Hello, Thank you for your consult at DoctorSpring.
The exact characteristics of bone involvement would actually vary from each person. It's not the dark and white area or the salt and pepper areas in the scans which usually bother the radiologist but in fact soft tissue mass lesions with changes in HU in CT or density changes in MRI T1 and T2 , etc sequences..
These may sound very technical and may not be interpreted by everyone, even non radiology doctors ( sometimes ).
If in doubt, I would advice you to go for a PET CT scan which can give us a little more idea but AGAIN I CANNOT BE 100% SURE.
I would suggest you be on follow up with your oncologist and follow his advices regarding treatment and investigations.
Kind regards,
Patient replied :
Thank you.
So, if I understand correctly, you are saying that if there were bone cancer--an MRI would show density changes and the radiologist could see this.
I don't know what the HU is in the CT? Is it something that would look different on top of the salt and pepper image that is already there?
What about the bone scan? How do they see small cancerous lesions in the pelvis, since the pelvis normally lights up so much? Can this be trusted?
Thank you.
Thank you for writing to us again.
Yes. Radiologist and nuclear medicine physician would have suspected any abnormality if present and suspicious of cancer. If they have not commented on it, it means it is not there.
Feel free to discuss further,
Regards.
Patient replied :
And you think these abnormalities (bone cancer) would not be hidden by the diffuse sclerosis that I have from my bone condition (which is possibly fluorosis)?
My whole worry is that the cancer will look like the diffuse sclerosis which is everywhere and trick the radiologist. It would be osteoblastic cancer, if I had it, because that is what lobular breast cancer metastasizes to.
Hello. Thank you for writing to us again.
It need not be all the time. Even sclerosed bone will have some amount of changes which would have been picked up by CT or MRI. Since your scans did not pick those cancer specific abnormalities, your doctors would have not been much concerned. CT/MRI are very accurate in picking up cancer specific abnormalities. Hence you should not worry. May be, they could be normal physiological findings in your case.
Feel free to discuss further,
Regards
Patient replied :
Thank you. My bone condition gives very dense bone--beyond the 99th percentile. So, do you think that blastic cancer would look different on mri and ct scan? Blastic cancer is pretty dense, too.
Thank you for writing to us again.
Yes. HU units on CT scans will vary between blastic mets and dense bone. Also, MRI can pick up sclerosis and mets. Bone scan and PET scan will have different appearances in these conditions. Regards