OtherClinical Investigations

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

Wim G. Meijer, Eveline van der Veer, Piet L. Jager, Erik J. van der Jagt, Bert A. Piers, Ido P. Kema, Elisabeth G.E. de Vries and Pax H.B. Willemse
Journal of Nuclear Medicine February 2003, 44 (2) 184-191;

Article Figures & Data

Figures

  • FIGURE 1.
    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.

  • FIGURE 2.
    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.

  • FIGURE 3.
    FIGURE 3.

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

Tables

  • TABLE 1

    Patients with Bone Metastases in Relation to Primary Site of Tumor

    Primary sitePatients at risk (n)Patients suspected of having bone metastases (n)Patients with bone metastases
    n%95% CI* (%)
    Foregut141000–22
    Midgut551811209–31
    Hindgut11000–79
    Unknown204000–16
    All primary sites902411125–19

    • ↵* 95% CI for percentage of bone metastases.

  • TABLE 2

    Clinical and Biochemical Characteristics of Carcinoid Patients With and Without Bone Metastases

    CharacteristicPatients with bone metastasesControl patients
    No. of patients1111
     Males33
     Females88
    Age (y) (range)65 (36–75)69 (46–75)
    Duration of disease (mo) (range)17 (0–239)25 (0–126)
    Midgut primary site (no. of patients)1111
    Carcinoid syndrome present (no. of patients)119
    Site of metastases (no. of patients)
     Liver107
     Intraabdominal86
     Mediastinal33
     Pulmonary31
     Skeleton110
     Other44
    Treatment (no. of patients)
     Somatostatin analog75
     Interferon-α04
     Somatostatin analog and interferon-α31
     None11
    Laboratory (median) (range)
     5-HIAA (mmol/mol creatinine)23.1 (4.0–143.9)29.9 (5.9–286.5)
     Platelet serotonin (nmol/109 platelets)23.0 (4.6–60.1)27.6 (17.1–50.4)
     PINP (μg/L)47.8 (9.7–110.0)58.2 (21.0–104.0)
     BSAP (U/L)12.2 (8.4–26.7)12.8 (7.6–33.3)
     INTP (BCE/L)20.8 (8.7–35.1)22.1 (13.4–29.6)

    • INTP = amino-terminal telopeptide of type I collagen; BCE = bone collagen equivalents.

  • TABLE 3

    Clinical Characteristics and Outcome of Imaging Techniques in Patients with Bone Metastases of Carcinoid Tumors

    Patient no.SexAge (y)Time since diagnosis (mo)Site of bone metastasesPlain radiographyMRIBone scintigraphyOctreotide scintigraphy
    1M55239Lumbar spine, chest, skull, extremitiesN—PP
    2M5919Total spine, chestNPPP
    3M6917Total spine, chest, pelvis, extremitiesPPPP
    4F360PelvisP—PN
    5F5821Skull, extremities———P
    6F630Total spine, chest, pelvis, extremitiesNPPP
    7F6565Total spine, chest, pelvis, skull, extremitiesNPP—
    8F696Thoracic spine, chest, pelvisP—PP
    9F7018Thoracic spine, chest, pelvis, skull, extremities—PPN
    10F729PelvisN—NP
    11F756Thoracic spinePPPN
    Positive (performed) technique4 (9)6 (6)9 (10)7 (10)
    Sensitivity (%)441009070
    95% CI of sensitivity (%)12–7661–10072–10035–93

    • N = negative; — = not done; P = positive.

  • TABLE 4

    Visualization of Bone Metastases: Bone Scintigraphy Compared with Octreotide Scintigraphy

    Patient no.*Bone metastases visible withTotal
    BS and OSBSOS
    11416
    2628
    377
    411
    661815
    8213
    933
    1011
    1111
    Total22101345
    % of total (= 45)492229100
    95% CI (%)34–6410–3416–42

    • ↵* Patients 5 and 7 did not undergo both procedures.

    • BS = bone scintigraphy; OS = octreotide scintigraphy.

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