[SAME DAY] Bone Scan + CT Scan and different results from both - Please review and explain

[God_Loves_Me]

DR or Insurance both are not providing PSMA PET SCAN.

BONE SCAN RESULT :

Narrative

EXAM: NM BONE SCAN WHOLE BODY

CLINICAL INDICATION: clinical eval. Metastatic prostate cancer.

TECHNIQUE: Approximately 2-4 hours following intravenous administration of 27.1 mCi of Tc99m-MDP, whole body delayed planar images were obtained from the anterior and posterior projections. Lateral spot images of the calvarium were also obtained

COMPARISON: Whole-body bone scan 9/3/2024

FINDINGS:

Images demonstrate new foci of increased radiotracer uptake in bilateral ribs (2nd left rib, 3rd right anterior rib, 7th left posterior rib), concerning for new metastatic lesions. There is interval increase in intensity/extent of radiotracer activity within the L5 vertebral body and left ischial lesions. Redemonstration of multiple foci of increased radiotracer uptake of bilateral sacral ala and thoracic vertebrae, stable from prior.

There is normal biodistribution of the radiotracer within the genitourinary system and soft tissues.

************************

CT SCAN

1. Unchanged extensive diffuse osteoblastic metastasis throughout the axial and proximal appendicular skeleton.

2. Interval resolution of abdominal pelvic ascites.

3. Mild hepatic steatosis.

4. Chronic stable findings as above.

Narrative

EXAM: CT ABDOMEN PELVIS W IV CONTRAST

CLINICAL INDICATION: History of stage IV prostate cancer status post colectomy on 3/2019.

TECHNIQUE: Following administration of non-ionic IV contrast, postcontrast images through the abdomen and pelvis were obtained. ESRC.1.7.1 If applicable, point-of-care testing?was approved following departmental protocol.

COMPARISON: CT abdomen pelvis without contrast on 10/9/2024

, CT abdomen pelvis with IV contrast on 9/3/2024.

FINDINGS:

Lower Thorax: Please see separately dictated report of the chest from the same day for findings above the diaphragm.

Liver: Mild hepatic steatosis.

Gallbladder/Biliary Tree: Unremarkable

Spleen: Unremarkable

Pancreas: No pancreatic ductal dilation

Adrenal Glands: Unremarkable

Kidneys/Ureters: No hydronephrosis

Gastrointestinal: Colonic diverticulosis without inflammation. Duodenum diverticulum (3:30). Noninflamed appendix. No small bowel wall dilatation.

Bladder: Normal.

Prostate/Seminal Vesicles: Limited evaluation using CT technique.

Lymph Nodes: Subcentimeter short axis lymph nodes.

Vessels: Mild atherosclerotic calcification without aneurysmal dilatation.

Peritoneum/Retroperitoneum: No significant ascites.

Bones/Soft Tissues: Redemonstration of diffuse sclerotic osseous metastasis throughout the axial and proximal appendicular skeleton, grossly unchanged compared to 10/9/2024.

Should I trust CT SCAN OR BONE SCAN ? What are next steps ?

PSA is stable

[GP24]

You make a CT and a bone scan because these are different imaging methods. The bone scan detect bone mets and the CT scan can detect lymph node mets and visceral mets if they are big enough. The bone scan is much better for detecting bone mets than the CT scan.

[Tall_Allen]

Both. The bone scan tells you about bones that are sclerotic, which may be because of metastases or may be from arthritis or other bone ailments (like bones that were fractured years ago). The CT shows you a better picture of the bone, and helps distinguish metastases from other bone ailments.

[Retireddoc]

I will explain the difference in the imaging tests (retired radiologist ).

A bone scan is a non specific test that will show "activity/hot spots" in any bone that has metabolic activity and active repair process. So trauma/fracture (even months/ years old), arthritis, certain metabolic diseases, infection and, of course, cancer (whether primary or metastatic to the bone). That is why radiologists will sometime order a plain x-ray of an area of concern to help differentiate between the various causes if there is a question.

In your case there was a CT scan. CT only measures density of tissues and presents it in images on a gray scale. So, very dense bone (sclerosis from prostate cancer or the bone cortex itself) appears whit and very low density (air in bowel or sinuses ) appears black. Everything else is a gradation in between.

In your case the CT revealed extensive osteoblastic/sclerotic areas in your axial (spine/pelvis) and appendicular (long bones) which were typical for prostate metastasis disease. The CT can't differentiate which are "active" but can tell which are new if compared to prior CT scans.

The bone scan revealed active uptake in new areas of your ribs and pelvis indicating new and active metastatic disease. Additional areas where present, stable from prior exams.

So, the exams are complimentary and show the same thing. They are not at odds with each other.

Good luck to you in your journey.

[God_Loves_Me in reply to Retireddoc]

Thank you

[j-o-h-n in reply to Retireddoc]

Doctor, I've said this before but needs saying again, you're a God sent to all of our members. Thank you!!! (And I like you too, btw it's "white not whit" 🤡)

Good Luck, Good Health and Good Humor.

j-o-h-n

[Retireddoc in reply to j-o-h-n]

Haha. I'm a terrible typist. I'm surprised there aren't more typos! I try to answer any technical questions, especially related to imaging, but I would never give advice as to treatment. Without 1) knowing the patient, 2) having access to complete H & P, labs etc, 3) being a specialist in that field -urology/radiation oncology/medical oncology, I think offering opinions on treatment has the potential to do more harm than good. Of course, what we all have to offer is our own experience, treatment, side effects, success/failure-and most of all hope.

I enjoy your funny and witty comments. It adds a ray of sunshine in such a serious discussion.