Older than 40 years

The malignancies that are most likely to metastasize to bone are breast, lung, prostate, kidney, and thyroid

Pain more common with lytic metastases than with blastic lesions

Typically intramedullary

Lung and kidney metastases can originate in cortex

Distribution: preference for hematopoietic sites, i.e., ribs, spine, pelvis, proximal femur

Metastatic carcinoma uncommon distal to the elbow and knee

Lytic metastases can demonstrate geographic to motheaten/permeative bone destruction

Variable

Prominent reactive bone formation can be seen in breast, thyroid, and prostate metastases

Bronchogenic carcinoma appears as a mass ( arrow ) adjacent to the left hilum on chest x-ray ( left ).

In a patient with known cancer, the presence of two or more lesions, as demonstrated here with a bone scan ( right ), corresponds to a greater than 90% probability of metastatic disease.

Breast cancer metastasis appears as a mixed lytic and blastic lesion in the left pelvis and femur ( left ). This pattern can also be seen in thyroid cancer. Note also pathologic acetabulum fracture.

In this example, metastatic breast carcinoma appears as an area of aggressive lytic bone destruction in the proximal femur ( right ).

Prostate cancer produces blastic metastases ( arrows ) in 75% of instances ( left ). Note the radiation seeds in the prostate.

Metastases originating in the cortex appear as “cookie bites” ( arrow ) and are most commonly seen with lung and kidney carcinomas ( right ).

Distal (acral) metastases are unusual but most commonly seen with lung cancer ( left ).

Metastatic lesions in children are most commonly neuroblastomas, as seen in this forearm lesion ( right ).

Destructive lesions about the peritrochanteric region, as seen on this radiograph ( left ), should raise concern about an impending pathologic fracture. Often, pain precedes the fracture.

MRI (STIR sequence) shows marrow and soft tissue edema, increasing concern about an impending fracture ( right ).