Bone Mets or Haemangiomas?

[Hillwalker87]

Hi everyone! A recent MRI report for my old man listed haemangiomas at the C7 and T6 verterbal bodies. How is a radiologist able to determine between a haemangioma and bone metastases? Many thanks

[LearnAll]

Hi...Vertibral hemangiomas are found in approx 10% people. They are benign and mostly harmless lesions and hardly ever cause symptoms.Radiologists can distinguish between hemangiomas and bone mets based on their appearance. Hemangiomas have vertical lines and honeycomb design on them which bone mets do not have. Experienced eyes of a radiologist can see the specific pattern and make a judgement.

A more definitive way to distinguish between hemangiomas and bone mets is to check Bone Specific Alkaline Phosphatase level..if it is elevated then it goes in favor of bone mets. Hemangiomas do not cause increase in bone specific alkaline phosphatase.

[SeosamhM in reply to LearnAll]

As always, I support LA's mantra of "use other readily available data" on this one (ALP) to give yourself an idea of possible bone met activity and then simply press your oncology team for answers on how they determined hemangioma v. bone met. It's your guy's image, not theirs - ask for a tour!

[LearnAll in reply to SeosamhM]

Absolutely SeosamhM....We have to empower ourselves with authentic medical knowledge and then engage our Doctors and Nurses in discussion. It is a matter of life and death for us and our loved ones who suffer from this disease.Doctors initially might resent you for these discussions as it consumes more of their time. But, They end up respecting you as a well informed consumer. And that's the way of getting best possible care.

[dhccpa in reply to LearnAll]

You've mentioned BAP test a number of times. Never had one but my last total AP test level was below normal range. What does that mean in relation to my 3-10 bone mets? Thanks.

[SeosamhM in reply to dhccpa]

Bone alkaline phosphatase (BAP) is the bone-specific isoform of alkaline phosphatase. As you point out, BAP is not typically in our routine test panel, it is total ALP. The good news is that BAP trends within the ALP, so unless the trend is going up or someone has a high ALP where BAP becomes more important to determine, ALP will suffice (e.g., high ALP may be caused by liver or gallbladder issues, as well).

Like PSA, it is this trend of ALP that really means something, not necessarily the number itself. Taking our low ALP as a "good sign" is misleading as to our prognosis and cannot be directly correlated with numbers of bone mets. However, I do see it as an advantageous baseline to determine change and see if/when new scans/treatments are necessary. We will likely see elevating ALP before any scan-visible mets...or maybe even before elevating PSA if our cancer is adapting in some manner.

[dhccpa in reply to SeosamhM]

Thank you. I posted this question in more detail (and after new blood test yesterday) in a separate post.

[Hillwalker87 in reply to LearnAll]

Hi LA, thanks for your response. He does already have spinal mets so I assume he would already have elevated ALP would he? Would it simply be a case of looking for an upward trend as with PSA?

[LearnAll in reply to Hillwalker87]

Bone mets heal and then, ALP goes down to baselineALP which is below 70 in most liver healthy people. Bone ALP indicate the extent of bone repair going on at that point of time. So basically.. Bone ALP corresponds with active bone mets,Yes...Just like PSA which tells how much cancer is inside...a rising trend in Bone ALP tells how much bone met are active /growing. If Bone ALP is below 20, it means just normal wear and tear being repaired. And that is good news.

[Hillwalker87 in reply to LearnAll]

That's brill, I think that and a germ line test should be next on the list for us then. Thanks again LA

[dhccpa]

Good question!

[pjoshea13]

I find that scan reports have plenty of CYA language. One report mentioned possible lesions in ribs & collarbone. My radio-oncologist was willing to treat L5 because, he said, "all those other things are not cancer".

-Patrick