Planar Bone Scan Research Articles

Utility of Tc-99m MDP bone SPECT in evaluation of osseous involvement in craniofacial malignancies

PurposeTo assess the role of technetium-99m methoxy diphosphonate (Tc-99m MDP) single photon emission tomography (SPECT) imaging for the detection of osseous invasion in craniofacial malignancies. Material and methodsThe study was performed in 45 subjects using Tc-99m MDP (740 MBq). Out of 45 subjects, 30 were patients had different craniofacial malignancies, and 15 subjects who did not have any malignancy served as controls. Planar imaging was performed. Anterior, lateral and oblique lateral views of the skull were obtained. SPECT imaging was done taking 64 views of the skull in a 360 ° circular path, each 40 s with 128 × 128 matrices. Scans were visually interpreted using a score of 0, 1, and 2, representing a lesion as definitely absent, doubtful, and definitely present, respectively. Planar scans were compared with the SPECT images. ResultsBone SPECT detected more lesions as compared to planar bone scan and plain radiographs. SPECT was found to be superior to planar imaging and radiographs in the detection and efficient demonstration of the extent of osseous invasion of craniofacial cancer. Sensitivity was 100% for SPECT and 83.33% for planar bone scan. ConclusionSPECT imaging of the skull is a very beneficial complementary form of investigation in patients with craniofacial malignancies for the assessment of osseous invasion, particularly in tumors likely to invade the skull base.

Valeur ajoutée d’une acquisition TEMP/TDM centrée sur le bassin complétant une scintigraphie osseuse dans un cas de sacroiliite à pyogène

Pyogenic sacroiliitis is a rare entity, which occurs most often in children and young adults. The diversity of clinical presentation makes the diagnosis difficult and delays the prescription of appropriate treatment. The psoas muscle abscess is a rare complication of infectious sacroiliitis. Herein, we report the case of a 47-years-old patient, complaining of low back pain with psoitis and fever, lasting for 12 days. Planar bone scan and SPECT/CT acquisitions were totally contributive by the visualization of the sacroiliac joint damage and a psoas abscess missed on the initial CT. The bacteriological proof has been provided by the direct examination and culture of the drainage abscess fluid.

Current Evidence Regarding Diagnostic Imaging Methods for Pediatric Lumbar Spondylolysis: A Report From the Scoliosis Research Society Evidence-Based Medicine Committee

BackgroundSpondylolysis is common among the pediatric population, yet no formal systematic literature review regarding diagnostic imaging has been performed. The Scoliosis Research Society (SRS) requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis. MethodsLiterature was searched professionally and citations retrieved. Abstracts were reviewed and analyzed by the SRS Evidence-Based Medicine Committee. Level I studies were considered to provide Good Evidence for the clinical question. Level II or III studies were considered Fair Evidence. Level IV studies were considered Poor Evidence. From 947 abstracts, 383 full texts reviewed. Best available evidence for the questions of diagnostic methods was provided by 27 studies: no Level I sensitivity/specificity studies, five Level II and two Level III evidence, and 19 Level IV evidence. ResultsPain with hyperextension in athletes is the most widely reported finding in history and physical examination. Plain radiography is considered a first-line diagnostic test for suspected spondylolysis, but validation evidence is lacking. There is consistent Level II and III evidence that pars defects are detected by advanced imaging in 32% to 44% of adolescents with spondylolysis based on history and physical. Level III evidence that single-photon emission computed tomography (SPECT) is superior to planar bone scan and plain radiographs but limited by high rates of false-positive and false-negative results and by high radiation dose. Computed tomography (CT) is considered the gold standard and most accurate modality for detecting the bony defect and assessment of osseous healing but exposes the pediatric patient to ionizing radiation. Magnetic resonance imaging (MRI) is reported to be as accurate as CT and useful in detecting early stress reactions of the pars without a fracture. ConclusionPlain radiographs are widely used as screening tools for pediatric spondylolysis. CT scan is considered the gold standard but exposes the patient to a significant amount of ionizing radiation. Evidence is fair and promising that MRI is comparable to CT.

