Radiological diagnosis of bone metastases

Metastases are the most common malignant tumors of the skeleton. Several imaging modalities can be engaged for the diagnosis of skeletal metastases. They may be combined, depending on the individual clinical setting. Plain films are used for evaluation of symptomatic regions of the skeleton. Sensitivity is low, but benign skeletal disorders causing clinical symptoms can usually be identified in plain films. Bone scintigraphy is employed for a survey of the entire skeleton with high sensitivity for the presence of metastases, but only poor specificity. Computed tomography (CT) and magnetic resonance imaging (MRI) are advanced diagnostic methods, essential particularly in the diagnosis of metastatic spinal disease. Using CT, additional percutaneous bone biopsies can be performed easily and safely. Of all imaging modalities, MRI has the highest sensitivity for skeletal metastases. Other advantages are the possibility of multidirectional slice positioning and excellent soft tissue contrast.