Diagnostic performance of whole-body bone scintigraphy in combination with SPECT/CT for detection of bone metastases

Abstract

Objective

This retrospective study investigated the performance of whole-body bone scintigraphy combined with SPECT/CT and established a grading diagnostic criterion for bone metastases.

Methods

We summarized signs of whole-body bone imaging combined with SPECT in nuclear medicine and CT signs of corresponding parts. Then we established a diagnostic criterion for bone metastases by using whole-body bone scintigraphy combined with local SPECT/CT. The criterion is classified into five grades. 120 patients with a total of 141 lesions underwent whole-body bone scintigraphy and SPECT/CT. Two reviewers read the images according to the diagnostic criterion. With pathological diagnosis as the “gold standard”, the diagnostic efficacy for bone metastases and the diagnostic agreement between the two reviewers were analyzed to validate the feasibility of the criterion. Diagnostic effectiveness was expressed in terms of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.

Results

The diagnostic accuracy of the two reviewers was 90.1% and 92.9% respectively, sensitivity was both 100%, specificity was 41.7% and 58.3%, positive predictive value was 89.3% and 92.1%, and negative predictive value was both 100%. The kappa value of the diagnostic tests performed by the two reviewers on whole-body bone scintigraphy combined with SPECT/CT was 0.919 (P < 0.001).

Conclusion

The grading diagnostic criterion for bone metastases by whole-body bone scintigraphy combined with SPECT/CT has high diagnostic accuracy and good consistency between reviewers, but the specificity was still low even with SPECT/CT.

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References

  1. 1.

    Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ. Radionuclide bone imaging: an illustrative review. Radiographics. 2003;23:341–58.

    Article  Google Scholar 

  2. 2.

    Bellah RD, Summerville DA, Treves ST, Micheli LJ. Low back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT. Radiology. 1991;180:509–12.

    CAS  Article  Google Scholar 

  3. 3.

    Kobayashi K, Okuyama C, Kubota T, Nakai T, Ushijima Y, Nishimura T. Do short-time SPECT images of bone scintigraphy improve the diagnostic value in the evaluation of solitary lesions in the thoracic spine in patients with extraskeletal malignancies? Ann Nucl Med. 2005;19:557–66.

    Article  Google Scholar 

  4. 4.

    Rybak LD, Rosenthal DI. Radiological imaging for the diagnosis of bone metastases. Q J Nucl Med. 2001;45:53–64.

    CAS  PubMed  Google Scholar 

  5. 5.

    Zhao Z, Li L, Li F, Zhao L. Single photon emission computed tomography/spiral computed tomography fusion imaging for the diagnosis of bone metastasis in patients with known cancer. Skeletal Radiol. 2010;39:147–53.

    Article  Google Scholar 

  6. 6.

    Helyar V, Mohan HK, Barwick T, Livieratos L, Gnanasegaran G, Clarke SE. The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma of the prostate. Eur J Nucl Med Mol Imaging. 2010;37:706–13.

    Article  Google Scholar 

  7. 7.

    Zhang Y, Shi H, Gu Y, Xiu Y, Li B, Zhu W. Differential diagnostic value of single-photon emission computed tomography/spiral computed tomography with Tc-99m-methylene diphosphonate in patients with spinal lesions. Nucl Med Commun. 2011;32:1194–200.

    Article  Google Scholar 

  8. 8.

    Sharma P, Singh H, Kumar R, Bal C, Thulkar S, Seenu V, et al. Bone scintigraphy in breast cancer: added value of hybrid SPECT-CT and its impact on patient management. Nucl Med Commun. 2012;33:139–47.

    Article  Google Scholar 

  9. 9.

    Zhang Y, Shi H, Cheng D, Jiang L, Xiu Y, Li B, et al. Added value of SPECT/spiral CT versus SPECT in diagnosing solitary spinal lesions in patients with extraskeletal malignancies. Nucl Med Commun. 2013;34:451–8.

    Article  Google Scholar 

  10. 10.

    Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology. 2006;238:264–71.

    Article  Google Scholar 

  11. 11.

