MRI of Bone vs. bone scan???

My mom had her 2nd round of chemo yesterday, did great. Spoke to the Onc. dr beforehand and he said after the 3rd treatment she will get a CT scan of chest to "restage". But said he wants to give her an MRI of her low back/hips to see about the bone mets. My question is does an MRI of the bone show more than a Bone scan or PET scan? She had both, and they confirmed mets in a "few small areas" of her spine. He made it sound like he wants the MRI now, and the CT after the 3rd treatment. I asked and they said it depends on how the hospital schedules it. I am kind of concerned why now he is in a hurry to do bone images. She isn't having any pain or anything. Is this standard for bone mets? Any ideas? Thanks in advance.

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hi -
the MRI is fairly standard and is generally called a "bone scan" - they give special medicines to make the bones show up better and to look for areas that are low density - the doctor is just gathering data to make better decisions with (isn't that good?!) - now for a hard talk - your mom has likely had the disease for a long time - a lot of scientists think LC is hanging around for up to 7-10 years before it's discovered - you know what that means? mom is already a long-term survivor. and the doctors need more information to help them figure out how to be a longer-term survivor . I always find that thought puts my head into perspective - plus gives more reason to look the beast in the eye and be hopeful.

time for another deep breath and a big hug

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Dear pat, I just read what you wrote about scientists tinking it is possible for LC top have bene around 7 to 10 years before dx/ this is interesting and actually ifI think back i can tell it was arouns that time I astarted having some changes in my body and lungs. i think mnay people can say this too. It makes me wonder then if it is this liong aqnd we are all long term survivors right now, how long dowe actually have? any more information from where that came from?i am just really curious as to why some die just a few months after they were dx with it and some live on a long time.
god bless sandy

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Bone metastasis was something that we were trying to be vigilent about with my wife's cancer. The "type" of bone scan was very important. Before the days of the Pet Scan (and now the PET/CT Scan) the triple phase bone scan and the utilization of combination unenhanced/enhanced MRI was critical for bone metastasis analysis.

A Regular Bone Scan cannot distinguish what a lesion (shown by an MRI) represents and cannot differentiate between a tumor, an infection or a fracture. A Triple Phase Bone Scan is helpful in determining benign from malignant lesions.

The Pet Scan replaces some studies that are considered conventional nuclear medicine (bone scan) because of its tremendous capability to image the biochemistry of tumors noninvasively. The technique is useful in patients with both metastatic and primary brain tumor who have been treated with chemotherapy and whose MRI scans show an increase in the residual abnormality (like necrotizing leukoencephalopathy).

Morphologically, it's impossible to distinguish radiation change (like radiation necrosis) from recurrent tumor. Pet is very accurate in distinguishing between those two diagnoses, and it is often used to base treatment decisions without further biopsies, since brain biopsy isn't easy and is very invasive.

Since Pet images biochemical activity, it can accurately predict whether a tumor is benign or malignant, thereby avoiding surgical biopsy when the Pet Scan is negative. Since a Pet Scan images the entire body, confirmation of non-local metastasis can alter treatment plans. Confirmation of advanced metastases allows the physician and patient to more accurately decide on how to proceed. Checking for recurrences is Pet's most accurate diagnostic procedure.

The Pet Scan monitors the biochemical functioning of cells by detecting how they process certain compounds, such as glucose (sugar). Cancer cells metabolize glucose at a much higher level than normal tissues. By detecting increased glucose use with a high degree of sensitivity, Pet identifies cancerous cells, even at an early stage when other modalities may miss them. However, Pet cannot pinpoint the exact size and location of tumors to a precision necessary for optimal diagnosis and treatment planning.

The CT Scan yields a detailed picture of the body's anatomical structures by taking cross-sectional images or X-ray slices of the body. While CT does an excellent job of depicting structures and anatomy, it may miss small or early stage tumors. They can now overlay the results of Pet and CT scans performed separately to identify and locate tumors, but because a patient may not be positioned identically for both scans, the two can be difficult to line up exactly, degrading the accuracy of the diagnostic information.

That's where the combined PET/CT comes into play. It allows physicians to rapidly perform both scans in one session without having to move the patient. This means physicians can precisely overlay the metabolic data of the Pet Scan and the detailed anatomic data of the CT Scan to pinpoint the location of potential metastatic tumors. PET/CT is able to distinguish cancer from non-cancer 100% of the time.

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hey Sandy,
when my daddy was diagnosed, I picked up a bunch of brochures from the ACS outpost at the hospital. one of them was kind of a LC 101 and it had the 7-10 years noted in it with some nice pictures. I'll have to dig it up and find the name. looking back at daddy's condition, I can even see when his bone mets happened (about 6 years before diagnosis) because he had some fierce pains (diagnosed as polymialgia, because they couldn't figure out anything else), he started shrinking then (vertically), and I can also look back and see shortness of breath developing (about 4 years prior to diagnosis). lots of other little signs also. my belief is that there is a period where sclc lays pretty low, just creating some random mischief - and then at some point, something flips a switch and makes it real ugly and real active.

one of the other tidbits I ponder is that the scientists really don't know what causes LC, or causes it to go real active. at the end of the day, there are only statistical correlations linking things like smoking to LC development, but no actual cause&effect linkages. that's just like saying people get eaten more by sharks in the summer - the statistical correlation is there, but the underlying cause is completely different - it's because there are more swimmers when it gets hot outside, so there is more availability of people to be eaten.

more later

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I think I was showing signs of lung cancer in the late 80's, but wasn't diagnosed until 2005. Sometimes I found small spots of blood on the quilted lining of my bedspread, and think I must have coughed up a little blood in the night. My husband said I coughed all night. I've never had that happen since my dx, but I quit smoking a year or two before I was dx'd. I wonder where I'd be now if I had told my PCP about it in 1989 and had a PET. I have BAC, which you can have for many years, so I guess I could have had lung cancer for maybe 15 years before I was dx'd. If that's true, I'm a really long term survivor. Maybe it's just catching up with me all these years later. Charlene

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Thank you all for the responses. Very interesting information.

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