Treated invasive cervical carcinoma utility of computed tomography in distinguishing between skeletal metastases and radiation necrosis

      This paper is only available as a PDF. To read, Please Download here.


      The bony pelvis should be carefully evaluated on computed tomography (CT) scans of the lower abdomen and pelvis performed for staging cervical cancer or for evaluating suspected recurrence. CT provides optimal imaging of the spine and pelvis, frequently providing a clinically relevant supplement to bone scan or plain film information. In a study of eight patients with skeletal metastases from cervical carcinoma and three cases of radiation osteitis, overlap existed in their imaging characteristics. Metastases were always lytic but nearby sclerotic areas from radiation were often present. Radiation osteitis may be lytic, sclerotic, or mixed, and both may avidly accumulate bone-scanning radiotracers. The absence of a soft tissue mass, slow progression, blastic elements, and sharply defined borders on CT suggest radiation necrosis. However, in some lesions within a radiation portal, biopsy or MRI may be required for final diagnosis.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kottmeir H.C.
        Annual report of International Federation of Gynecology and Obstetrics. Stockholm. 1976; Vol. 16
        • Barmeir E.
        • Langer O.
        • Levy J.I.
        • Nissenbaum M.
        • DeMoor N.G.
        • Blumenthal N.J.
        Unusual skeletal metastases in carcinoma of the cervix.
        Gyn Oncol. 1985; 20: 307-316
        • Blythe J.G.
        • Ptacek J.J.
        • Buchsbaum H.J.
        • Latourette H.B.
        Bony metastases from carcinoma of cervix.
        Cancer. 1975; 35: 475-484
        • Carlson V.
        • Delclos L.
        • Fletcher C.H.
        Distant metastases in squamous-cell carcinoma of the uterine cervix.
        Radiology. 1967; 88: 961-966
        • Drescher H.
        Zurklinik der adenokarzinomas der cervix uteri.
        Geburtshilfe Frauenheilkd. 1949; 9: 31-37
        • Kim R.Y.
        • Weppelmann B.
        • Salter M.M.
        • Brascho D.J.
        Skeletal metastases from cancer of the uterine cervix: frequency, patterns, and radiotherapeutic significance.
        Int J Rad Onc Biol Phys. 1987; 13: 705-708
        • Badib A.O.
        • Kurohara S.S.
        • Webster J.H.
        • Pickren J.W.
        Metastasis to organs in carcinoma of the uterine cervix.
        Cancer. 1968; 21: 434-439
        • Bassan J.S.
        • Glaser M.G.
        Bony metastasis in carcinoma of the uterine cervix.
        Clin Radiol. 1982; 33: 623-625
        • Morris J.M.
        • Meigs J.V.
        Carcinoma of the cervix.
        Surg Gyn Obst. 1950; 90: 135-150
        • Sotto L.S.J.
        • Graham J.B.
        • Pickren J.W.
        Postmortem findings in cancer of the cervix.
        Am J Obst Gynec. 1960; 80: 791-795
        • Kamath C.R.V.
        • Maruyama Y.
        • DeLand F.H.
        • Van Nagel J.R.
        Role of bone scanning for evaluation of carcinoma of the cervix.
        Gyn Oncol. 1983; 15: 171-185
        • Peeples W.J.
        • Inalsingh C.H.A.
        • Hazra T.A.
        • Graft D.
        The occurrence of metastasis outside the abdomen and retroperitoneal space in invasive carcinoma of the cervix.
        Gyn Oncl. 1976; 4: 307-310
        • Rubin P.
        • Prabhasawat D.
        Characteristic bone lesions in postirradiated carcinoma of the cervix.
        Radiology. 1961; 76: 703-717
        • Fisher M.S.
        Lumbar spine metastasis in cervical carcinoma: a characteristic pattern.
        Radiology. 1980; 134: 631-634
        • Henriksen E.
        The lymphatic spread of carcinoma of the cervix and of the body of the uterus.
        Am J Obstr Gynec. 1949; 58: 924-942
        • Marcial-Rojas R.A.
        • Meigs J.V.
        Cancer of the cervix uteri.
        Am J Pathol. 1955; 31: 1077-1082
        • Katz R.D.
        • Alderson P.O.
        • Rosenshein N.B.
        • Bowerman J.W.
        • Wagner Jr, H.N.
        Utility of bone scanning in detecting occult skeletal metastases from cervical carcinoma.
        Radiology. 1979; 133: 469-472
        • McNeil B.J.
        Value of bone scanning in neoplastic disease.
        Semin Nuc Med. 1984; 14: 277-286
        • Paling M.R.
        • Herdt J.R.
        Radiation osteitis: a problem of recognition.
        Radiology. 1980; 137: 339-342
        • Cooper K.L.
        • Beabout J.W.
        • Swee R.G.
        Insufficiency fractures of the sacrum.
        Radiology. 1985; 156: 15-20
        • Glazer H.S.
        • Lee J.K.T.
        • Levitt R.G.
        • et al.
        Radiation fibrosis: differentiation from recurrent tumor by MR imaging.
        Radiology. 1985; 156: 721-726
        • Vanel D.
        • Di Paola R.
        • Contesso G.
        Magnetic resonance imaging in musculoskeletal primary malignant tumors.
        in: Kressel H. Magnetic Resonance Annual 1987. 1987: 237-261
        • Li K.C.
        • Poon P.Y.
        Sensitivity and specificity of MRI in detecting cord compression from vertebral metastases and distinguishing malignant from benign compression fractures. (Abstract 10).
        Society of Magnetic Resonance in Medicine. 1987; 1: 17-21
        • Orel S.G.
        • Zerhouni E.A.
        • Fishman E.K.
        • Pessar M.L.
        • Soulen R.L.
        Detection of locally recurrent rectal carcinoma with MR imaging.
        in: Abstract 479, RSNA Metting. December 2, 1987