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Assessing visibility and bone changes of spinal metastases in CT scans: a comprehensive analysis across diverse cancer types

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Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objectives

To analyze the characteristics of spinal metastasis in CT scans across diverse cancers for effective diagnosis and treatment, using MRI as the gold standard.

Methods

A retrospective study of 309 patients from four centers, who underwent concurrent CT and spinal MRI, revealing spinal metastasis, was conducted. Data on metastasis including total number, volume, visibility on CT (visible, indeterminate, or invisible), and type of bone change were collected. Through chi-square and Mann–Whitney U tests, we characterized the metastasis across diverse cancers and investigated the variation in the intra-individual ratio representing the percentage of lesions within each category for each patient.

Results

Out of 3333 spinal metastases from 309 patients, 55% were visible, 21% indeterminate, and 24% invisible. Sclerotic and lytic lesions made up 47% and 43% of the visible and indeterminate categories, respectively. Renal cell carcinoma (RCC), prostate cancer, and hepatocellular carcinoma (HCC) had the highest visibility at 86%, 73%, and 67% (p < 0.0001, p < 0.0001, and p = 0.003), while pancreatic cancer was lowest at 29% (p < 0.0001). RCC and HCC had significantly high lytic metastasis ratios (interquartile range (IQR) 0.96–1.0 and 0.31–1.0, p < 0.001 and p = 0.005). Prostate cancer exhibited a high sclerotic lesion ratio (IQR 0.52–0.97, p < 0.001). About 39% of individuals had invisible or indeterminate lesions, even with a single visible lesion on CT. The intra-individual ratio for indeterminate and invisible metastases surpassed 18%, regardless of the maximal size of the visible metastasis.

Conclusions

This study highlights the variability in characteristics of spinal metastasis based on the primary cancer type through unique lesion-centric analysis.

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Data Availability

The datasets generated or analyzed during the study are not publicly available due to institutional policy but are available from the corresponding author upon reasonable request.

Abbreviations

HCC:

Hepatocellular carcinoma

IHCC:

Intrahepatic cholangiocarcinoma

RCC:

Renal cell carcinoma

IQR:

Interquartile range

References

  1. Coleman RE, Croucher PI, Padhani AR, Clézardin P, Chow E, Fallon M, et al. Bone metastases. Nat Rev Dis Primer. 2020;6:83.

    Article  Google Scholar 

  2. Perrin RG, Laxton AW. Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am. 2004;15:365–73.

    Article  PubMed  Google Scholar 

  3. Cole JS, Patchell RA. Metastatic epidural spinal cord compression. Lancet Neurol. 2008;7:459–66.

    Article  PubMed  Google Scholar 

  4. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7–30.

    Article  PubMed  Google Scholar 

  5. Sciubba DM, Petteys RJ, Dekutoski MB, Fisher CG, Fehlings MG, Ondra SL, et al. Diagnosis and management of metastatic spine disease: a review. J Neurosurg Spine. 2010;13:94–108.

    Article  PubMed  Google Scholar 

  6. O’Sullivan GJ. Imaging of bone metastasis: an update. World J Radiol. 2015;7:202.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hussain I, Barzilai O, Reiner AS, McLaughlin L, DiStefano NM, Ogilvie S, et al. Spinal Instability Neoplastic Score component validation using patient-reported outcomes. J Neurosurg Spine. 2019;30:432–8.

    Article  Google Scholar 

  8. Coleman RE. Skeletal complications of malignancy. Cancer. 1997;80:1588–94.

    Article  PubMed  CAS  Google Scholar 

  9. Roodman GD. Mechanisms of Bone Metastasis. N Engl J Med. 2004;350:1655–64.

    Article  PubMed  CAS  Google Scholar 

  10. Suva LJ, Washam C, Nicholas RW, Griffin RJ. Bone metastasis: mechanisms and therapeutic opportunities. Nat Rev Endocrinol. 2011;7:208–18.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  11. Ishiwata Y, Hieda Y, Kaki S, Aso S, Horie K, Kobayashi Y, et al. Improved diagnostic accuracy of bone metastasis detection by water-HAP associated to non-contrast CT. Diagnostics. 2020;10:853.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Sciubba DM, Pennington Z, Colman MW, Goodwin CR, Laufer I, Patt JC, et al. Spinal metastases 2021: a review of the current state of the art and future directions. Spine J. 2021;21:1414–29.

    Article  PubMed  Google Scholar 

  13. Pennington Z, Ahmed AK, Cottrill E, Westbroek EM, Goodwin ML, Sciubba DM. Intra- and interobserver reliability of the Spinal Instability Neoplastic Score system for instability in spine metastases: a systematic review and meta-analysis. Ann Transl Med. 2019;7:218–218.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yang H-L, Liu T, Wang X-M, Xu Y, Deng S-M. Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy. Eur Radiol. 2011;21:2604–17.

    Article  PubMed  Google Scholar 

  15. Jimenez-Carretero D, Bermejo-Peláez D, Nardelli P, Fraga P, Fraile E, San José Estépar R, et al. A graph-cut approach for pulmonary artery-vein segmentation in noncontrast CT images. Med Image Anal. 2019;52:144–59.

    Article  PubMed  Google Scholar 

  16. Kang MJ, Won Y-J, Lee JJ, Jung K-W, Kim H-J, Kong H-J, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2019. Cancer Res Treat. 2022;54:330–44.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mundy GR. Metastasis to bone: causes, consequences and therapeutic opportunities. Nat Rev Cancer. 2002;2:584–93.

    Article  PubMed  CAS  Google Scholar 

  18. Maccauro G, Spinelli MS, Mauro S, Perisano C, Graci C, Rosa MA. Physiopathology of Spine Metastasis. Int J Surg Oncol. 2011;2011:1–8.

    Google Scholar 

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Acknowledgements

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2019R1C1C1009044).

Funding

This study was funded by the Ministry of Science and ICT, South Korea (2019R1C1C1009044) on Dong Hyun Kim.

Author information

Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea

    Jung Oh Lee & Hee-Dong Chae

  2. Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea

    Dong Hyun Kim, Ji Hyun Lee, Hyo Jin Kim, Jiwoon Seo & Jee Won Chai

  3. Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-Do, Republic of Korea

    Eugene Lee

  4. Department of Radiology, Konkuk University Medical Center, Seoul, Republic of Korea

    Ji Hee Kang

Authors
  1. Jung Oh Lee
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  2. Dong Hyun Kim
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  4. Eugene Lee
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Correspondence to Dong Hyun Kim.

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Key points

•The study assessed spinal metastasis characteristics on CT scans across varied cancer types using MRI as a reference.

•Among the 3333 identified spinal metastases, 55% were visible on CT. RCC, prostate cancer, and HCC showed the highest visibility. Prostate cancer mainly displayed sclerotic lesions, whereas RCC and HCC were predominantly lytic.

•Differences in visibility and bone changes on CT scans across diverse cancers were validated through unique lesion-centric analysis.

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Lee, J.O., Kim, D.H., Chae, HD. et al. Assessing visibility and bone changes of spinal metastases in CT scans: a comprehensive analysis across diverse cancer types. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04623-5

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  • DOI: https://doi.org/10.1007/s00256-024-04623-5

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