SCAN REPORTS

Bonescan 1 (1996/06/07)

NO OLD EXAMS ARE AVAILABLE FOR COMPARISON.

20 MILLICURIES OF TECHNETIUM MDP WAS INJECTED INTRAVENOUSLY AND ANTERIOR, POSTERIOR, WHOLE BODY IMAGES OF THE SKELETON WERE OBTAINED USING A GAMMA CAMERA.

IN ADDITION, BILATERAL LATERAL VIEWS OF THE SKULL, CERVICAL SPINE AND ANTERIOR POSTERIOR VIEWS OF THE CHEST AND PELVIS WERE OBTAINED.

BOTH KIDNEYS ARE IDENTIFIED.

THERE IS NO AREA OF DEFINITE ABNORMAL, INCREASED OR DECREASED UPTAKE OF THE RADIONUCLIDE NOTED.

CONCLUS ION: UNREMARKABLE BONE SCAN.
SPECIFICALLY, THERE IS NO SCINTIGRAPHIC EVIDENCE FOR METASTATIC DISEASE
(Dr. Susan Weinberg)

CT Scan of Abdomen and Pelvis (1995/08/08)

COMPARISON: none

TECHNICAL FACTORS: Following administration of oral, rectal and IV contrast, 10mm axial images were obtained at 15mm in the abdomen and 10mm in the pelvis. The field of view is 38cm.

FINDINGS: The parenchymal organs of the abdomen and pelvis are normal in morphology and enhancement. With the exception of scattered diverticula involving the colon, the GI tract is wihtin normal limits in CT appearance. No significant lymphadenopathy or bony lesions are identified. The lung bases are clear.

IMPRESSION: NO CT EVIDENCE OF METASTATIC PROSTATE CARCINOMA.
(Dr. Philip M. Meyers)

Bonescan 3 (1997/05/27)

Following intravenous injection of 25mCi TcMDP planar images of the entire skeleton were obtained. Comparison is made with the last examination of 2-12-97.
There is increased uptake in the right mid clavicle due to old fracture. The present examination demonstrates a focus of increased uptake in the left knee corresponding to the patellofemoral joint. The axial skeleton appears normal.

Impression:
There is no evidence of metastatic disease.
Changes in the left knee are most likely related to degenerative osteoarthritis.
Changes in the right clavicle are consistent with old fracture.
(Dr. Eleftherios Traiforos)


Bonescan 5 (1998/03/04)

The bone scan of 3/4/1998 was compared with the bone scans dated 5/27/1997 (bone scan 3) and 6/7/1996 (bone scan 1).
For almost 2 years there has been present a small subtle focus in the left L5-S1 articular facet region which has not changed significantly. Similarly a tiny focus in the inferior margin of the left sacroiliac region has been present for 21 months. Arthritis of the knees which was not present in June 1996 appeared in May of 1997 and persists to this time. There is also mild periarticular uptake in both medial malleolar regions which has been noted for approximately a year.
The right clavicle has a deformity and an apparent photopenic area in its center. There is a tiny area just below the left greater trochanter which was not apparent in May 1997.

Impressions: 1) lower lumbar spondylosis; 2) the left inferior sacroiliac focus is far more likely due to arthritis than to tumor; 3) x-ray correlation was ordered in the inferior aspect of the left greater trochanter which has a tiny new focus of increased uptake; 4) there is arthritis about the ankles and feet, and 5) nonunion of right clavicle.
(Dr. Edward B. Silberstein)

Comparison of X-ray of hip with bonescan: There is mild osteoarthrosis in both hips and sacroiliac joints. The focus of increased activity in the shelving portion of the acetabulum seen on the contemporaneous bone scan does not correlate with any non degenerative lesion.
(Dr. Robert M. Cantor)

Bonescan 6 (1998/06/21)

Whole body images were obtained and compared with the study of 3/4/1998 (bone scan 5). Images demonstrate mild increased uptake in the left aspect of L5, unchanged. Increased uptake is again noted in the mid portion of the right clavicle, unchanged. There is a small focal area of increased uptake again noted in the lateral cortex of the subtrochanteric region of the left femur, unchanged. The rest of the skeleton is unremarkable, except for the presence of arthritis in the extremities.

