Table 2 Imaging of metastatic breast cancer

CNS

MRI

• Modality of choice due to superior soft tissue resolution

• DWI and perfusion MRI: help to differentiate between tumour recurrence and post-radiation changes

PET/CT

• Differentiation between tumour recurrence and post-radiation changes

Lung

X-ray

• Initial screening modality

• Less sensitive than CT for detection of pulmonary metastasis

CT

• Modality of choice for detection of pulmonary metastasis and mediastinal adenopathy

• Evaluation of treatment response as well as detecting various pulmonary toxicities associated with radiation and systemic chemotherapy

Liver

CT

• Multiphasic CT with non contrast, arterial and venous phase imaging is most commonly used for evaluation of treatment response in patients undergoing systemic therapies

• Non-contrast images are useful for better delineation of lesions

MRI

• Better characterization of suspicious lesion on CT

• Hepatocyte-specific contrast agents: for detection of smaller lesions (<1 cm) and differentiation between metastasis and FNH

• Better sensitivity than CT in presence of hepatic steatosis

Bone

X-ray

• Usually the first modality in the case of musculoskeletal signs and symptoms

CT

• Assessment of axial skeleton during follow-up CT studies in patients undergoing systemic therapies

MRI

• Superior contrast resolution and useful for evaluation of extraosseous soft tissue extension

Tc 99m MDP bone scintigraphy

• Evaluation of asymptomatic patients to detect occult bone metastases

PET/CT

• More sensitive than scintigraphy for detecting lytic metastases and marrow involvement

• Differentiation of flare phenomena vs. true disease worsening