A prospective study determining and comparing the diagnostic accuracy of fluoride-PET/CT, choline-PET/CT, whole-body bone SPECT/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer

Abstract

BackgroundTo determine and compare the diagnostic accuracy of fluoride-PET/CT (NaF-PET/CT), choline-PET/CT, whole-body bone SPECT/CT (WB-SPECT/CT) and whole-body MRI (WB-MRI) for the detection of bone metastases in patients with prostate cancer.MethodsFrom April 2014 to April 2016, 230 patients with prostate cancer referred for bone imaging were included in the study and underwent three index tests: A routine NaF-PET/CT, a WB-MRI, and half of the patients a WB-SPECT/CT and the other half of the patients a choline-PET/CT. Experienced specialist assessed whether 0, 1–5 or > 5 bone metastases were present. In the absence of a histological reference standard, the final diagnosis was determined by an expert panel based on a review of the index tests, patient files and clinical follow-up images for a minimum of 1.5 years.ResultsTwo hundred thirteen patients constituted the final study population. Sixty-two patients (29%) were classified with metastatic bone disease as their final diagnosis. The proportion of patients misclassified was (false positive vs false negative): NaF-PET/CT 5% vs 1%, choline-PET/CT 1% vs 1%, WB-SPECT/CT 6% vs 0% and WB-MRI 7% vs 3%. Patient-based diagnostic performances were (sensitivity, specificity, overall accuracy): NaF-PET/CT (95%, 93%, 93%), choline-PET/CT (97%, 99%, 98%), WB-SPECT/CT (100%, 91%, 94%) and WB-MRI (89%, 90%, 90%). No significant differences in the diagnostic performances were detected.A trend towards overestimating the number of bone metastases was observed for NaF-PET/CT only (p = 0.04).ConclusionsAll three nuclear medicine methods and WB-MRI had favourable diagnostic performances for the detection of bone metastases with no significant difference between them.