in cancer patients. This cancer is divided into the osteoblast and osteolytic metastasis. Although Computer Tomography(CT) could be an useful tool in diagnosis of bone metastasis, lesions are often missed by the visual inspection and it makes clinicians difficult to detect metastasis earlier. Therefore, in this study, we construct a three-dimensional(3D) volume rendering data from tomography images of the chest CT, and apply a 3D based image processing algorithm to them for detection bone metastasis lesions. Then we perform a three-dimensional visualization of the detected lesions.From our test using 10 clinical cases, we confirmed 94.1% of average sensitivity for osteoblast, and 90.0% of average sensitivity, respectively. Consequently, our findings showed a promising possibility and potential usefulness in diagnosis of metastastic bone cancer.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.38-44
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• 1995

Metastatic bone tumor is the most common bone tumor and 32.5% of all primary malignant tumors are eventually metastasize to bone. Metastatic bone tumor has been more frequently encountered disease in the orthopedic fields due to the greater longevity of life of the patients with primary visceral cancers by major advances in early detection, diagnosis, and surgical/radiotherapeutic/chemotherapeutic treatment of primary and metastatic lesions. Therefore, the epidemiologic data about the incidences and the patterns of bone metastasis is important. We reviewed 417 patients who were diagnosed and treated for metastatic bone tumor at Kosin University Medical Center from 1985 to 1993 to analyse the primary lesion, age and sex distributions, location of bone metastasis, patterns of metastasis according to the primary. The results were as follows : 1. The common origin of bone metastasis were lung(29.5%), stomach(15.3%), breast(11.3%), unknown(7.7%), cervix(5.3%), liver(4.8%) in order of frequency. 2. There were 251 men and 166 women and their mean age was 54.8 years and the peak age incidence was in 6th decades. Most cases(85.3%) were occured beyond 5th decades. 3. The preferred sites of metastatic deposits were spine(64.0%), pelvis(40.5%), rib(38.8%), femur(36.7%), skull(21.1%), humerus(13.9%), scapula(13.0%) in order of frequency. In the spine, thoracic(42.1%), lumbar(39.1%), cervical(13.2%), sacral(5.6%) vertebrae were involved in order of frequency. 4. Multiple bone metastases were more common(73.1%) than single metastasis(26.9%). 5. In the lung cancer, the peak age incidence was 6th decades, and the preferred sites of bone metastasis were spine, pelvis, femur. 6. In the stomach cancer, the peak age incidence was 6th decades, and the preferred sites of bone metastasis were spine, femur, pelvis. 7. In the breast cancer, the peak age incidence was 5th decades, and the preferred sites of bone metastasis were spine, rib, pelvis. 8. In the bone metastasis with unknown primary site, the peak age incidence was 7th decades, the preferred sites of bone metastasis were spine, femur, pelvis, and the common histologic types were adenocarcinoma and squamous cell carcinoma.

• The Korean Journal of Nuclear Medicine
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• v.33 no.6
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• pp.512-518
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• 1999

Purpose: We evaluated the usefulness of 24 hour/3 hour radio-uptake ratio, lesion to non-lesion ratio, in differentiating bony metastases from acute (<2 months) and healing (${\geq}2$ months) fractures. Materials and Methods: Sixty-three patients (age range: 26-81, 32 males, 31 females) having 90 lesions (30 bone metastases, 30 acute fractures, 30 healing fractures) were included. Bone scans were obtained 3 and 24 hours after administration of 740 MBq of $^{99m}Tc$-MDP. The ratio of radio-uptake in the lesion to normal area was measured as 24/3 hour radio-uptake ratio ([lesion/non-lesion RUR at 24 hour]/[lesion/non-lesion RUR at 3 hour], 24/3 RUR) and analyzed clinical significance in differentiating bone metastases from acute or healing fractures. Results: Mean 24/3 RUR were $1.22{\pm}0.18$ for bone metastases, $1.25{\pm}0.14$ for acute fractures, and $0.99{\pm}0.15$ for healing fractures. 24/3 RUR values of bone metastases and acute fractures were not significantly different. But 24/3 RUR values of bone metastases and healing fractures, and those of acute and healing fractures were found to be significantly different (p<0.001). When 24/3 RUR of 1.0 was considered as the cut off point separating metastases from fracture, a sensitivity of 100% (30/30) was obtained. The specificity was 0% (0/30) in separating metastases from acute fractures, and 47% (14/30) in separating metastases from healing fractures. When 24/3 RUR of 1.2 was considered as the cut off point, sensitivity of 53% (16/30) in the diagnosis of bone metastasis, and specificity of 37% (11/30) in separating metastases from acute fractures, and 100% (30/30) in separating metastases from healing fractures were obtained. Conclusion: 24/3 RUR is useful in differentiating bone metastases from healing fractures, but not in differentiating bone metastases from acute fractures. A 24/3 RUR of less than 1.0 suggests healing fractures. A 24/3 RUR of more than 1.2 suggests bone metastases or acute fractures.

