Occult trauma mimicking metastases on bone scans in pediatric oncology patients
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Tracer-avid osseous lesions are usually considered to represent metastases in pediatric oncology patients. However, sites of minor, clinically occult, skeletal trauma may be mistaken for osseous metastases.
The objective of this study was to review our experience with skeletal scintigraphy in pediatrie oncology patients to determine specificity for metastatic disease.
Materials and methods
We reviewed 164 bone scans performed on 96 consecutive patients (ages 5 months to 23 years) at presentation with malignancy or during chemotherapy. Tumors included osteosarcoma (13), Ewing sarcoma (11), lymphoma (19), neuroblastoma (12), brain tumors (16), rhabdomyosarcoma (10), renal tumors (5), and miscellaneous neoplasms (10). Scintigraphic abnormalities were considered metastatic based on radiographie findings, subsequent tumor progression, or multiplicity of lesions. Lesions were considered benign when spontaneous resolution occurred without change in therapy or radiographs demonstrated a traumatic or other benign lesion.
Of the 96 patients, 51 had normal studies or showed only the primary lesion. Of the 45 patients with abnormal scintigraphy, 16 (35 %) had metastases and 29 (65 %) had one or more focal benign lesions. These lesions included abnormalities due to stress/trauma (25), benign neoplasm (2), infection (3), disuse (6), surgery (10) and artifacts (4).
The majority of scintigraphic abnormalities have nonmalignant etiologies, most commonly stress reaction and trauma. In patients without known extraosseous metastases, one or two skeletal lesions should not be assumed to represent metastatic disease.
- Gorenberg M, Groshar D, Israel O, Ben-Arush MW, Kolodny GM, Front D (1992) Stress fractures associated with osteosarcoma of the lower limb. J Nucl Med 33: 1699–1700
- Daffner RH, Pavlov H (1992) Stress fractures: current concepts. AJR 159: 245–252
- Ben-Ami T, Treves ST, Tumeh S, Cox-Bryan J, McCarthey C (1987) Stress fractures after surgery for osteosarcoma: scintigraphic assessment. Radiology 163: 157–162
- Zlatkin MB, Bjorkengren A, Sartous DJ, Resnick D (1987) Stress fractures of the distal tibia and calcaneus subsequent to acute fractures of the tibia and fibula. AJR 149: 329–332
- Sty JR, Wells RG, Smith WB (1988) The child with acute leg pain. Semin Nucl Med 18: 137–158 CrossRef
- Jacobson AF, Stomper PC, Cronin EB, Kaplan WD (1990) Bone scans with one or two new abnormalities in cancer patients with no known metastases: reliability of interpretation of initial correlative radiographs. Radiology 174: 503–507
- Brown ML (1983) Significance of the solitary lesion in pediatric bone scanning: concise communication. J Nucl Med 24: 114–115
- Englaro EE, Gelfand MJ, Paltiel JH (1991) Bone scanning in preschool children with lower extremity pain of unknown origin. J Nucl Med 33: 351–354
- Blumberg K, Patterson RJ (1991) The toddler’s cuboid fracture. Radiology 179: 93–94
- Starshak RJ, Simons GW, Sty JR (1984) Occult fracture of the calcaneus-another toddler’s fracture. Pediatr Radiol 14: 37–40 CrossRef
- Occult trauma mimicking metastases on bone scans in pediatric oncology patients
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