Prostate metastases (DEXA)

Case contributed by Chris Newman
Diagnosis certain

Presentation

Routine DEXA following a few thoracic spine insufficiency fractures. ? Osteoporosis

Patient Data

Age: 75 years
Gender: Male
x-ray
  • T-scores in the lumbar spine, femur and forearm are: 1.3 (lumbar); -1.4 (femur); -1.0 (forearm) 
  • the scores of -1.4 and -1.0 are considered osteopenic scores as per the WHO guidelines
  • however, note the multiple sclerotic lesions throughout the femur, pelvis and lumbar spine on these single planar images
ct

CT confirms the innumerable sclerotic lesions throughout the imaged spine, pelvis and proximal femora.

Note the enlarged prostate within the limits of the bone windows.

In an older male, the most likely diagnosis is metastasis from a prostate primary.

Case Discussion

Prostate metastases diagnosed on DEXA study.

This case illustrates the importance of actually assessing the image quality of DEXA studies and factors that might void the calculated T and Z score values.

Prior surgery and degeneration are the most common artefacts that cause abnormally high T-score values and preclude meaningful assessment.

In this case, the region of interest markers have at least partially been placed through metastatic deposits.

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