What do you think about these test results re: spot on spine?

Emily2008

I'm having another CT and Bone scan next week as a baseline now that rads is over. When I had those tests done last November, the CT report said, among other things:

"2 cm ovoid lesion in the L2 vertebral body may represent a hemangioma given the presence of striations, though a thin sclerotic rim is also present. Metastasis cannot be excluded. Recommend correlation with nuclear medicine bone scan or MRI."

I had a bone scan the same day, and the results said:

"The L2 vertebral body abnormal on today's CT scan appears scintigraphically normal."

So, the radiologist who read the CT said he couldn't exclude mets, and the one who read the bone scan said all was normal. How do I account for this difference? How could it be normal? Is it because the one who read the bone scan thinks the lesion is a hemangioma, therefore, unremarkable? Or was he not even able to see it on the bone scan?

Doing some reading on "sclerotic rims" yields some concern about mets. I've also been reading about which diagnostic tests are better for detecting bone mets, and many say CTs are more comprehensive than bone scans. Since I'll be having both tests again next week, how do I go about making sure the doctor who reads it is looking very carefully at this spot? The hospital system is huge and these were 2 different radiologists. Can I request that both docs who read my tests in November be the same ones who read them now?

I'm getting a bit of scanxiety with these tests coming up, which I know is very normal. I don't want to overthink, but at the same time I didn't ask a lot of questions back in November when I had the tests done. When my MO said everything looked clear on the scans, we focused on the tumor excision, Oncotype testing, then getting through rads. So I didn't really question the results since they were in my favor.

Anybody ever have an experience like this, where a bone scan doesn't pick up mets, but a CT does?

melmcbee

I had this happen I had several lesions show up on ct that were sclerotic. It didnt say sclerotic rims. It also didnt say it was a hemangioma. My bone scan was normal. I asked the radiologist about the discrepancy and he said my lesions were toi small for the bone scan to pick up. Radiologist can usually tell the difference between a hemangioma and a metastatic lesion. But they have to put all remote possibilities in the report to cover their bottom. The rads said my lesions were too small to biopsy. And to continue to follow with CT. I did end up doing a biopsy. And it was positive. However my tumor markers were elevated. How is your tumor markers. Prayers and hugs sent. Most biopsies are negative

Emily2008

Interesting that a lesion may be too small for a bone scan to pick up. I guess this is why some articles I've read say to confirm with MRI.

I don't know about my tumor markers. I recently had blood work done and I don't have the results yet.

I suppose that the scans done next week will show if there's any changes and if we need to be concerned.

Thanks for responding!

NancyHB

I've had a similar experience recently, but with opposite results. I had a CT in preparation for my DIEP surgery last summer that revealed small lesions on L2 and L3. A follow up a few months later at a different institution showed the same lesions. A third CT four months later - no lesions on spine (erg - where did they go?) Fourth CT and bone scan four months after that (a year after first CT) shows nothing on my spine - but now mets on my ribs, one on each side. MO and radiologist says the CT confirms the bone scan. I can't biopsy right now (ribs are tricky and dangerous, I'm told) so I don't know receptor status. My tumor marker tests are currently normal (but AST is slightly elevated). So for me the CT picked up suspected mets that didn't appear on the bone scan, however the bone scan revealed different areas of metastatic disease that were confirmed by the CT. I'm still new to all of this scanning (I had minimal scanning with my two previous dx) but I understand bone scans are the gold standard for bone mets, and CTs are pretty darned good for lungs and soft tissue mets (and PET even better).

Scanxiety is to be expected - it's hard not to be afraid at a time like this. I hope you get some solid answers soon so at least you know what you're dealing with.

Emily2008

Thanks, Nancy. I've followed your story on the boards, and I must say, it's bad enough to be facing cancer, but to not know for certain if and where you have mets...ack!

I'm not sure how you've managed to stay sane in the midst of all the tests and discordant results!