Whole-Body SPECT/CT versus Planar Bone Scan with Targeted SPECT/CT for Metastatic Workup.

Purpose The use of SPECT/CT in bone scans has been widespread in recent years, but there are no specific guidelines concerning the optimal acquisition protocol. Two strategies have been proposed: targeted SPECT/CT for equivocal lesions detected on planar images or systematic whole-body SPECT/CT. Our aim was to compare the diagnostic accuracy of the two approaches. Methods 212 consecutive patients with a history of cancer were referred for bone scans to detect bone metastases. Two experienced readers randomly evaluated for each patient either planar images with one-field SPECT/CT targeted on equivocal focal uptakes (targeted SPECT/CT) or a whole-body (two-field) SPECT/CT acquisition from the base of the skull to the proximal femurs (whole-body SPECT/CT). The exams were categorized as “nonmetastatic,” “equivocal,” or “metastatic” on both protocols. The presence or absence of any extra-axial skeletal lesions was also assessed. The sensitivity and specificity of both strategies were measured using the results of subsequent imaging follow-up as the reference standard. Results Whole-body SPECT/CT had a significantly higher sensitivity than targeted SPECT/CT to detect bone metastases (p = 0.0297) and to detect extra-axial metastases (p = 0.0266). There was no significant difference in specificity among the two approaches. Conclusion Whole-body SPECT/CT is the optimal modality of choice for metastatic workup, including detection of extra-axial lesions, with improved sensitivity and similar specificity compared to targeted SPECT/CT.

Effective Dose and Effective Risk from Post–Single Photon Emission Computed Tomography Imaging of the Lumbar Spine

PurposePlanar bone scans play an important role in the staging and monitoring of malignancy and metastases. Metastases in the lumbar spine are associated with significant morbidity; therefore, accurate diagnosis is essential. Supplementary imaging after planar bone scans is often required to characterize lesions; however, this is associated with additional radiation dose. This article provides information on the comparative effective dose and effective risk from supplementary lumbar spine radiographs, low-dose computed tomography (LDCT), and diagnostic CT (DCT). MethodOrgan dose was measured in a phantom using thermoluminescent dosimeters. Effective dose and effective risk were calculated for radiographs, LDCT, and DCT imaging of the lumbar spine. ResultsRadiation dose was 0.56 mSv for the anteroposterior and lateral lumbar spine radiographs, 0.80 mSv for LDCT, and 3.78 mSv for DCT. Additional imaging resulted in an increase in effective dose of 12.28%, 17.54%, and 82.89% for radiographs, LDCT, and DCT, respectively. Risk of cancer induction decreased as age increased. The difference in risk between the modalities also decreased. Males had a statistically significant higher risk than female patients (P = .023), attributed to the sensitive organs being closer to the exposed area. ConclusionsEffective dose for LDCT is comparable with radiographs of the lumbar spine. With the known benefits of image fusion, it is recommended that LDCT replace radiograph imaging for characterization of lumbar spine lesions identified on planar bone scans. DCT is associated with significantly higher effective dose than LDCT. Effective risk is also higher, and the difference is more marked in younger female patients.

Imaging Bone Metastases in Breast Cancer: Staging and Response Assessment.

