Determining Old vs. New Tumor Damage To Bone

[Bill]

Has anybody ever been told how, or even if, one can distinguish between old ( inactive ) tumor damage to bone vs. new ( active ) tumor damage to bone when viewing x-ray, CT scan and MRI films ? If it can't be determined directly from viewing these films are you aware of what alternative methods can be utilized to assist in this determination ?

Thanks.

[BoBennett]

Bill,

Not sure if my response will be helpful to your specific question but I will respond based on my X rays. Basically it comes down to comparing X-rays. Not very scientific but a pic is worth a thousand words. My X-rays of my tumor were obvious then the comparative were obvious. If the mets come back I have no doubt I will be able to see the differences and decipher if there is new mets. I am assuming the old mets are not active and have “healed”. None of my thoughts came from a qualified source, I’m just grabbing. One thing is, I’m sure different bone areas are easier to read, as may be the case with my arm as opposed to spinal areas.

Bo

[BoBennett]

As for determining old V new. Again, I am assuming the old mets healed and the healing look is marked as opposed to old look, cancer look and healing look.

Anyway.

[Bill]

As for determining old V new. Again, I am assuming the old mets healed and the healing look is marked as opposed to old look, cancer look and healing look.

Anyway.

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Bo :

Thanks for the reply. I am interested in determining if an oncologist or radiologist can distinguish the difference between old vs. new tumor damage to bone w/o having any prior films to compare against. You may be on to something re: old tumor damage having a healed look vs. new ( active ) damage having a different look. Hopefully, I can get something definitive on this subject.

[BoBennett]

FYI,

The report for my comparative Xray, stated, new bone growth due to focally directed radiation. I had no radiation. So they, some, may be able to distinguish between new or old but not necessarily why or how. At least in this case.

[Snowflake]

Bill,

My first x-ray after surgery showed an area in the ribs that was whiter than the other bones. This was pointed out as an area of healing bone (and this was when I found out that one of my ribs had been cut). My guess, from Bo's input, would be that older mets that are inactive may be working on healing and therefore whiter around the edges. There is probably a color change where the active mets are, as well...

The rib bone "fracture" did show up in a later bone scan, as well.

Becky

[cindi o'h]

Bill,

It would be difficult to determine old mets from new mets I would think without having a chronolgy of films to follow.

When new bone is laid down there is osteoclastic and osteoblastic activity at the cellular level. And as snow pointed out the edges may show more white as new bone forms. In my experience it takes awhile for the bone to fill in. In this area, over a period of time, the area would change from black to grades of gray before becoming whiter and whiter to match the kind of bone that is missing... ie cortical bone vs. spongy bone. I would think it would take a very experienced eye to determine what is going on from just one film without a comparison film. Almost impossible, I would guess...could be wrong though, (been wrong before)

Cindi o'h

[Bill]

Thanks for the additional input. Here's the problem that we keep having. My wife has had several x-rays, CT scans and MRIs that include her lower spine and pelvis. But, for some reason it's the same old story each time when it comes to describing and detailing the bone damage in her pelvic area. The radiologist only makes general comments about " diffuse " or " extensive " bony damage. Never any comparisons or specific details offered about this area. To add to the frustration, the med onc and rad onc really don't want to review the films and offer an opinion. So, what we have after 8 months of imaging is that the pelvis is still described as having extensive / diffuse bony damage with no commentary as to whether or not this damage is getting better, worse or unchanged.

[cindi o'h]

Bill,

This seems illogical to me. I think that you and your wife as a patient deserve a full explanation of what is going on. It seems to me that your questioning of this is very rational. And, also, I might add, I would think that is something that both the onc. and rad. onc. would want to know as well. This would, for me, determining factor in whether to proceed with further treatment. If it were me, I would pursue and press further.

If your docs aren't willing to talk with you, you can always get an "outside read". They are pricey...your ins. (if you have) may or may not cover it.

Another option might be to have a consult with the consulting radiologist. They will sometimes speak directly with the patient, but not always...depending on the personality of the doc and the group policies.

Best luck.

Cindi o'h

[Bill]

Bill,

This seems illogical to me. I think that you and your wife as a patient deserve a full explanation of what is going on. It seems to me that your questioning of this is very rational. And, also, I might add, I would think that is something that both the onc. and rad. onc. would want to know as well. This would, for me, determining factor in whether to proceed with further treatment. If it were me, I would pursue and press further.

If your docs aren't willing to talk with you, you can always get an "outside read". They are pricey...your ins. (if you have) may or may not cover it.

Another option might be to have a consult with the consulting radiologist. They will sometimes speak directly with the patient, but not always...depending on the personality of the doc and the group policies.

Best luck.

