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Bone Case 8 Answers

1) Are there any abnormal areas of uptake?
2) If so, where?

Both hemipelvises are enlarged and show markedly raised uptake but the no other bone is affected. There is increased uptake in the both radiocarpal joints, both shoulders and the medial aspect of both knees.

3) What is the likely cause(s) for this?

The uptake in the joints of the peripheral skeleton is most likely to be degenerative in nature.

The pelvic uptake is due to Paget's disease, confirmed by conventional radiographs of the area. The symmetrical appearance is slightly unusual but it is the expansion and enlargement of the affected bone that is typical for Paget's. Also, metastatic disease is patchy or only involves part of a bone, whereas Paget's tends to affect the whole bone, particularly in the later stages of the disease. In the early stage of the disease, where Paget's advances along a bone, there may be some diagnostic doubt.

4) Discuss the role of PSA in determining the need for bone scans in prostate cancer staging.

There are several large studies showing that if the Prostate Specific Antigen levels are less than 10, then the likelihood of metastatic disease is very low. There is now a move away from performing bone scintigraphy on such patients. There is a slight grey area in those with a PSA of 10-20 as the incidence of bone metastases is still low (~1 in 500-1000) but those with a PSA of over 20 should definitely have bone scintigraphy as part of their staging investigations.

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The text is entirely the opinion of the author and does not necessarily reflect that of RUH NHS Trust or the Bristol Radiology Training Scheme. Website content devised by Paul McCoubrie.