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

Wim G. Meijer, MD, PhD1, Eveline van der Veer, MD, PhD2, Piet L. Jager, MD, PhD3, Erik J. van der Jagt, MD, PhD4, Bert A. Piers, MD, PhD3, Ido P. Kema, MD, PhD2, Elisabeth G.E. de Vries, MD, PhD1 and Pax H.B. Willemse, MD, PhD1

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



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  		FIGURE 1. Visualization of bone metastases by bone scintigraphy (B) but not by octreotide scintigraphy (A) in 70-y-old female midgut carcinoid patient (patient 9). Upper panel (A) and left panel (B) represent anterior images. Bone lesions are present in vertebral body thoracic 5, dorsal part of left costa 5 and costa 10. Lesions located in skull and left femur are not accurately visualized with octreotide scintigraphy. Note hydronephrosis of right kidney.

 


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  		FIGURE 2. Complementary visualization of bone metastases by octreotide scintigraphy (A) and bone scintigraphy (B) in 63-y-old female midgut carcinoid patient (patient 6). Octreotide scintigraphy visualizes bone metastases in left humerus, pelvis, and bilateral femur. Cervical vertebral hot spot is visualized by bone scintigraphy but not by octreotide scintigraphy. Hot spots located in thoracic skeleton and lumbar spine are visible with both investigations.

 


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  		FIGURE 3. Multiples of upper reference limits of BSAP, PINP, and NTx. ({circ}), Patients without bone metastases; (•), patients with bone metastases. Horizontal dotted line represents upper reference limit.

 




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