Impressions: 1) stable bone scan without definite evidence to suggest presence of metastatic disease; 2) findings in the proximal femur may represent old trauma. Tumor however in this area is not definitely excluded; 3) status post trauma of the right clavicle, and 4) findings in L5 are consistent with spondylosis.
(Dr. Mariano Fernandez-Ulloa)

Bonescan 8 (1998/11/10)

TECHNICAL: THE PATIENT WAS INJECTED WITH Tc-99m-MDP AND 3 HOURS LATER ANTERIOR AND POSTERIOR PLANAR IMAGES WERE OBTAINED WITH SPECIAL VIEWS OF THE PELVIS, RIBS AND SKULL. THE PELVIC VIEWS WERE REPEATED 8.5 HOURS POST-INJECTUM. THESE SCANS WERE COMPARED TO THE MOST RECENT STUDIES DATED 8/11/1998.

FINDINGS: THE FOCUS IN THE INFERIOR ASPECT OF THE LEFT SACRAL ALA, OR THE LEFT SI JOINT, IS AGAIN NOTED.

IN ADDITION THERE APPEARS TO BE URETERAL VISUALIZATION FOR MANY MORE HOURS THAN ONE USUALLY SEES THIS PHENOMENON, WITH THE URETERAL ACTIVITY ENDING SOMEWHAT PROXIMAL TO THE URETEROVESICAL JUNCTION.

A SUBTLE FOCUS OF UPTAKE IN THE CORTEX OF THE LEFT PROXIMAL FEMUR IS AGAIN NOTED.

IMPRESSION: 1)THE LEFT SACRAL ALA, OR SI, LESION PERSISTS AND COULD REPRESENT TUMOR, WITH ARTHRITIS LESS LIKELY BUT NOT EXCLUDED
2) THE LEFT DISTAL URETER IS VISUALIZED EVEN AT 8.5 HOURS POST INJECTION WELL WITHIN THE PELVIS. ALTHOUGH OUR VISUALIZATION STOPS SHORT OF THE BLADDER AS IF THERE MIGHT BE PARTIAL OBSTRUCTION HERE
3)THE LEFT TINY CORTICAL FOCUS IS UNCHANGED
4) ARTHRITIS IN THE KNEES IS SLIGHTLY MORE PRONOUNCED.
5) THE RIGHT CLAVICULAR FOCUS, PRESUMABLY FRACTURE, IS AGAIN NOTED. TUMOR CANNOT BE EXCLUDED HERE.
6) MILD LOW LUMBAR SPONDYLOSIS IS AGAIN SEEN
7) THERE IS ARTHRITIS OR FRACTURE IN THE LEFT 5TH TOE WHICH WAS NOT PRESENT BEFORE.
(Dr. Edward B. Silberstein)

Bonescan 9 (1999/03/09)

Clinical: this patient was referred for evaluation of possible bone metastases.

Technical: whole body imaging was performed 3 hours after the administration of the radiopharmaceutical

Findings: Again noted is focal uptake in the SI joint region, probably in the left sacral ala. This has been present for several previous scans. There is mildly increased uptake in the articular facets joining the L3-4 and L4-5 vertebrae.
Again noted is prolonged visualization of the left ureter which does not appear dilated. A tiny focus is again seen in the proximal cortex of the left femur just below the left greater trochanter, which was also noted before.
The increased uptake in both knees is again noted.
A focus of increased uptake in the mid right clavicle persists. Activity in the left 5th toe is again noted.,/P>
Impressions: 1) There has been no significant change in the bone scan since 11/10/1998.
2) The focal area of increased uptake in the left sacral ala or SI joint could represent tumor or benign lesion with arthritis less likely but not excluded.
3) Possible mild left partial ureteral obstruction.
4) Tiny left cortical focus in the proximal left femur, not changed and is probably of little significance but tumor can never be fully excluded.
5) Arthritis is noted in the knees.
6) The right clavicular focus could represent fracture or tumor. (DeJ: clavicle was broken 8 years ago)
7) Mild lower lumbar spondylosis persists.
8) Arthritis or fracture is again noted in the left great toe. (DeJ: bumped toe half a year ago)
(Dr. Edward B. Silberstein)


Bonescan #13 (2001/10/04)

FINDINGS
Two areas  of increased radionuclide accumulation are again identified in the lateral aspect of L5, which were seen in the previous two studies of 2000/10/02 and 2001/03/20. Mild increased uptake is again noted in the left acroiliac joint also unchanged.
Arthritis is again identified in the cervical spine and the extremities. No new lesions are present.