Bone metastases are common in patients with advanced breast cancer. Given the significant associated morbidity, the introduction of new, effective systemic therapies, and the improvement in survival time, early detection and response assessment of skeletal metastases have become even more important. Although planar bone scanning has recognized limitations, in particular, poor specificity in staging and response assessment, it continues to be the main method in current clinical practice for staging of the skeleton in patients at risk of bone metastases. However, the accuracy of bone scanning can be improved with the addition of SPECT/CT. There have been reported improvements in sensitivity and specificity for staging of the skeleton with either bone-specific PET/CT tracers, such as (18)F-NaF, or tumor-specific tracers, such as (18)F-FDG, although these methods are less widely available and more costly. There is a paucity of data on the use of (18)F-NaF PET/CT for response assessment in breast cancer, but there is increasing evidence that (18)F-FDG PET/CT may improve on current methods in this regard. At the same time, interest and experience in using whole-body morphologic MRI augmented with diffusion-weighted imaging for both staging and response assessment in the skeleton have been increasing. However, data on comparisons of these methods with PET methods to determine the best technique for current clinical practice or for clinical trials are insufficient. There are early data supporting the use (18)F-FDG PET/MRI to assess malignant disease in the skeleton, with the possibility of taking advantage of the synergies offered by combining morphologic, physiologic, and metabolic imaging.

99mTc-MIBI Scintigraphy to differentiate malignancies from benign lesions detected on Planar bone scans

The aim of study was to evaluate the effectiveness of 99mTc-MIBI (hexakis 2-methoxyisobutyl isonitrile) scintigraphy to differentiate malignant from benign lesions, detected on 99mTc-MDP planar bone scans. 59 patients with bony lesions were studied prospectively and compared with histopathology. Each patient underwent a 99mTc-MDP scan, and if evidence of lesion found, patient underwent 99mTc-MIBI scintigraphy after three to four days. 99mTc-MIBI scans were evaluated visually and quantitatively. For quantitative analysis count ratio of lesion to contralateral normal side (L/C) was taken and Student T test was applied.99mTc-MDP scans showed increase tracer uptake but no significant difference between benign and malignant uptake was seen. Significant difference (p value 0.015), was seen in malignant (L/C 3.51±1.02) and benign lesions (L/C 2.50±0.42) on 99mTc-MIBI scan. Three of thirty benign lesions did not show significant 99mTc-MIBI uptake. Six malignant lesions appeared as false negatives. Specificity of 99mTc-MIBI was 86.66%, Negative Predictive Value (NPV) 81.25% whereas the sensitivity was 79.31%.99mTc-MIBI scintigraphy provides its usefulness by distinguishing malignant from benign lesions along with correct identification of metastatic lesions. NPV points toward its ability to correctly diagnose the normal (benign) cases. However biopsy still remains the gold standard and a definitive diagnostic modality.

Osteosarcoma Pulmonary Metastasis Mimicking Abnormal Skeletal Uptake in Bone Scan

We present a case of a 15-year-old boy with osteoblastic osteosarcoma of the left distal femur. The patient was referred to bone scan for initial staging. On planar bone scan, there is increased uptake of 99mTc-MDP (99mTc-methylene diphosphonate) in the left distal femur. There are also multiple sites of abnormal tracer uptake projecting to the thoracic cage, initially assumed to be localized in the ribs. SPECT/CT correctly identified them as pulmonary metastases. This case illustrates the potential advantages and utility of SPECT/CT imaging of skeletal bone scan in order to decide on the optimal treatment.

Dual-isotope SPECT/CT impact on hospitalized patients with suspected diabetic foot infection

Foot ulcer with suspected infection is one of the most common reasons for hospitalization and a major factor contributing to morbidity and high healthcare-related expenses among diabetic patients. Many patients will require amputation; however, major amputation is associated with an alarmingly high 5-year mortality rate. In this study, we assess the diagnosis and management of suspected foot infection in diabetic patients using dual-isotope (DI) single-photon emission computed tomography/computed tomography (SPECT/CT) compared with conventional imaging. The diagnostic accuracy in and management of 227 patients who had undergone DI SPECT/CT was compared with that of 232 similar patients who had undergone conventional imaging including plain radiography, CT, planar bone scanning, planar indium-111 white blood cell scanning, and MRI. The duration of hospitalization was additionally compared between these two groups of patients after excluding patients with other active comorbidities. Soft-tissue infection, osteomyelitis with or without soft-tissue infection, and other bony pathologies were more accurately and confidently identified with DI SPECT/CT than with conventional imaging. DI SPECT/CT use was associated with significantly fewer major amputations and more selective bony resection as well as with shorter duration of hospitalization when compared with conventional imaging. In this large population of diabetic patients with suspected foot infection DI SPECT/CT was more accurate in diagnosing and localizing infection compared with conventional imaging. In addition, DI SPECT/CT provided clear guidance and promoted many limb salvage procedures. Of equal importance to health economics, DI SPECT/CT use was associated with considerably reduced length of hospitalization compared with conventional imaging.

