Bone Metastases brings together the many recent developments that are gradually improving the prospects for patients with secondary involvement of the skeleton in a primary cancer elsewhere. The morbidity from bone metastases is extensive, and the palliative and supportive treatment that sufferers require for many months or even years constitutes a major health problem. A multidisciplinary approach is essential since a variety of specialists are involved: radiation and medical oncologists, general and orthopaedic surgeons, general physicians, radiologists and nuclear medicine physicians, symptom control and terminal care specialists. The book's editors, themselves authorities in the fields of oncology and bone disease respectively, have brought together experts from all these disciplines to provide comprehensive coverage of metastatic bone disease. They cover the biology and pathophysiology, hypercalcaemia, imaging, assessment of response to treatment, types of treatment (systemic, radiotherapy, surgery), and symptomatic and supportive care. Particularly new approaches included are magnetic resonance imaging, the assessment of skeletal response and isotope therapy.

The most frequently requested investigation in any nuclear medicine department remains the technetium-99m (99mTc)-labelled diphosphonate bone scan. Despite rapid advances in all imaging modalities. there has been no serious challenge to the role of bone scanning in the evaluation of the skeleton. The main reason for this is the exquisite sensitivity of the bone scan for lesion detection. combined with clear visualisation of the whole skeleton. In recent years several new diphosphonate agents have become available with claims for superior imaging of the skeleton. Essentially. they all have higher affinity for bone. thus allowing the normal skeleton to be visualised all the more clearly. However. as will be dis cussed. this may occur at some cost to the principal role of bone scanning. lesion detection. The major strength of nuclear medicine is its ability to provide functional and physiological information. With bone scanning this leads to high sensitivity for focal disease if there has been any disturbance of skeletal metabolism. However. in many other clinical situations. and particularly in metabolic bone disease. more generalised alteration in skeletal turnover may occur. and quantitation of diphosphonate uptake by the skeleton can provide valuable clinical information."

This book, written by authors with national and international reputations in the field, covers all aspects of radionuclide and hybrid bone imaging. Introductory sections present the basic science and consider the current status and limitations of conventional radiological techniques. The underlying principles of PET-CT and SPECT-CT are carefully explained, and the value of different PET and SPECT tracers, assessed. The role of single- and dual-modality approaches in the imaging of benign bone diseases and malignancies is then discussed in detail in a series of well-illustrated chapters. The pathologies addressed include metabolic bone disease, arthritis, bone and joint infections, primary bone and soft tissue tumors, and metastases from breast and prostate cancer. A further section considers the role of bone scintigraphy in the pediatric patient, and the closing chapters focus on miscellaneous subjects, including bone densitometry and radionuclide targeted therapy.