IMPRESSIONS
1) Findings in L5 most likely represent facet disease.
2) Change the left sacroliliac joint is stable and likely represents benign disease such as arthritis.
3)  No scintigraphc evidence to suggest the presence of metastatic disease.
(Dr. Mariano Fernandez-Ulloa)


Bonescan #14 (2002/02/20)

FINDINGS
In comparison  with the scan of 2001/10/04 both ureters are now visible, with the right side emptying on an upright view but the left side again noted throughout its length.
Again noted are areas of radionuclide accumulation in the L5/S1 articular facet region bilaterally as well as in the L4-L5 articular facet region on the right.
There is mild asymmetrically uptake in the left sacroiliac joint noted anteriorly which is not changed since 2001/10/04.
Focally increased uptake is again noted in the left lower cervicular articular facet region, probably C5-C6.

IMPRESSIONS
1. a new finding is persistent ureteral visualization on the left side where distal partial obstruction must be excluded.
2. persistent lumbosacral and cervical spondylosis.
3. mild arthritis persists in the left sacroiliac joint region and probably in the right foot and minimally in the left knee.

COMMENT
I see no osteoblastic metastatic disease. Pelvic disease on the left causing partial ureteral obstruction should be excluded.
(Dr. Edward Silberstein)


Bonescan #15 (2003/01/17)

FINDINGS
There is a new focus of abnormal osteoblastic activity in the right 4th rib anterolaterally.
The ureters are not longer visualized.
Again noted is L5-S1 articular facet disease bilaterally

IMPRESSIONS
1. The new focus in the right 4th rib anterolaterally has approximately a 10% chance of representing tumor and 90% chance of being due to fracture. The area is small and might not show up on an rib X-ray.
2. Persistent lumbosacral spondylosis.
3. No evidence of ureteral obstruction.
4. Today we see no evidence of arthritis in the feet and knees.
(Dr. Edward Silberstein)

DeJ: this 10-90% is not what I conclude from the following abstracts:
-----The aetiology of solitary hot spots in the ribs on planar bone scans. Nucl Med Commun 1995 Oct;16(10):834-7 Baxter AD, Coakley FV, Finlay DB, West C. Department of Radiology, Leicester Royal Infirmary, UK.
-The aim of this study was to determine the aetiology of solitary hot spots in the ribs found at bone scintigraphy in patients with known extraskeletal malignancy. A group of 34 patients whose bone scans showed a solitary hot spot in a rib were identified retrospectively over a 4-year period. They all had a known extraskeletal malignancy. Aetiology of the rib hot spot was established in 26 patients based on a review of clinical features, radiographic findings and clinical follow-up. In eight cases it remained indeterminate. In 14 (41%) cases, the rib lesion was malignant in origin, 9 were due to metastasis and 5 due to direct spread from intrapulmonary malignancy. In 12 (35%) cases, it was benign. In the remaining 8 (24%) cases, the aetiology was indeterminate. In the subgroup of 14 hot spots confined to the anterior rib end, 5 (36%) were due to malignancy, 4 (28%) were benign and 5 (36%) were indeterminate. We conclude that solitary hot spots in the ribs of patients with known extraskeletal malignancy undergoing bone scintigraphy are frequently (41%) malignant in origin. This also applies when the hot spot is in the anterior rib end (36% malignant). Thus, such hot spots are far more sinister than previously reported and require careful clinical and radiographic evaluation.
------Fine-needle aspiration of bone lesions in patients with a previous history of malignancy.Diagn Cytopathol 2002 Jun;26(6):380-3 Treaba D, Assad L, Govil H, Sariya D, Reddy VB, Kluskens L, Green L, Selvaggi SM, Gattuso P. Department of Pathology, Rush-Presbyterian - St. Luke's Medical Center, Chicago, Illinois.
-At the present time fine-needle aspiration (FNA) is considered a routine diagnostic procedure in evaluating neoplastic vs. nonneoplastic lesions in many organs, with high sensitivity and specificity. The purpose of this study was to assess the utility of FNA in areas of diagnostic difficulty and its limitations in evaluating bone lesions in patients with a previous history of malignancy. From 1989 to 2000, 249 CT-guided FNAs of bone lesion were performed at our institutions; 187/249 (75.1%) patients had a previous history of malignancy. Aspirated material was air-dried for Diff-Quik stain or fixed in ethanol for Papanicolaou staining. Subsequent surgical tissue was available in 69/187 (36.9%) of the cases. There were 114 males and 73 females, ages 14-86 yr (mean, 64 yr). The primary tumor site was lung 49, genitourinary 46, breast 31, gastrointestinal 28, hematopoietic 26, soft tissue/skin 5, and thyroid 2. There were 125 FNAs of the vertebral spine, 19 from the pelvis, 11 from the ribs, 9 from the sternum, 5 from the femur, and 18 from miscellaneous bone sites. Out of 187, 166 (88.7%) were malignant aspirates confirming the patients' primary malignancies. The most common malignancy encountered was adenocarcinoma, 126/187 (67.4%). Surgical tissue was available for review in 69 patients and the results were in agreement with the FNAs diagnosis in all cases. Nine out of 187 (4.8%) cases were diagnosed as marrow elements on cytological material. These patients have been followed for 1-9 yr and have failed to reveal signs or symptoms of clinical recurrence. Three out of 187 (1.6%) cases showed osteomyelitis. Nine out of 187 (4.8%) were unsatisfactory specimens, with biopsy follow-up available in four cases, showing three metastatic tumors and one case of osteomyelitis. FNA of metastatic bone lesions is a major step in pretreatment diagnosis. On satisfactory specimens, the cytological diagnosis viewed in the clinical-radiological context proves to be similar to surgical diagnosis. FNA is an excellent technique with a high accuracy rate in assessing metastatic bone lesions.