Comparison of 18F Fluoride PET/CT and 99mTc-MDP Bone Scan in the Detection of Skeletal Metastases in Urinary Bladder Carcinoma

The aim of this study was to compare (18)F-fluoride PET/CT and (99m)Tc-MDP bone scintigraphy in the detection of skeletal metastases in urinary bladder carcinoma. In this prospective study, 48 patients with urinary bladder carcinoma (44 male and 4 female patients, aged 35-80 years) underwent (99m)Tc-MDP planar and SPECT/CT bone scan (BS) followed by (18)F-fluoride PET/CT within 48 hours. Skeletal metastasis diagnosed on each of these techniques was compared against a final diagnosis based on contrast-enhanced CT, MRI, skeletal survey, clinical follow-up, and histological correlation. (18)F-fluoride PET/CT identified bony metastases and changed the management in 17 of 48 patients (35%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of (99m)Tc-MDP planar BS were 82.35%, 64.51%, 56%, 86.95%, and 70.83%; of (99m)Tc-MDP SPECT/CT were 88.23%, 74.19%, 65.21%, 92%, and 79.16%; and of (18)F-fluoride PET/CT were 100%, 87.09%, 80.95%, 100%, and 91.66%, respectively. Fair agreement between (99m)Tc-MDP planar BS and F-fluoride PET/CT (κ = 0.42) and excellent agreement between SPECT/CT and (18)F-fluoride PET/CT (κ = 0.74) were found. ( 18)F-fluoride PET/CT has higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in detecting bone metastases in urinary bladder carcinoma than conventional (99m)Tc-MDP planar BS. SPECT/CT improves all these parameters compared with planar BS and may serve as a cost-effective screening procedure for the detection of skeletal metastases in high-risk patients.

Évaluation d’une méthode de quantification de la masse métastatique osseuse par mesure automatisée du Bone Scan Index, dans le suivi thérapeutique des cancers du sein

IntroductionThe objective assessment of therapeutic response is a major diagnostic and therapeutic management in breast cancer with bone metastases. The objective of the study was to test performance of an automated method for quantifying the extent of skeletal tumour involvement in breast cancer, using the Bone Scan Index (BSI), and study if BSI could be considered as an imaging biomarker of metastatic bone disease. Materials and methodsOne hundred and two planar bone scans, corresponding to 34 treatment (three successive bone scans) of 31 patients were retrospectively analyzed. Each image was reviewed by two nuclear physicians, a senior and a junior. Exini Bone® software calculated automatically the BSI for each scan. ResultsAt 3 times of the study, agreements between automatic and visual methods were intermediate: 55.88% (kappa=0.3704), 52.94% (kappa=0.3052) and 52.94% (kappa=0.2173) with junior nuclear physician and 52.94% (kappa=0.33), 55.88% (kappa=0.3333) and 50% (kappa=0.1939) with senior nuclear physician. Six initial bone scans (17%) were considered normal (BSI=0) by the software; with bone lesions confirmed by morphological imaging and/or histology. Agreements between junior and senior were high, with kappa=0.81, 0.91 and 0.94 at 3 times of the study. Confrontation with routine analysis showed significant variability with agreements from 47.06 to 76.47%. We did not find any significant relationship between evolution of BSI and tumor markers over time. Only a trend between evolution of CA15-3 and BSI was observed. We did not find any significant association between overall survival and value of BSI. ConclusionIn breast cancer, the fully automated platform of quantifying the BSI seems to have limitations, because of characteristics of bone metastases of breast cancer, and their scintigraphic translation. BSI seems to be an interesting tool, and it could be improved: development of diagnostic “assisted” by computer, combining power of medical knowledge and technical computing could help to score bone disease, and allow standardized monitoring.

