Figure 111

Plain films in (A) AP and (B) lateral view showing an ivory vertebra. Courtesy Dr. N. Haramati.

well seen in posteroanterior views and can be screened rather quickly. Absence, erosion, or sclerosis of a pedicle may indicate the presence of a bone metastase at that location (Figure 11-2).

Bone scanning is an efficient and cheap tool to detect cancer at an early stage. It has a high sensitivity with lower specificity but may remain falsely negative in patients with lytic lesions such as multiple myeloma.

High-resolution CT is very helpful in detecting small bony lesions. Axial CT allows accurate depiction of bony details without being hampered by overlap bones as is the case with plain films (Figure 11-3). Sagittal and coronal reconstructions of multislice CT help in determining the integrity and the stability of the affected vertebral bodies, and are highly recommended when a search for bony metastases is conducted (Figure 11-4). The diagnostic yield can be further enhanced by the administration of contrast material, because it can differentiate innocent fatty infiltration or hemngioma from metastatic soft tissue within the vertebrae as well as facilitate the detection of epidural and, at times, intradural tumor extension. Recently the combination of CT and positron emission tomography (CT-PET) has become available. It might add a powerful diagnostic tool for bony metastases in the work-up of the oncological patient.

MRI is an excellent diagnostic modality for tumor detection, especially of bone marrow metastases, and it is the most sensitive modality compared with other imaging techniques. It might detect tiny lesions that may have otherwise been overlooked by nuclear imaging or by CT. MRI provides important information about the vertebrae as well as the soft tissues. It helps detect epidural tumor extension and, following contrast administration, it may show leptomeningeal spread.

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