Lab/SPP Imaging of Tumors Exam 3

Question 1

Aneurysmal bone cyst

imaging

Answer 1

• bone scan: increase uptake
• CT: fluid-fluid levels due to blood layering and identification of cortex
• MRI: multiple cysts or different signal intensity representing different stages of blood by-products

Question 2

Osteoid osteoma

imaging

Answer 2

• bone scan: intense uptake, “double density sign”
• CT: for precise detection and localization of the nidus
• angiography: highly vascularized nidus w intense circumscribed blush appearing in early arterial phase

Question 3

Paget’s disease

imaging

Answer 3

Laboratory:
-increased hydoxyproline

• Increased alkaline phosphatase
• normal serum calcium and phosphorus

Question 4

Multiple Myeloma

imaging

Answer 4

Laboratory:

• elevated ESR
• thrombocytopenia
• Rouleaux formation
• increase serum calcium
• normal to increased serum phosphorus
• elevated plasma protein in 50-60%
• hyperglobuinemia w revered globulin ratio
• protein electrophoresis with “M-spike*” confirmatory in 80-90%
• Bence Jones proteinuria in 40%
• BM biopsy >10%

MRI
-still a “headache”
-diffused low T1 w high signal endplates
-lil T2 changes, use STIR
-multiple wedge compression fxs
-lil soft tissue mass
Detection of spinal myeloma: 
-STIR imaging 
-selective preset (bone)
-contrast enhance T1

Question 5

Osteosarcoma

imaging

Answer 5

• sclerotic (50%)
• lytic (25%)
• mixed (25%)
• metastasis to the lungs is common
• NUC: intensely increased activity (hypervascularity, new bone formation)
• soft tissue extension demonstrated, especially on SPECT
• MRI* clearly defines marrow involvement on T1 and soft tissue component on T2