Cindi o'h

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My wife will be getting updated CT scans ( chest / abd / pelvis ) in the next week or so. Hopefully, this next radiology report will provide some much needed detail on her ( bony ) pelvic condition. If it doesn't I'll have to step up the pressure. Especially, I'd like to know if the Zometa she's been receiving since July '04 is helping. Some of the past radiology reports have been well written, thorough and provided good comparison commentary relating to other cancerous areas but for some reason the ( bony ) pelvic description is always just a general statement as I mentioned above.

Thanks again to all for the input.

[jcawork]

A couple thoughts.

One, the orginal question could be posted on ask the experts.

Second, I also had months of chest scans and had to demand comparisons from one scan to the next. This was accomplished by me writing on the order "compare to CT study of 11/8/04". Low and behold, the next scan w/ this as the instruction/order did just that, compared the two. The other trick is to request that the same radiologist read the films. Most places hate this, but are compelled to do it when requeted. So mine now say. Please have Dr. Sinaih read and compare. The reason, they each use different templates and read very differently (scary).

Jen

[stand4hope]

Bill,

I hear you on this complaint loud and clear.

My husband's CT reports are always very vague and they say things like "persistent extensive bony metastatic disease", "multiple sclerotic lesions in the vertebral bodies, hips and pelvis" "persistent lesion is noted in liver". And the biggest gripe about his CT reports is that not since the 1st report, which actually gave tumor size, has the radiologist ever talked about the lung tumor. The sizes or measurements have never been noted since that 1st report.

After many months of this, I finally asked the primary oncologist why the reports don't ever mention the lung tumor. How big is it? He said, "Well, it's significantly busted up." We asked him to show us, and he pointed to an area that looked like a snowflake, so I guess that's what "busted up" meant. I then asked him to show us the pericardial effusion and he flies through the films on the CD and stops at a picture and says "there it is". So, I give a big sigh and say "WHERE? Point to it, please." I mean those films just look like a abstract art picture to me, ya know?

My husband has had 2 PET scans. We got the films on the second one and you can clearly see the bone mets on those scans and even count them. Also, the PET scan reports, have always been very detailed. It's just the CT reports that are vague.

Good luck with getting answers. For those of us that like detail, it can be very frustrating. I understand.

Love,

Peggy

[Bill]

Bill,

I hear you on this complaint loud and clear.

My husband's CT reports are always very vague and they say things like "persistent extensive bony metastatic disease", "multiple sclerotic lesions in the vertebral bodies, hips and pelvis" "persistent lesion is noted in liver". And the biggest gripe about his CT reports is that not since the 1st report, which actually gave tumor size, has the radiologist ever talked about the lung tumor. The sizes or measurements have never been noted since that 1st report.

After many months of this, I finally asked the primary oncologist why the reports don't ever mention the lung tumor. How big is it? He said, "Well, it's significantly busted up." We asked him to show us, and he pointed to an area that looked like a snowflake, so I guess that's what "busted up" meant. I then asked him to show us the pericardial effusion and he flies through the films on the CD and stops at a picture and says "there it is". So, I give a big sigh and say "WHERE? Point to it, please." I mean those films just look like a abstract art picture to me, ya know?

My husband has had 2 PET scans. We got the films on the second one and you can clearly see the bone mets on those scans and even count them. Also, the PET scan reports, have always been very detailed. It's just the CT reports that are vague.

Good luck with getting answers. For those of us that like detail, it can be very frustrating. I understand.

Love,

Peggy

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Peggy et al :

I have also noticed that tumor measurements are not mentioned very much in my wife's more recent rad reports. Also, my wife just had updated MRIs of her brain and C-T-L spine. Overall, better than average quality rad reports this time but, once again, no specifics on the sacrum / pelvic area other than the usual " difuse bony metastatic disease " observed. However, I guess I have to give the radiologist a pass on this one since the comments were made secondary to his L-spine reading. Same goes for some general lung tumor comments that he made secondary to his T-spine read. BUT, the previous MRI rad reports ( ~ 3 months prior to this ) were terrible. Very poorly written, very little detail ( literally some one-liners ! ), the rad completely forgot to read the T-spine and he failed to do a comparison report against the previous MRIs on file right there in the same hospital from ~ 3 months earlier ! These reports were largely useless. The only saving Grace was that the neurosurgeon does his own read. But, the med onc and rad onc had a fit. I'm not 100% sure why her med onc and rad onc are very reluctant to do their own reads and offer opinion. The med onc relies completely on the rad reports and refuses to even look at the films. The rad onc is more flexible and will look at the films and discuss them in a limited way. I think that there could be a liability concern mixed in there. The rad onc did state once to us that he isn't the radiologist, it isn't his job or expertise to read films and he was furious that a poorly written rad report had put him on the spot. As I stated, CT scans to be scheduled within the next week. Can't wait to see what those reports look like ! LOL !

[kitkathi]

Bill,

Can't add any useful information but just wanted to let you know that you and your wife are in my prayers. Hoping she finds relief/answers soon.

kitkathi