Diagnostic Accuracy Of Bone Scintigraphy Research Articles

An evaluation of the diagnostic performance of the triphasic bone scintigraphy in patients suspected of aseptic total knee arthroplasty loosening.

BackgroundTotal Knee Arthroplasty (TKA) is a widely conducted and successful orthopedic procedure. However, aseptic loosening, a common cause of TKA failure, necessitates revision surgery. Diagnostic accuracy of triphasic bone scintigraphy, a common imaging modality for aseptic loosening detection, remains controversial. This study investigated the diagnostic accuracy of bone scintigraphy when separately evaluated by a nuclear physicist and an orthopedic surgeon, and the interrater reliability between the two. MethodsPatients undergoing knee revision surgery due to suspected aseptic loosening at three medical centers from 2006-2023 were included. Relevant demographic, clinical, and procedural data were extracted from the records. The bone scintigraphy results as noted by the nuclear physicist and orthopedic surgeon were used as index test and intraoperative findings of loosening were used as reference tests. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated, and kappa’s agreement was assessed. ResultsOut of 611 revision TKAs, 59 cases were analyzed. The nuclear physicist’s evaluation of bone scintigraphy had a sensitivity of 73%, specificity of 0%, positive predictive value of 93%, negative predictive value of 0%, and diagnostic accuracy of 69%. The orthopedic surgeon's evaluation showed higher sensitivity, specificity, positive and negative predictive values, and an accuracy of 84%. Agreement levels were moderate (kappa = 0.46) between the nuclear physicist’s and orthopedic surgeons evaluation. InterpretationThe diagnostic accuracy of bone scintigraphy for aseptic loosening is 84% when evaluated by the orthopedic surgeon compared to 69% for the nuclear physicist’s evaluation. Kappa’s agreement between the two was moderate.

Diagnostic Accuracy of Bone Scintigraphy for the Histopathological Diagnosis of Cardiac Transthyretin Amyloidosis-A Retrospective Austrian Multicenter Study.

We aimed to ascertain the real-world diagnostic accuracy of bone scintigraphy in combination with free light chain (FLC) assessment for transthyretin (ATTR) cardiac amyloidosis (CA) using the histopathological diagnosis derived from endomyocardial biopsy (EMB) as a reference standard. We retrospectively analyzed 102 patients (22% women) with suspected CA from seven Austrian amyloidosis referral centers. The inclusion criteria comprised the available results of bone scintigraphy, FLC assessment, and EMB with histopathological analysis. ATTR and AL were diagnosed in 60 and 21 patients (59%, 21%), respectively, and concomitant AL and ATTR was identified in one patient. The specificity and positive predictive value (PPV) of Perugini score ≥ 2 for ATTR CA were 95% and 96%. AL was diagnosed in three out of 31 patients (10%) who had evidence of monoclonal proteins and a Perugini score ≥ 2. When excluding all patients with detectable monoclonal proteins (n = 62) from analyses, the PPV of Perugini score ≥ 2 for ATTR CA was 100% and the NPV of Perugini score < 2 for ATTR CA was 79%. Conclusively, ATTR CA can be diagnosed non-invasively in the case of a Perugini score ≥ 2 and an unremarkable FLC assessment. However, tissue biopsy is mandatory in suspected CA in any other constellation of non-invasive diagnostic work-up.

Diagnostic value of quantitative SPECT/CT in assessing active sacroiliitis in patients with axial spondylarthritis and/or inflammatory low back pain.

The diagnostic accuracy of bone scintigraphy (BS) increases with SPECT/CT imaging. It would therefore be appropriate to reassess the diagnostic utility of scintigraphy in sacroiliitis with axial spondyloarthritis (SpA). The aim of this study was to compare the diagnostic performance of MRI, SPECT/CT and a combination of both techniques in sacro-iliitis, and to evaluate the correlation between quantitative SPECT/CT indices and quantitative MRI inflammatory lesion scores. Thirty-one patients with active SpA and 22 patients with inflammatory low back pain underwent MRI and SPECT/CT of the sacroiliac joints. The diagnostic accuracy of both techniques was calculated using clinical diagnosis as the gold standard. The correlation between MRI and SPECT/CT was calculated by comparing the SPECT/CT activity indices and the Berlin/SPARCC scoring systems for MRI. The sensitivity and specificity values in quantitative SPECT/CT, taking the sacroiliac/promontory ratio of >1.36 as the cut-off value, were close to those from MRI published in the literature. The combination of both techniques increased sensitivity while maintaining high specificity. There was a moderate correlation between SPECT/CT and MRI total scores. This correlation was improved by using solely the MRI inflammation scores. Quantitative SPECT/CT showed better diagnostic accuracy than planar scintigraphy and showed a moderate correlation with MRI scores in active sacroiliitis. The combination of both tests increased the diagnostic accuracy. Quanti-tative SPECT/CT could play a relevant role in the diagnosis of active sacroiliitis in patients with high a suspicion of SpA and a negative/inconclusive MRI test or in patients with whom MRI studies cannot be carried out.

