Ndlovu X., George R., Ellmann A., Warwick J.
Department of Nuclear Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa; Department of Radiology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
Ndlovu, X., Department of Nuclear Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa; George, R., Department of Radiology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa; Ellmann, A., Department of Nuclear Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa; Warwick, J., Department of Nuclear Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
INTRODUCTION: Bone scintigraphy is used extensively in evaluating metastatic disease. There are currently no clear recommendations for the use of single photon emission computed tomography (SPECT)/CT in metastatic bone disease. Given its limited availability there is a need to identify the clinical indications for which SPECT/CT is clearly beneficial in influencing patient care and outcome. METHODS: Forty-two patients with equivocal lesions on planar scintigraphy were recruited and underwent SPECT/CT imaging. On reading of SPECT alone and then SPECT/CT, lesions were classified as malignant, benign or equivocal. Follow-up clinical information, radiological studies and/or bone scans were used as a gold standard. SPECT and SPECT/CT were compared in terms of the number of equivocal findings and accuracy on a patient-wise and lesion-wise basis. RESULTS: Forty-two patients with 189 skeletal lesions were examined. There was a diverse variety of primary tumours, with the majority being breast (n=22) and prostate cancer (n=8). SPECT/CT resulted in a significant reduction in the proportion of patients (48-14%, P=0.0015) and lesions (31-9%, P<0.0001) with equivocal findings. The overall accuracy of SPECT/CT was significantly higher on both a patient-wise (52-79%, P=0.0026) and lesion-wise basis (67-92%, P<0.0001). CONCLUSION: SPECT/CT significantly outperforms SPECT alone for the interpretation of skeletal lesions in patients undergoing bone scanning for metastases. When available SPECT/CT is indicated in patients in whom correct classification of equivocal lesions is expected to alter the patient's management. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.
medronate technetium tc 99m; adult; aged; article; benign tumor; bone disease; bone metastasis; bone scintiscanning; breast cancer; clinical article; clinical trial; computer assisted tomography; controlled study; diagnostic accuracy; female; follow up; human; image analysis; intermethod comparison; male; malignant neoplastic disease; medical information; primary tumor; prostate cancer; radiodiagnosis; single photon emission computer tomography; tumor classification; Adult; Aged; Bone and Bones; Bone Neoplasms; Female; Humans; Male; Middle Aged; Prospective Studies; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