• Nuclear Medicine and Molecular Imaging
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• v.41 no.1
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• pp.30-41
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• 2007

Purpose: Bone metastasis in breast cancer patients are usually assessed by conventional Tc-99m methylene diphosphonate whole-body bone scan, which has a high sensitivity but a poor specificity. However, positron emission tomography with $^{18}F-2-deoxyglucose$ (FDG-PET) can offer superior spatial resolution and improved specificity. FDG-PET/CT can offer more information to assess bone metastasis than PET alone, by giving a anatomical information of non-enhanced CT image. We attempted to evaluate the usefulness of FDG-PET/CT for detecting bone metastasis in breast cancer and to compare FDG-PET/CT results with bone scan findings. Materials and Methods: The study group comprised 157 women patients (range: $28{\sim}78$ years old, $mean{\pm}SD=49.5{\pm}8.5$) with biopsy-proven breast cancer who underwent bone scan and FDG-PET/CT within 1 week interval. The final diagnosis of bone metastasis was established by histopathological findings, radiological correlation, or clinical follow-up. Bone scan was acquired over 4 hours after administration of 740 MBq Tc-99m MDP. Bone scan image was interpreted as normal, low, intermediate or high probability for osseous metastasis. FDG PET/CT was performed after 6 hours fasting. 370 MBq F-18 FDG was administered intravenously 1 hour before imaging. PET data was obtained by 3D mode and CT data, used as transmission correction database, was acquired during shallow respiration. PET images were evaluated by visual interpretation, and quantification of FDG accumulation in bone lesion was performed by maximal SUV(SUVmax) and relative SUV(SUVrel). Results: Six patients(4.4%) showed metastatic bone lesions. Four(66.6%) of 6 patients with osseous metastasis was detected by bone scan and all 6 patients(100%) were detected by PET/CT. A total of 135 bone lesions found on either FDG-PET or bone scan were consist of 108 osseous metastatic lesion and 27 benign bone lesions. Osseous metastatic lesion had higher SUVmax and SUVrel compared to benign bone lesion($4.79{\pm}3.32$ vs $1.45{\pm}0.44$, p=0.000, $3.08{\pm}2.85$ vs $0.30{\pm}0.43$, p=0.000). Among 108 osseous metastatic lesions, 76 lesions showed as abnormal uptake on bone scan, and 76 lesions also showed as increased FDG uptake on PET/CT scan. There was good agreement between FDG uptake and abnormal bone scan finding (Kendall tau-b : 0.689, p=0.000). Lesion showed increased bone tracer uptake had higher SUVmax and SUVrel compared to lesion showed no abnormal bone scan finding ($6.03{\pm}3.12$ vs $1.09{\pm}1.49$, p=0.000, $4.76{\pm}3.31$ vs $1.29{\pm}0.92$, p=0.000). The order of frequency of osseous metastatic site was vertebra, pelvis, rib, skull, sternum, scapula, femur, clavicle, and humerus. Metastatic lesion on skull had highest SUVmax and metastatic lesion on rib had highest SUVrel. Osteosclerotic metastatic lesion had lowest SUVmax and SUVrel. Conclusion: These results suggest that FDG-PET/CT is more sensitive to detect breast cancer patients with osseous metastasis. CT scan must be reviewed cautiously skeleton with bone window, because osteosclerotic metastatic lesion did not showed abnormal FDG accumulation frequently.

• The Korean Journal of Nuclear Medicine
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• v.30 no.4
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• pp.524-531
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• 1996

Purpose : To evaluate the pattern- of skeletal metastases and to classify the pattern of renal uptakes on bone scans in renal cell carcinoma. Materials and Methods : We reviewed the bone scans of 158 patients with RCC established pathologically. In order to identify individual scan lesion as a bone metastasis, we reviewed all available correlative radiological studies, follow-up bone scans, and biopsies for each lesion. The metastatic bone lesions were divided into seven anatomic regions; skull, spine, shoulder girdle, sternum, ribs, pelvis, and long bones of extremities. The individual scan lesions were divided into two groups as the pattern of uptakes, hot and cold lesion. In addition, the contours and uptakes of kidneys with RCC were classified into 6 groups ; normal uptake, photon-deficient lesion, faint up-take with enlargement, uneven uptake with enlargement, lateralization with crescentic shape, and increased uptake. Results : Twenty out of 158(12.7%) patients with RCC at varying stages showed 71 metastatic bone lesions at presentation and on follow- up bone scans. Nearly 80% of all metastatic lesions were in the axial skeleton with predominantly increased uptake of the radioactivity However a considerable number(22.5%) showed cold lesions on bone scan. A half of bone scans revealed abnormal uptake of involved kidney and much more(82.4%) in case of bone metastases. Two common patterns of abnormal renal uptake were photon-deficient lesion (50%) and faint uptake with enlargement(24.3%). In four patients with bone pain or pathologic fracture, bone scans were useful for the serendipitious localization of previously unrecognized primary lesion of RCC as well as for the detection of bone metastases from RCC. Conclusion : The understanding of the pat-terns of skeletal metastases and renal uptakes on bone scans in RCC is important for the useful information about primary lesion(RCC) as well as detection of bone metastases.