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Table 2 Imaging of metastatic breast cancer

From: Systemic treatment in breast cancer: a primer for radiologists

Location Imaging modalities Remarks
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
  1. MRI magnetic resonance imaging, PET positron emission tomography, CT computed tomography, MDP methylene diphosphonate, FNH focal nodular hyperplasia