Can the Diagnostic Accuracy of Bone Scintigraphy Be Maintained with Half the Scanning Time?

We aimed to show that the acquisition time of a conventional bone scan could be reduced by half without losing the diagnostic value of the scan. Methods: Fifty adult patients (37 male and 13 female; mean age, 62.5 y; SD, 8.7 y) were enrolled. The patients were injected with 925-1,110 MBq (25-30 mCi) of 99mTc-methylene diphosphonate intravenously. The standard-protocol whole-body planar images were acquired first (scan speed, 10 cm/min; acquisition time, ∼20 min) and were followed immediately by the half-time protocol whole-body planar images (scan speed, 20 cm/min; acquisition time, ∼10 min). Both sets of images were interpreted by 2 nuclear medicine physicians. Each reviewer, when reviewing the standard-protocol images, was self-masked to the result he or she had obtained when reviewing the half-time images, and vice versa. This self-masking was accomplished by allowing a minimum of 2 wk to elapse between the 2 interpretations. We used the κ-coefficient to compare agreement between the standard-protocol results and the half-time results. Results: There was no difference in clinically significant diagnostic information between the half-time and standard protocols. The diagnostic quality of half-time and standard-protocol images did not significantly differ (0.86 < κ < 1.0). Conclusion: Our data suggest that if we reduce the 99mTc-methylene diphosphonate dose by half and keep the acquisition time at its standard value, we gain the benefit of reduced dose without loss of diagnostic value.

Bone Scintigraphy in the Examining of Treatment-Naive Pediatric Patients With Langerhans Cell Histiocytosis

Introduction: Histiocytosis is a heterogeneous group of rare diseases of unknown etiology. LCH is characterized by an abnormal proliferation of histiocytes (activated dendric cells and macrophages). Langerhans cell histiocytosis (LCH) is the most common form of histiocytosis, it is a potentially fatal diseases. Early detection of LCH plays an important role in its prognosis and outcome. However, the role of advanced methods of nuclear medicine in diagnosis of LCH is still to be researched. We have long-term experience in observing pediatric patients with LCH. Taking into the account the difficulty of diagnostic task for bone scintigraphy in identifying lytic bone destruction, we stated the following objective of the study.Purpose: Retrospective and prospective analysis of bone scintigraphy examinations of treatment-naive pediatric patients with LCH and calculate the diagnostic efficacy of bone scintigraphy. Material and methods: We analyzed 60 examinations of treatment-naive pediatric patients with proven case of LCH (2014-2019). The scanning was performed using whole body mode, 3 hours after intravenous injection of bone-seeking radiopharmaceutical 99mTc-MDP on Symbia E, T2 (Siemens, Germany). The median age was 5.6 years.Results: During examination we visualized 88 lesions with pathological level of accumulation of radiopharmaceutical in 60 patients. 84 with high level of accumulation (&gt;120 %); 3 with slightly increased level of accumulation (100–120 %) and 1 with lower than normal level of accumulation (&lt;100 %). The median level of accumulation of radiopharmaceutical was 268 %. Max level of accumulation was 1422 % (patient with subtotal involvement of femoral bone). Min — 60 % (patient with lytic destruction in orbital bone). During X-Ray we found out 97 pathological focuses of bone lytic destruction. In 3 patients with polyostotic form we found extra focuses on scintigraphy, which were confirmed with following examination and X-Ray. 8 lesions were not found on scintigraphy in 8 patients.Сonclusions: We evaluated diagnostic accuracy of bone scintigraphy with 99mTc-MDP in treatment-naïve pediatric patients with proven case of LCH. Sensitivity, specificity, NPV and PPV — 91.6, 50.0, 11.1, 98.6 %, respectively.

Low Sensitivity of Bone Scintigraphy in Detecting Phe64Leu Mutation-Related Transthyretin Cardiac Amyloidosis

