PMC6159113_01
Additional imaging requested to investigate increased density in the lumbar spine on DEXA scan of a 57-year-old female with early-stage breast cancer (Case 1). (a) X-ray of lumbosacral spine showing focal bony sclerosis at T12 and L1. (b) Sagittal section of CT of lumbosacral spine showing sclerotic lesions in L1 to L4. (c) Sagittal T1 section of MRI of lumbosacral spine showing corresponding low signal lesions in the vertebral bodies.
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The patient's baseline DEXA scan revealed increased density in the lumbar spine, which prompted further investigations including X-ray of the lumbosacral spine and CT scan of the chest, abdomen and pelvis (Figure 1). A repeat CT scan in 2013 and MRI scan of the spine in 2014 (Figure 1) showed appearances consistent with skeletal metastases.
Isotope bone scan for a 57-year-old female with early stage breast cancer (Case 1) showing subtle focal uptake in L1, possibly L3, left sacroiliac joint, left iliac bone and left acetabulum. There was surprisingly little uptake considering the X-ray appearances. Potential explanations provided for the relative lack of uptake on the bone scan were: inactive metastatic disease, perhaps in response to Letrozole; or an aggressive osteoclastic component masking uptake.
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The patient also had an isotope bone scan (Figure 2) which showed only subtle focal uptake in the lumbar spine, left sacroiliac joint, left iliac bone and left acetabulum, that was discordant with plain films.
PMC6159113_02
Isotope bone scan of a 50-year-old female with node-positive breast cancer (Case 2) showing subtle increased uptake in the left anterior chest consistent with recent breast surgery but no evidence of bone metastases.
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The patient's isotope bone scan showed no evidence of metastatic disease (Figure 3) but an X-ray of the pelvis showed sclerotic lesions mostly localized in the iliac wings (Figure 4), and CT scan of the thorax and abdomen showed multiple small sclerotic nodules throughout the entire skeleton (Figure 5).
X-ray of pelvis of a 50-year-old female with node-positive breast cancer (Case 2) showing multiple sclerotic lesions in the iliac wings and proximal femora.
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The patient's isotope bone scan showed no evidence of metastatic disease (Figure 3) but an X-ray of the pelvis showed sclerotic lesions mostly localized in the iliac wings (Figure 4), and CT scan of the thorax and abdomen showed multiple small sclerotic nodules throughout the entire skeleton (Figure 5).
CT scan of a 50-year-old female with node-positive breast cancer (Case 2). (a) Axial CT image of the thorax showing multiple, small, rounded sclerotic foci in the T7 vertebral body. (b) Sagittal CT image showing multiple, small, rounded, sclerotic lesions throughout the vertebra and sternum.
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The patient's isotope bone scan showed no evidence of metastatic disease (Figure 3) but an X-ray of the pelvis showed sclerotic lesions mostly localized in the iliac wings (Figure 4), and CT scan of the thorax and abdomen showed multiple small sclerotic nodules throughout the entire skeleton (Figure 5).