Bone scintigraphy of skeletal metastasis in hepatoma patients treated by TAE.

Background/aims: Skeletal metastasis in hepatocellular carcinoma patients has become clinically important as a result of advances in treatment modalities. However, the diagnostic accuracy of bone scintigraphy in hepatocellular carcinoma has been questioned.

Methodology: 99mTc-MDP bone scintigraphy was performed in 63 unresectable hepatocellular carcinoma patients treated by transcatheter arterial embolization who either developed musculoskeletal pain (n = 43) or elevated serum alpha-fetoprotein levels (n = 20) during follow-up. Results were categorized as positive or negative for metastases, and their accuracy was evaluated by radiological studies, biopsy, and clinical follow-up.

Results: Bone scintigraphy was positive in 22/43 (51.2%) subjects with pain and 2/20 with alpha-feto-protein elevation. Among 24 bone scintigraphy(+) patients, metastasis was confirmed in 17 and excluded in 6. Frequent sites for metastatic bone scintigraphy lesions were the spine, pelvic bone and ribs. Although 8 metastatic lesions had low or mixed uptake, most had increased uptake on bone scintigraphy. Among 39 bone scintigraphy(-) patients, metastasis was excluded in 32 and confirmed in 1. The sensitivity and specificity of bone scintigraphy in this subset of patients was 94.4% and 84.2%, respectively.

Conclusions: Transcatheter arterial embolization treated hepatocellular carcinoma patients with musculoskeletal pain have a high likelihood of bone metastasis, and bone scintigraphy is a highly reliable method for its detection.