Table 1.

Strengths and limits of the main imaging modalities used for the detection of BM in DTC patients

Imaging technique	Strengths	Limits
Plain radiograph	Diffuse availability Low costs Assessment of potential pathological fractures	Low sensitivity Incapacity of detecting soft tissue involvement
CT	High resolution and three-dimensional information Lesion characterization Assessment of cortical integrity Guidance for bone biopsy	Intermediate sensitivity
MRI	High sensitivity Assessment of soft tissue and neural structures involvement Possibility of employment of functional techniques (DWI, DCE)	High costs Longer scan times Contraindicated in presence of implantable devices
131I scintigraphy	High sensitivity for RAI-avid lesions Whole body assessment Theranostic value	Limited spatial resolution (improved by SPECT/CT) Limited value in case of non RAI-avid lesions
Bone scintigraphy	Whole body assessment	Limited spatial resolution (improved by SPECT/CT) Limited accuracy in detecting lytic lesions
18F-FDG PET/CT	Whole body assessment High sensitivity in non-RAI-avid lesions Prognostic value	Lower sensitivity than 131I scintigraphy for RAI-avid lesions Lower anatomical assessment accuracy than high-resolution CT
18F-NaF PET/CT	Whole body assessment Higher sensitivity than 18F-FDG PET/CT in detecting osteoblastic lesions	Lower sensitivity than 18F-FDG PET/CT in evaluating bone marrow involvement and early bone lesions Low availability Low clinical experience

CT computed tomography, MRI magnetic resonance imaging, DWI diffusion-weighted imaging, DCE dynamic contrast enhanced, ¹³¹I ¹³¹iodine, RAI radioactive iodine, SPECT single-photon emission computed tomography, PET positron emission tomography, ¹⁸F–FDG ¹⁸fluorine–fluorodeoxyglucose, ¹⁸F–NaF ¹⁸fluorine–sodium fluoride