Diagnostic procedures for the detection of bone metastases in patients with neuroendocrine gastrointestinal and pancreatic tumors

Introduction: In patients with neuroendocrine gastrointestinal tumors and l iver metastases, but without known extrahepatic manifestations, liver trans plantation may be indicated as curativ or "long-term-palliativ" therapy. Fo r these patients the absence of bone lesions is mandatory. Methods: 4 patients with a histologically proven neuroendocrine tumor were examined in order to exclude further metastases. We compared the diagnostic value of somatostatin-receptor-scintigraphy(SRS),X-ra 99(m)Tc-DPD-scintigr aphy, CT and MRI. Results: In all 4 patients bone metastases could be detected using SRS, CT und MRT. In one case MRI proved multiple infiltrations, while SRS showed on ly a solitary, focal lesion. 99mTc-DPD-scintigraphy was positive in 3 cases , X-ray in 1 case. Conclusion: As a diagnostic strategy we initially recommend somatostatin-re ceptor scintigraphy. When locating suspect areas in SRS, MRI should be the method of choice for the exact evaluation of malignant bone infiltrations. A CT-guided biopsy is necessary to gain histological information.