ObjectivesThe aim of this study was to assess the diagnostic accuracy of bone scintigraphy in a large multicenter cohort of patients with cardiac amyloidotic involvement and Phe64Leu transthyretin (TTR) mutation. BackgroundDiagnostic accuracy of bone scintigraphy for transthyretin-related cardiac amyloidosis (TTR-CA) is considered extremely high, enabling this technique to be the noninvasive diagnostic standard for TTR-CA. Nevertheless, this approach has not been systematically validated across the entire spectrum of TTR mutations. MethodsA total of 55 patients with Phe64Leu TTR mutation were retrospectively analyzed and evaluated between 1993 and 2018 at 7 specialized Italian tertiary centers. Cardiac involvement was defined as presence of an end-diastolic interventricular septum thickness ≥12 mm, without other possible causes of left ventricular hypertrophy (i.e., arterial hypertension or valvulopathies). A technetium-99m (99mTc)–diphosphonate (DPD) or 99mTc–hydroxyl-methylene-diphosphonate (HMDP) bone scintigraphy was reviewed, and visual scoring was evaluated according to Perugini’s method. ResultsAmong 26 patients with definite cardiac involvement, 19 underwent 99mTc-DPD or 99mTc-HMDP bone scintigraphy. Of them, 17 (89.5%) patients had low or absent myocardial bone tracer uptake, whereas only 2 (10.5%) showed high-grade myocardial uptake. The sensitivity and the accuracy of bone scintigraphy in detecting TTR-CA were 10.5% and 37%, respectively. Patients with cardiac involvement and low or absent bone tracer uptake were similar to those with high-grade myocardial uptake in terms of age, sex, and electrocardiographic and echocardiographic findings. ConclusionsThe sensitivity of bone scintigraphy (DPD and HMDP) in detecting TTR-CA is extremely low in patients with Phe64Leu TTR mutation, suggesting the need to assess diagnostic accuracy of bone scintigraphy to identify cardiac involvement across a wider spectrum of TTR mutations.

Diagnostic accuracy of bone scintigraphy in the assessment of cardiac transthyretin-related amyloidosis: a bivariate meta-analysis.

Cardiac transthyretin-related amyloidosis (ATTR) is a progressive and fatal cardiomyopathy. The diagnosis of this disease is frequently delayed or missed due to the limited specificity of echocardiography. An increasing amount of data in the literature demonstrate the ability of bone scintigraphy with bone-seeking radiopharmaceuticals to detect myocardial amyloid deposits, in particular in patients with ATTR. Therefore we performed a systematic review and bivariate meta-analysis of the diagnostic accuracy of bone scintigraphy in patients with suspected cardiac ATTR. A comprehensive computer literature search of studies published up to 30 November 2017 on the role of bone scintigraphy in patients with ATTR was performed using the following search algorithm: (a) "amyloid" OR "amyloidosis" AND (b) "TTR" OR "ATTR" OR "transthyretin" AND (c) "scintigraphy" OR "scan" OR "SPECT" OR "SPET" OR "bone" OR "skeletal" OR "skeleton" OR "PYP" OR "DPD" OR "HMDP" OR "MDP" OR "HDP". Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR) of bone scintigraphy were calculated. The meta-analysis of six selected studies on bone scintigraphy in cardiac ATTR including 529 patients provided the following results: sensitivity 92.2% (95% CI 89-95%), specificity 95.4% (95% CI 77-99%), LR+ 7.02 (95% CI 3.42-14.4), LR- 0.09 (95% CI 0.06-0.14), and DOR 81.6 (95% CI 44-153). Mild heterogeneity was found among the selected studies. Our evidence-based data demonstrate that bone scintigraphy using technetium-labelled radiotracers provides very high diagnostic accuracy in the non-invasive assessment of cardiac ATTR.

Diagnostic Value of Technetium-99m Bone Scintigraphy in the Detection of Cervical Spine Metastases in Oncological Patients.

A retrospective cohort, radiographic study. To assess the diagnostic accuracy of bone scintigraphy (BS) for the detection of cervical spine metastases in oncological patients. BS remains the modality of choice for the screening of bone metastases, because of its feasibility in whole-body scanning and its widespread availability at low cost. Current practice guidelines for patients with malignant diseases recommend BS imaging as the primary screening method for detecting both axial and appendicular skeletal metastases. Of 481 patients, 242 were diagnosed with cervical spinal metastases from a primary cancer. The BS findings of these patients, evaluated by nuclear medicine physicians, were assessed with respect to their usefulness for detecting cervical spine metastases. Magnetic resonance imaging findings, evaluated by radiologists, were used as the reference standards. The diagnostic value of BS was compared between subgroups according to the order in which the diagnostic procedures (magnetic resonance imaging and BS) were completed, the presence of pathological fractures, the location of the primary malignancy, and the number of cervical metastases. The sensitivity of BS in the detection of cervical spine metastases was 59.1%, with a 40.9% rate of false-negative diagnoses; the specificity was 94.6%, with a 5.4% rate of false-positive diagnoses. The sensitivity tended to be higher in the presence of pathological fractures (72.1% in cases with a fracture vs. 3% in cases without a fracture) and a greater number of lesions (r = 0.921). Neither the order in which the diagnostic examinations were performed nor the location of the primary cancer, except for those in the stomach and liver, appeared to affect the diagnostic accuracy of BS. Considering the moderately high false-negative diagnostic rate obtained in the present study, BS alone cannot accurately diagnose metastases in the cervical spine in oncological patients. 3.