[Proton spin tomographic errors--overevaluation of a new method].

Abstract

This case report represents an addendum to the article by B. Holland and J. Freyschmidt in the same issue of this journal. It demonstrates that premature use of magnetic resonance imaging (MRI) of an osteolytic lesion in the femur of a 53-year-old patient led to confusion with a false diagnosis (fibrous dysplasia) of great importance for the patient. Correct interpretation of the destruction pattern on plain film is of much greater diagnostic value than the MR images. In the case described the lesion would have been classified as a Lodwick grade II lesion. Statistically the first differential diagnosis of such a lesion in a 53-year-old man with a smoking history would be "metastasis of a lung carcinoma". The next diagnostic step should have been a plain film of the chest with demonstration of the primary tumor. Indiscriminate application of expensive methods like MRI or CT will never replace what we call the "diagnostic idea", based on the information from plain film, the history of the patient and statistical probabilities.