Bonescan #16 (2003/07/07)

FINDINGS
Small foci of increased uptake are again noted in the lower left cervical spine a well as both facets at L4-L5 in the lumbar spine. There is relatively decreased uptake in the right 4th rib compatible with healing fracture. No new areas of abnormal uptake are noted.

IMPRESSIONS
1. Stable bone scan without scintigraphic evidence for metastatic disease.
2. Healing right 4th rib fracture anteriorly.
3. Spondylosis in the cervical and lumbar spines.
(Dr. Mariano Fernandez-Ulloa)


Bonescan #17(2004/01/21)

FINDINGS
A small foci of increased uptake are again seen in the lower left cervical spine as well as both facets at L4-L5. This has not significantly changed in appearance since the prior examination. Increased focus of uptake is seen in the left foot. These areas are consistent with osteoarthritis.
New areas of osteoblastic activity are seen within the left posterolateral 9th, 10th and 11th ribs in a linear fashion.

IMPRESSION
Increased osteoblastic activity in three left posterolateral ribs in a linear fashion consistent with traumatic injury. Otherwise, there is no definite scintigraphic evidence of metastatic disease.
(Dr. Mariano Fernandez-Ulloa)


Bonescan #18(2004/11/30)

CLINICAL
This patient with prostate cancer is referred for evaluation of pain in the left mid neck laterally.
FINDINGS
Since the previous scan dated 1/21/04, we again see focally increased uptake in ribs 9 through 12 posteriorly in a linear pattern which was noted on the previous scan.
Also persisting is focally increased uptake in the articular facet region of one or more lower cervical vertebrae on the left and the anterior aspect of the body of a mid to lower cervical vertebra on the right, all changes which had been previously observed.
Again noted is focally increased uptake in the left acromioclavicular joint which had been present 1/21/04.
Uptake is seen in the articular facet regions of L5-S1.