    Schillaci O, Danieli R, Manni C, Simonetti G. Is SPECT/CT with a hybrid camera useful to improve scintigraphic imaging interpretation? Nucl Med Commun. 2004;25:705–10.

    Article  Google Scholar 

  12. 12.

    Hamann M, Aldridge M, Dickson J, Endozo R, Lozhkin K, Hutton BF. Evaluation of a low-dose slow-rotating SPECT-CT system. Phys Med Biol. 2008;53:2495–508.

    CAS  Article  Google Scholar 

  13. 13.

    Strobel K, Burger C, Seifert B, Husarik DB, Soyka JD, Hany TF. Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. Am J Roentgenol. 2007;188:W467–W474474.

    Article  Google Scholar 

  14. 14.

    Romer W, Nomayr A, Uder M, Bautz W, Kuwert T. SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients. J Nucl Med. 2006;47:1102–6.

    PubMed  Google Scholar 

  15. 15.

    Iqbal B, Currie GM, Wheat JM, Raza H, Kiat H. The incremental value of SPECT/CT in characterizing solitary spine lesions. J Nucl Med Technol. 2011;39:201–7.

    Article  Google Scholar 

  16. 16.

    Horger M, Bares R. The role of single-photon emission computed tomography/computed tomography in benign and malignant bone disease. Semin Nucl Med. 2006;36:286–94.

    Article  Google Scholar 

  17. 17.

    Reinartz P, Schaffeldt J, Sabri O, Zimny M, Nowak B, Ostwald E, et al. Benign versus malignant osseous lesions in the lumbar vertebrae: differentiation by means of bone SPET. Eur J Nucl Med. 2000;27:721–6.

    CAS  Article  Google Scholar 

  18. 18.

    Zhang Y, Shi H, Li B, Cai L, Gu Y, Xiu Y. The added value of SPECT/spiral CT in patients with equivocal bony metastasis from hepatocellular carcinoma. Nuklearmedizin. 2015;54:255–61.

    CAS  Article  Google Scholar 

  19. 19.

    Lei J, Lei H, Tan H, Hu P, Zhang Y, Shi H. Diagnostic value of 99mTc-MDP SPECT/spiral CT in assessing indeterminate spinal solitary lesion of patients without malignant history. Ann Nucl Med. 2013;27:460–7.

    Article  Google Scholar 

  20. 20.

    Zhang Y, Shi H, Li B, Xiu Y, Cai L, Gu Y, et al. Diagnostic value of 99mTc-MDP SPECT/Spiral CT combined with three-phase bone scintigraphy in assessing suspected bone tumors in patients with no malignant history. Nucl Med Commun. 2015;36:686–94.

    CAS  Article  Google Scholar 

  21. 21.

    Zhang Y, Li B, Shi H, Yu H, Gu Y, Xiu Y. Added value of SPECT/spiral CT versus SPECT or CT alone in diagnosing solitary skeletal lesions. Nuklearmedizin. 2017;56:139–45.

    Article  Google Scholar 

  22. 22.

    Keidar Z, Israel O, Krausz Y. SPECT/CT in tumor imaging: technical aspects and clinical applications. Semin Nucl Med. 2003;33:205–18.

    Article  Google Scholar 

  23. 23.

    Yamaguchi T. Intertrabecular vertebral metastases: metastases only detectable on MR imaging. Semin Musculoskelet Radiol. 2001;5(2):171–5.

    CAS  Article  Google Scholar 

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Acknowledgements

This work was supported by the Scientific Research Program of Shanghai Municipal Commission of Health and Family Planning (Grant no. 201740201), the Shanghai Municipal Key Clinical Specialty (Grant no. shslczdzk03401) and the Technology Support Projects of Shanghai Science and Technology Committee (Grant no. 17411950300).

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Correspondence to Hongcheng Shi.

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Zhang, Y., Li, B., Wu, B. et al. Diagnostic performance of whole-body bone scintigraphy in combination with SPECT/CT for detection of bone metastases. Ann Nucl Med (2020). https://doi.org/10.1007/s12149-020-01488-1

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Keywords

  • SPECT/CT
  • Malignant tumor
  • Diagnostic
  • Bone metastases