Radiographs negative or do not explain symptoms. Next imaging study. In cases in which radiographs are negative or radiographic findings do not adequately explain the symptoms, further evaluation with advanced imaging (such as MRI or CT) should be contemplated based on history and level of clinical concern. CT Area of Interest In cases in which radiographs are negative or fail to adequately explain symptoms, CT can be a helpful tool in facilitating detection of bony abnormalities, such as nondisplaced fractures, subtle periosteal reaction, or occult bone tumors. CT can be especially helpful in evaluating regions of complex or overlapping osseous anatomy, in which radiographic evaluation can be limited. In a retrospective study of 47 patients with negative radiographic Primary Bone Tumors findings and positive bone scintigraphy findings specifically involving the ribs, CT was effective in detecting rib fractures and avoiding further unnecessary examinations [11]. CT is also a viable imaging alternative for patients who cannot receive an MRI. Some cases may benefit from both MRI and CT because these modalities provide complementary information regarding soft-tissue (often better evaluated on MRI) and matrix mineralization (often better evaluated on CT). There is no relevant literature specifically regarding the use of CT with intravenous (IV) contrast or CT without and with IV contrast in the evaluation of suspected primary bone tumor with negative or equivocal radiographs or radiographs that do not explain symptoms. Contrast may be helpful if a soft-tissue component is suspected. However, if contrast is given, CT without and with IV contrast is preferred because it allows differentiation of areas of contrast enhancement from areas of osseous matrix production. FDG-PET/CT Whole Body FDG-PET/CT is not routinely used for the evaluation of primary bone tumors in patients with positive localized or regional symptoms and negative radiographs or findings that do not explain symptoms.
Primary Bone Tumors. Radiographs negative or do not explain symptoms. Next imaging study. In cases in which radiographs are negative or radiographic findings do not adequately explain the symptoms, further evaluation with advanced imaging (such as MRI or CT) should be contemplated based on history and level of clinical concern. CT Area of Interest In cases in which radiographs are negative or fail to adequately explain symptoms, CT can be a helpful tool in facilitating detection of bony abnormalities, such as nondisplaced fractures, subtle periosteal reaction, or occult bone tumors. CT can be especially helpful in evaluating regions of complex or overlapping osseous anatomy, in which radiographic evaluation can be limited. In a retrospective study of 47 patients with negative radiographic Primary Bone Tumors findings and positive bone scintigraphy findings specifically involving the ribs, CT was effective in detecting rib fractures and avoiding further unnecessary examinations [11]. CT is also a viable imaging alternative for patients who cannot receive an MRI. Some cases may benefit from both MRI and CT because these modalities provide complementary information regarding soft-tissue (often better evaluated on MRI) and matrix mineralization (often better evaluated on CT). There is no relevant literature specifically regarding the use of CT with intravenous (IV) contrast or CT without and with IV contrast in the evaluation of suspected primary bone tumor with negative or equivocal radiographs or radiographs that do not explain symptoms. Contrast may be helpful if a soft-tissue component is suspected. However, if contrast is given, CT without and with IV contrast is preferred because it allows differentiation of areas of contrast enhancement from areas of osseous matrix production. FDG-PET/CT Whole Body FDG-PET/CT is not routinely used for the evaluation of primary bone tumors in patients with positive localized or regional symptoms and negative radiographs or findings that do not explain symptoms.