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- W2299835960 abstract "1364 Objectives: Increased serum alkaline phosphatase (SAP) in an asymptomatic patient may pose a diagnostic dilemma for the clinician. Major sources of SAP are bone and liver. A retrospective review was done to assess the value of routine bone scan (BS) to identify occult bone pathology such as Paget’s disease (PD) or metastatic disease as the source of elevated SAP. Methods: 87 BS were performed because of increased SAP (range 126-986 U/L, mean 222 U/L, reference range 25-125 U/L). There were 59 men and 28 women, age 29-87 years (mean 64 years). Patients with elevated SAP and known malignancy or PD were excluded. Whole-body (and where necessary spot/SPECT) Tc-99m HDP BS was performed in all patients. Diagnosis was based on characteristic scintigraphic patterns and radiographic/pathologic correlation. Results: In 67/87 (77%), no significant bone abnormality was identified other than age-related degenerative change (Table). PD was found in 11/87 (13%), including the lowest SAP (126). In three (SAP 136, 138, 293), the major abnormalities were lumbar vertebral body, sacral insufficiency and multiple rib fractures, respectively. In one (SAP 356), abnormal liver uptake on BS led to the diagnosis of colon cancer with extensive lymph node and liver metastases (the likely source of elevated SAP). 5 cases of previously undiagnosed metastatic cancer (4 prostate, 1 lung) (SAP range 215-986, including the 2 highest) were identified. In general, it appeared that for either PD or metastases, the higher the SAP, the greater the bone involvement. Conclusions: Metabolic bone disease and metastases are present over a wide range of SAP levels, reflecting the degree of active metabolism. In general, minor elevations in SAP have a lower incidence of PD or other significant pathology and BS may be better reserved for SAP > 200. Correlation with serum calcium, SAP fractionation and serum PSA (where clinically appropriate) may be alternative approaches to routine BS." @default.
- W2299835960 created "2016-06-24" @default.
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- W2299835960 date "2006-05-01" @default.
- W2299835960 modified "2023-09-25" @default.
- W2299835960 title "Bone scan to assess asymptomatic increased serum alkaline phosphatase" @default.
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