Helped Over 500,000 patients with 98%+ satisfaction.

Connect & Get Personalized 1-to-1 Answers from Expert Doctors

DoctorSpring > Question Home

How would OSTEOBLASTIC CANCER show up in CT?

Resolved Question:

I have been worrying that each of my diagnostic tests in April may have been false negatives.

1. The bone scan: the pelvic area looks bright in a NORMAL bone scan, so if I had a small area of osteoblastic cancer in the pelvis, how would it show up? The radiologist would probably miss it against that already bright background.

I have a bone condition--they don't know what it is, but from biopsies, etc., they know it isn't cancer. I have EXTREMELY dense bones and it makes CT scans look like "salt and pepper". And MRI's look darker than they should. There are a lot of reasons that the condition does not look like cancer--it is completely symmetrical in pelvis and spine for one thing. There's no fluid around the spine. Anyway, I'm worried that this bone condition, which covers everything, is hiding actual cancer in my pelvis.

2. I am afraid with the whole pelvis looking dark on my MRI, that a cancer lesion would be hidden. How would it show up on that dark background? They did contrast with it--and saw no enhancement, but the radiologist told me that the enhancement doesn't show in 100 percent of the people. Is there any way they could look at that pelvic mri, that looked all dark, and see cancer--or would it be hidden (this is assuming the enhancement wasn't working).

3. Same problem with CT Scan. The pelvis all looks like salt and pepper. The first scan I had in February showed no uptake. The second scan was in April during chemo--I don't know if they could rely on the enhancement because apparently people get "chemo bones" and it's very unreliable. I know that a bone tumor can show on the CT part of the scan, but, again, would it be hidden by the salt and pepper background. How do you think it would show up?

Category: Oncologist

Ask Your Own Question

Category: Hematologist
 26 Doctors Online

Hello, Thank you for your consult at DoctorSpring.
The exact characteristics of bone involvement would actually vary from each person. It's not the dark and white area or the salt and pepper areas in the scans which usually bother the radiologist but in fact soft tissue mass lesions with changes in HU in CT or density changes in MRI T1 and T2 , etc sequences..
These may sound very technical and may not be interpreted by everyone, even non radiology doctors ( sometimes ).

If in doubt, I would advice you to go for a PET CT scan which can give us a little more idea but AGAIN I CANNOT BE 100% SURE.
I would suggest you be on follow up with your oncologist and follow his advices regarding treatment and investigations.
Kind regards,

Patient replied :

Thank you.
So, if I understand correctly, you are saying that if there were bone cancer--an MRI would show density changes and the radiologist could see this.
I don't know what the HU is in the CT? Is it something that would look different on top of the salt and pepper image that is already there?
What about the bone scan? How do they see small cancerous lesions in the pelvis, since the pelvis normally lights up so much? Can this be trusted?
Thank you.

Thank you for writing to us again.
Yes. Radiologist and nuclear medicine physician would have suspected any abnormality if present and suspicious of cancer. If they have not commented on it, it means it is not there.
Feel free to discuss further,

Patient replied :

And you think these abnormalities (bone cancer) would not be hidden by the diffuse sclerosis that I have from my bone condition (which is possibly fluorosis)?
My whole worry is that the cancer will look like the diffuse sclerosis which is everywhere and trick the radiologist. It would be osteoblastic cancer, if I had it, because that is what lobular breast cancer metastasizes to.

Hello. Thank you for writing to us again.
It need not be all the time. Even sclerosed bone will have some amount of changes which would have been picked up by CT or MRI. Since your scans did not pick those cancer specific abnormalities, your doctors would have not been much concerned. CT/MRI are very accurate in picking up cancer specific abnormalities. Hence you should not worry. May be, they could be normal physiological findings in your case.
Feel free to discuss further,

Patient replied :

Thank you. My bone condition gives very dense bone--beyond the 99th percentile. So, do you think that blastic cancer would look different on mri and ct scan? Blastic cancer is pretty dense, too.

Thank you for writing to us again.
Yes. HU units on CT scans will vary between blastic mets and dense bone. Also, MRI can pick up sclerosis and mets. Bone scan and PET scan will have different appearances in these conditions.

Dr. Prasad Eswaran
Category: Hematologist
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
Dr. Prasad Eswaran and 4 other Medical Specialists are ready to help you

Users who read this, also read:

Make informed and better medical decisions.

Join the 500,000 people who found a smarter, quicker way to get Answers, Recommendations & Expert Opinions.

Expert Doctors at fingertips

Recommendation on next step. Second-opinion.Multi-specialty.

Save Time

Average time for answers: 6 hours.

Save Money

$35 for typical specialist consult vs. $120 for a local appointment.

Free Follow-ups

Clarify, ask further questions for free in private conversation.

100% Satisfaction

Money back guarantee for the 1st reply. MEDNET Quality Board.

Start My Consultation



Doctor Spring is a novel online Doctor consultation platform where you can get your medical questions answered by leading Doctors. Just Submit your question and rest assured that you will consult a Doctor easily. Once you submit the question, the Doctor from the concerned specialty will reply within hours. You can always ask more questions or add details with follow-up question options and make it an online doctor chat. You may use this service to consult a specialty or for getting medical second opinion. All paid services come with a MEDNET quality assurance and 100% money back guarantee.

DoctorSpring in news