Incremental value of SPECT/CT over planar bone scan in the evaluation of skull base osteomyelitis: A potentially fatal disease in diabetics

Incremental value of SPECT/CT over planar bone scan in the evaluation of skull base osteomyelitis: A potentially fatal disease in diabetics

18F-FDG PET/CT in Staging Patients with Locally Advanced or Inflammatory Breast Cancer: Comparison to Conventional Staging

The prognosis of patients with locally advanced breast cancer (LABC) remains poor. We prospectively investigated the impact of (18)F-FDG PET/CT at initial staging in this clinical setting and compared PET/CT performance with that of conventional distant work-up. During 60 mo, consecutive patients with LABC (clinical T4 or N2-N3 disease) underwent (18)F-FDG PET/CT. The yield was assessed in the whole group and separately for noninflammatory and inflammatory cancer. The performance of PET/CT was compared with that of a conventional staging approach including bone scanning, chest radiography, or dedicated CT and abdominopelvic sonography or contrast-enhanced CT. 117 patients with inflammatory (n = 35) or noninflammatory (n = 82) LABC were included. (18)F-FDG PET/CT confirmed N3 nodal involvement in stage IIIC patients and revealed unsuspected N3 nodes (infraclavicular, supraclavicular, or internal mammary) in 32 additional patients. Distant metastases were visualized on PET/CT in 43 patients (46% of patients with inflammatory carcinoma and 33% of those with noninflammatory LABC). Overall, (18)F-FDG PET/CT changed the clinical stage in 61 patients (52%). Unguided conventional imaging detected metastases in only 28 of the 43 patients classified M1 with PET/CT (65%). (18)F-FDG PET/CT outperformed conventional imaging for bone metastases, distant lymph nodes, and liver metastases, whereas CT was more sensitive for lung metastases. The accuracy in diagnosing bone lesions was 89.7% for planar bone scanning versus 98.3% for (18)F-FDG PET/CT. The accuracy in diagnosing lung metastases was 98.3% for dedicated CT versus 97.4% for (18)F-FDG PET/CT. (18)F-FDG PET/CT had the advantage of allowing chest, abdomen and bone to be examined in a single session. Almost all distant lesions detected by conventional imaging were depicted with PET/CT, which also showed additional lesions.

Resolution recovery in planar bone scans

Recovery of spatial resolution lost through increasing lesion-to-detector distance can improve the spatial resolution of planar images. We compare two commercial solutions, HiScan (http://www.scivis.de) and Xact.bone (http://www.ultraspect.com), with unprocessed planar whole-body bone scans. Thirty-five patients with suspected bone metastases were scanned 3 h after injection of 600 MBq (99m)Tc-HMDP at 12 cm/min. Two patients with more than 20 lesions were used for reporter training and were excluded from the analysis. Two blinded reporters categorized each scan as benign, indeterminate or malignant and assigned individual lesions to those same categories. Image quality was first graded on a 1 (worst) to 10 (best) scale for each individual scan, and then all three scans of each patient were ranked according to image quality. Reporter A detected 65, 90 and 83 malignant lesions with the unprocessed scan, HiScan and Xact.bone and 23, 24 and 17 indeterminate lesions, respectively. Reporter B detected 60, 80 and 75 malignant lesions with the unprocessed scan, HiScan and Xact.bone and 17, 16 and 14 indeterminate lesions, respectively. To summarize, reporters A/B detected 38/33% and 28/25% more malignant lesions with HiScan and Xact.bone than with the unprocessed scan, respectively (Friedman's test, P<0.05). The number of indeterminate lesions did not increase, but the percentage of unclear lesions decreased. Mean image quality for the unprocessed scan, HiScan and Xact.bone was 6.5, 9.1 and 7.9 for reporter A and 5.6, 7.5 and 6.7 for reporter B, respectively (P<0.0001). HiScan was ranked best for image quality in 82% of patients and Xact.bone in 18%. Resolution recovery in planar whole-body bone scans significantly increases the absolute number of detectable malignant lesions, decreases the percentage of indeterminate lesions, significantly increases image quality and is an easy-to-implement addition to routine clinical practice.