IMPRESSIONS
1) NO EVIDENCE OF OSTEOBLASTIC METASTASES
2) THIS SCAN IS UNCHANGED OVER THE PAST 10 MONTHS WITH PERSISTENT LUMBOSACRAL AND CERVICAL SPONDYLOSIS, PERSISTENT EVIDENCE OF RIB FRACTURES IN LEFT RIBS 9 THROUGH 12, AND ARTHRITIS IN THE LEFT ACROMIOCLAVICULAR JOINT.
(Dr. Edward Silberstein)


 MRI December 28, 2004, University Hospital, Nijmegen, Netherlands

 A MRI was made 24 hrs after the administration of Sinerem (Combidex) at both 1.5 and 3T.
The lymph nodes from the level of L1 to the prostate level have been imaged. There are many normal size (< 8 mm axial diameter) lymph nodes. They are all black on Sinerem sensitive sequences, and thus non-metastatic (see scheme).
The prostate is small (3.3 x 2.2 cm), and contains a lot of seeds (see scheme). There are also some seeds in the bladder base and in the periprostatic fat. There is no sign of a significant local recurrence. There are no bone marrow abnormalities.
To conclude:
Normal lymph nodes, no metastases. The positive predictive value of this test is 98% (Harisinghani & Barentsz et al., N Engl J Med 2003;348:2491-9*). Therefore, for the abdominal region a Prostascint scan will not give additional information. Jelle Barentsz, Professor of Radiology

*)Noninvasive Detection of Clinically Occult Lymph-Node Metastases in Prostate Cancer. Abstract: Accurate detection of lymph-node metastases in prostate cancer is an essential component of the approach to treatment. We investigated whether highly lymphotropic superparamagnetic nanoparticles, which gain access to lymph nodes by means of interstitial–lymphatic fluid transport, could be used in conjunction with high-resolution magnetic resonance imaging (MRI) to reveal small nodal metastases.).


Bonescan #19 (2006/01/13)

FINDINGS
Since the prior study of  11/30/2004, there are new foci of uptake at the left anterior ribs 3-6. Focally increased uptake at posterior left ribs 9-12 is again seen. Stable spondylosis is noted at the lower cervical spine and the lobar lumbar spine. Left acromioclavicular joint uptake is again noted and is unchanged. Noted there is abnormal uptake are seen within the remainder skeleton (?)
IMPRESSIONS
1. No scintigraphic evidence to suggest metastatic disease.
2. Multiple new rib fractures along the left upper chest with stable fractures along the left lower chest
(Dr. Mariano Fernandez-Ulloa)


Bonescan #20 (2007/02/27)

Comparison: 1/13/2006
 
Clinical:
This patient is referred for the evaluation of elevated PSA with history of prostate cancer. The patient denies bone pain.

Technical:
Whole body bone imaging was performed.

Findings:
There are new areas of increased uptake in the T6, T10, and T11 vertebral bodies and the right aspect of the L3 vertebral body. There is also a new focus in the right ilium adjacent to the sacroiliac joint, and a more subtle focus seen in the right iliac wing.

There are stable foci of uptake within the left third through sixth anterior ribs, as well as through the left posterior 9th through 12th ribs, all likely from prior trauma. There are multiple foci within the cervical spine which are unchanged.

Arthritis is also noted within the shoulders. The remainder of the skeleton demonstrates normal distribution of radiopharmaceutical uptake.

Impressions:
1. New areas of uptake in the thoracic and lumbar spine, and left pelvis as above consistent with metastatic disease.
2. Stable areas of uptake within the ribs likely secondary to prior trauma.
3. Arthritis in the cervical spine and shoulders.

(Dr. Mariano Fernandez-Ulloa)


CT-ABDOMEN WITH CONTRAST
CT scan of the abdomen and pelvis dated 3/14/07
 
Ord Phys: Bracken, Bruce
Reason:  Prostate Ca
Indication: History of prostate cancer
Comparison: Images from PET CT dated 1/2/2007 and report from bone scan dated 1/2/2007
Technique: Helically acquired CT images were obtained from the lung bases through the pelvis following administration of oral and 150ml of Omnipaque 370 intravenous contrast with a slice thickness of 5 mm and a field-of-view of 34 cm.

