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Bone Metastases in Carcinoid Tumors: Clinical Features, Imaging Characteristics, and Markers of Bone Metabolism

¹ Department of Medical Oncology, University Hospital Groningen, Groningen, The Netherlands
² Department of Pathology and Laboratory Medicine, University Hospital Groningen, Groningen, The Netherlands
³ Department of Nuclear Medicine, University Hospital Groningen, Groningen, The Netherlands
⁴ Department of Radiology, University Hospital Groningen, Groningen, The Netherlands

The purpose of this study was to describe the clinical presentation of bone metastases in patients with carcinoid tumors and to determine the diagnostic value of imaging techniques and markers of bone metabolism. Methods: This retrospective study was performed on the entire group of patients with carcinoid tumors treated in our hospital from January 1992 to May 1999. Only patients with metastasized tumors were included. Results: Eleven of 90 patients (12%) (95% confidence interval [CI], 5%–19%) with a metastasized carcinoid tumor had symptomatic bone metastases. All bone metastases occurred in 55 patients with midgut carcinoids (20%; 95% CI, 9%–31%). Plain radiography had a sensitivity of 44% (95% CI, 12%–76%); MRI, 100% (95% CI, 61%–100%); bone scintigraphy, 90% (95% CI, 72%–100%); and octreotide scintigraphy, 60% (95% CI, 35%–93%). In 9 patients, both octreotide scintigraphy and bone scintigraphy were performed. Of 45 bone lesions, 22 (49%) were visualized by both modalities, 13 (29%) were visualized with octreotide scintigraphy but not with bone scintigraphy, and 10 (22%) were visualized with bone scintigraphy but not with octreotide scintigraphy. In 2 patients, octreotide scintigraphy and bone scintigraphy provided complementary results. Markers of bone metabolism could not discriminate carcinoid patients from those without bone metastases. The markers of bone metabolism did not reflect the osteolytic or osteoblastic appearance of metastases. Conclusion: Pain is the principal symptom of bone metastases in patients with carcinoid tumors. Plain radiography and markers of bone metabolism do not contribute to the diagnosis of bone metastases. MRI has a high sensitivity for bone metastases. Both bone scintigraphy and octreotide scintigraphy have acceptable sensitivity and can provide complementary results.

Key Words: carcinoid • bone metastases • imaging

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