Predicting Pathologic Bone Lesions Using Scout Computed Tomography (CT) Imaging.

Area of Science:

• Oncology
• Radiology
• Orthopedics

Background:

• Routine oncologic surveillance often involves CT imaging.
• Pathologic bony lesions can be subtle and easily missed on initial interpretation.
• Early identification of bone lesions is crucial for timely treatment and improved patient outcomes.

Purpose of the Study:

• To evaluate the benefit of reviewing scout CT images for early identification of pathologic bony lesions.
• To determine the rate at which lesions are missed in initial CT radiologic reports.
• To assess the impact of delayed diagnosis on patient morbidity.

Main Methods:

• Retrospective review of 144 patients treated for humerus or femur lesions (2009-2019).
• Analysis of available scout CT images obtained prior to official diagnosis.
• Independent review of scout CT images by two reviewers.
• Comparison of reviewer findings with initial radiologic reports.

Main Results:

• 39 patients had available scout CT images prior to diagnosis.
• Authors identified lesions in 64.1% of scout CTs, versus 23.1% documented in initial reports.
• 65.5% of identified lesions were not reported initially, with an average delay of 202 days to diagnosis.
• 16.7% of impending fractures progressed to complete fracture before orthopedic referral, with an average delay of 68 days.

Conclusions:

• Careful review of scout CT imaging is essential for detecting pathologic bony lesions.
• Utilizing scout CTs as a screening tool can expedite diagnosis and treatment.
• Early detection and treatment of metastatic bone disease can reduce patient morbidity.