Findings:
Limited evaluation of the lower chest demonstrates clear lung bases bilaterally.
The liver, pancreas, spleen, and adrenal glands are normal in appearance. The gallbladder is normal without evidence of intra orextrahepatic biliary ductal dilatation or stones. A low density lesion is seen extending off the upper pole of the left kidney, likely a cyst. A second low density lesion is seen in the mid to upper pole of the left kidney also likely representing a cyst. The left kidney otherwise appears normal. The right kidney appears normal. There is no evidence of hydronephrosis, hydroureter, or nephrolithiasis. The bladder appears collapsed with wall thickening. The small and large bowel are normal in caliber without evidence of focal wall thickening. There is no evidence of bowel obstruction. Brachytherapy seeds are noted within the prostate gland. Some seeds appear periprostatic. No abnormal soft tissue masses are seen adjacent to the prostate. The seminal vesicles appear normal. The visualized vascular structures appear normal.
No pathologic lymphadenopathy or free fluid collections are appreciated.
Bone windows demonstrate a sclerotic focus in Til which appears slightly larger than the prior examination. A sclerotic focus again noted in T10, the right posterior aspect ofL2, and the right pedicle ofL3 which are all unchanged. Sclerotic foci in the right ilium adjacent to the sacroiliac joint and right iliac wing are also unchanged.

Impression:
Abdomen:
1. No evidence of intra-abdominal metastatic disease.
2. Bony metastases as detailed above.
Pelvis:
1. Brachytherapy seeds within the prostate gland.
2. Collapsed bladder with wall thickening which may be seen normally during collapse but also may represent cystitis.
3. Bony metastases as detailed above.

Dictated by Kathryn Shumrick MD


Bonescan #21 (2007/08/02)

Clinical: This patient has a history of prostate cancer and is referred for evaluation

Technical: Whole body bone imaging was performed, no along with standard spot imaging and a standing view over the
posterior lumbar region.

Findings: Previously demonstrated foci of activity within the right aspect of the L3 vertebral body, as well as the right iliac bone adjacent to the SI joint are again identified and remain unchanged. The previously demonstrated subtle focus within the more lateral aspect of the right iliac bone is not seen on the current study. The previously demonstrated foci of uptake within the thoracic spine are not seen on the current study. Again are noted numerous foci within multiple left ribs in a linear pattern, consistent with prior trauma. A focus seen superimposed over the left twelfth rib medially on whole-body images is demonstrated on the standing view to lie within a left renal calyx.

No new foci of activity are demonstrated. Activity within the shoulders and cervical spine are consistent with arthritis.

Impression:
Stable to improved bone scan. No new lesions are demonstrated, and several previously demonstrated lesions are not seen on the current study.

(Dr. Mariano Fernandez-Ulloa)


Bonescan #22 (2007/12/13)

Clinical: Patient with history of prostate cancer and is referred for bone scan.

Technical: Whole body bone imaging was performed.

Comparison: 8/2/2007.

Findings: Images again demonstrate 3 focal areas of mild increased uptake in the left lower rib cage posterolaterally located.
Additional focal areas of mild increased uptake are present in the left upper rib cage anterior laterally. These rib abnormalities were identified on the study of 8/2/2007 and have not significantly changed.
Focal area of increased uptake is also noted in the posterior aspect of the right iliac crest, unchanged. There is faint increased uptake involving the L3 which remains unchanged.
There is evidence of arthritis in the cervical spine and shoulders. No new areas of increased activity are identified.
There is now dilatation of both collecting systems including the ureters.

Impressions:
1. Findings in the rib cage remain consistent with multiple trauma.
2. Increased uptake in the right iliac crest is consistent with a metastatic focus. This however remains unchanged.
3. Finding in the lumbar spine is consistent with spondylosis.
4. Since the previous study of August 2, 2007 bilateral hydronephrosis has developed.

(Dr. Mariano Fernandez-Ulloa)


Bonescan #23 (2008/06/02)

Findings: There has been interval development of widespread areas of abnormal increased radiotracer uptake in the sternum, most ribs and many vertebra. There has also been interval development of increased uptake within the proimal left femur. There has been interval worsening of uptake in the right sacroliliac joint.
There is persistent left hydroureter. Right hydroureter is no longer obvious.

Impressions:
1. Interval development of widespread skeletal metastases involving the sternum, most ribs, and many vertebrae.
2. Interval development on metastatic focus in the proximal left femur.
3. Interval worsening of a metastatic focus in the region of the right sacroliliac joint.
4. Persistent left hydroureter to the level of the UVJ.
5. Interval resolution of right hydroureter.