Table 1 Optimal/favored imaging modality/sequence based on clinical question
From: Imaging in metastatic breast cancer, CT, PET/CT, MRI, WB-DWI, CCA: review and new perspectives
Clinical question | Optimal imaging modality/sequence | Considerations |
Presence of osteoblastic metastases | 99mTc-MDP | Poor specificity, afftected by ‘flare’ reactions |
Presence of osteolytic or osteoblastic metastases, active disease residuum versus treatment response | FDG-PET/CT WB-MRI | WB-MRI not widely available as yet, longer image acquisition times and requirement to train radiologists in interpretation |
Presence of parenchymal CNS metastases | Contrast-enhanced T1 MRI | Higher sensitivity in detection of parenchymal versus leptomeningeal disease |
Presence of leptomenigeal disease | Contrast-enhanced FLAIR MRI | Limited, small-scale studies |
Residual CNS disease versus treatment-related effects | CCA | Inherently lengthy image acquisition times, require dedicated neuroradiology interpretation |
Presence of hepatic metastases | CT LIVER MRI WB-MRI | Differentiating active disease residuum from pseudo-cirrhosis of malignancy often challenging on CT |
Residual hepatic disease versus pseudo-cirrhosis of malignancy | WB-MRI | Interpretation influenced by radiologist experience |
Presence of oligometastatic disease | FDG-PET/CT WB-MRI | WB-MRI less widely available than FDG-PET/CT |
Presence of peritoneal carcinomatosis | WB-MRI | WB-MRI not widely available as yet as above |