[Imaging diagnostics in bone metastases]

Bone metastases are common, can cause a variety of relevant symptoms and are often associated with a poor prognosis. An early and accurate diagnosis is therefore crucial; however, the pattern is very heterogeneous and necessitates good knowledge of the possibilities and limitations of each imaging modality. Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET/CT) have the highest sensitivity and specificity for detecting bone metastases. Gradient echo and diffusion-weighted sequences are valuable supplements to the MRI protocol in doubtful cases and MRI is particularly suitable for distinguishing osteoporotic from metastatic spinal fractures with a high degree of diagnostic certainty; however, CT is the modality of choice for stability assessment. Reliable imaging parameters to predict therapy response in cases of bone metastases have not yet been elucidated in large clinical trials. The PET/MRI approach has shown promising preliminary results for diagnosis of bone metastases and further studies in larger cohorts are the subject of ongoing studies.