Abstract
BackgroundDespite recent technological advances allowing for quantitative single-photon emission computed tomography (SPECT), quantitative SPECT has not been widely used in the clinical practice. The aim of this study is to evaluate the feasibility of quantitative SPECT for measuring metastatic bone uptake in breast and prostate cancer by comparing standard uptake values (SUVs) measured with 99mTc-HDP SPECT/CT and 18F-NaF PET/CT.MethodsTwenty-six breast and 27 prostate cancer patients at high risk of bone metastases underwent both 99mTc-HDP SPECT/CT and 18F-NaF PET/CT within 14 days of each other. The SPECT and PET data were reconstructed using ordered-subset expectation-maximization algorithms achieving quantitative images. Metastatic and benign skeletal lesions visible in both data sets were identified, and their maximum, peak, and mean SUVs (SUVmax, SUVpeak, and SUVmean) were determined. SUV ratios (SUVRs) between the lesions and adjacent normal appearing bone were also calculated. Linear regression was used to evaluate the correlations between the SUVs of SPECT and PET and Bland-Altman plots to evaluate the differences between the SUVs and SUVRs of SPECT and PET.ResultsA total of 231 skeletal lesions, 129 metastatic and 102 benign, were analyzed. All three SUV measures correlated very strongly between SPECT and PET (R2 ≥ 0.80, p < 0.001) when all lesions were included, and the PET SUVs were significantly higher than SPECT SUVs (p < 0.001). The median differences were 21%, 12%, and 19% for SUVmax, SUVpeak, and SUVmean, respectively. On the other hand, the SUVRs were similar between SPECT and PET with median differences of 2%, − 9%, and 2% for SUVRmax, SUVRpeak, and SUVRmean, respectively.ConclusionThe strong correlation between SUVs and similar SUVRs of 99mTc-HDP SPECT/CT and 18F-NaF PET/CT demonstrate that SPECT is an applicable tool for clinical quantification of bone metabolism in osseous metastases in breast and prostate cancer patients.
Highlights
Despite recent technological advances allowing for quantitative single-photon emission computed tomography (SPECT), quantitative SPECT has not been widely used in the clinical practice
The strong correlation between Standardized uptake value (SUV) and similar Standard uptake value ratio (SUVR) of 99mTc-hydroxyethylene diphosphonate (HDP) SPECT/Computed tomography (CT) and 18F-NaF Positron emission tomography (PET)/CT demonstrate that SPECT is an applicable tool for clinical quantification of bone metabolism in osseous metastases in breast and prostate cancer patients
Our results demonstrate that 99mTc-HDP SPECT SUVs and SUVRs reflect the metabolic activity of lesions to 18F-NaF PET SUVs and SUVRs; SPECT measures can potentially be used to clinically evaluate bone metastases
Summary
Despite recent technological advances allowing for quantitative single-photon emission computed tomography (SPECT), quantitative SPECT has not been widely used in the clinical practice. The aim of this study is to evaluate the feasibility of quantitative SPECT for measuring metastatic bone uptake in breast and prostate cancer by comparing standard uptake values (SUVs) measured with 99mTc-HDP SPECT/CT and 18F-NaF PET/CT. Single-photon emission computed tomography (SPECT) has conventionally been used in a non-quantitative manner, i.e., the images have been interpreted using relative intensity values instead of absolute values of tracer concentration [1, 2]. 18F-NaF PET/CT is an even more sensitive method than 99mTc-diphosphonate SPECT/CT [6, 8], and PET is inherently quantitative [9]. 18F-NaF PET/CT is rather expensive and has limited availability [2, 6]
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