Diagnostic and therapeutic impact of SPECT/CT in patients with unspecific pain of the hand and wrist

BackgroundUnspecific pain of the hand/wrist is a diagnostic challenge. Radiographs and planar bone scan are useful diagnostic tools in patients with unspecific wrist pain. Both modalities are deficient, either by not presenting metabolic disorders or due to inadequate anatomical resolution. Single photon emission computed tomography/computed tomography (SPECT/CT) claims to fuse both features.MethodsFifty-one patients with persisting wrist pain were referred for evaluation by SPECT/CT. All patients received X-ray and early-phase/late-phase SPECT/CT imaging. SPECT/CT results were compared with X-ray alone and X-ray combined with planar bone scan. The therapeutic impact was evaluated in consensus with the referring hand surgeon.ResultsA total of 48 lesions were detected on plain radiographs, 117 on planar bone scan, and 142 on SPECT/CT. SPECT/CT detected significantly more lesions than the other imaging modalities. In 30 out of 51 patients (61%), a positive concordance between the clinical diagnosis and SPECT/CT findings was found. In 19 out of 51 patients (37%), SPECT/CT findings had significant impact on consecutive therapy.ConclusionsSPECT/CT showed higher lesion detection rates compared to standard X-rays and planar bone scan. Significant impact on patient management could be demonstrated. SPECT/CT might be added to the workup of such a specific patient population when standard imaging fails to detect the patient's main pathology.

A Prospective Study Comparing Whole-Body FDG PET/CT to Combined Planar Bone Scan With 67Ga SPECT/CT in the Diagnosis of Spondylodiskitis

This study aimed to prospectively evaluate the usefulness of PET/CT using F-FDG in comparison to bone scan and Ga in the diagnosis of spondylodiskitis. This prospective study included 34 patients (15 women and 19 men) aged 59 (18) years with clinical symptoms of spondylodiskitis. Whole-body PET/CT and bone scan combined with planar and SPECT/CT Ga was performed in all patients. Diagnosis of spondylodiskitis was made by microbiology and/or on the basis of clinical and laboratory findings and imaging follow-up. Spondylodiskitis was confirmed in 18 of 34 patients. In the other 16 patients, spondylodiskitis was finally excluded, and the most frequent findings observed were degenerative spondyloarthropathy (n = 7), vertebral fracture (n = 3), endocarditis (n = 2), and other processes (n = 4). The sensitivity and specificity of combined bone scan and Ga were 78% and 81%, with a positive predictive value of 82%, a negative predictive value of 76%, and an overall accuracy of 79%. SPECT/CT with Ga helped identify soft tissue involvement in 10 of 18 patients. The sensitivity and specificity of PET/CT were 89% and 88%, with a positive predictive value of 89%, a negative predictive value of 87%, and an overall accuracy of 88%. Concordance between Ga and PET/CT was good (κ = 0.71; 95% confidence interval, 0.48-0.94). PET/CT was able to detect soft tissue involvement in 12 of 18 patients. In 2 patients, a multifocality was found, which was only diagnosed by PET/CT. PET/CT is useful in the diagnosis of spondylodiskitis, with more accurate results than combined bone scan and Ga. SPECT/CT with Ga is recommended, especially when planar bone scan and Ga pattern is suggestive of spondylodiskitis.

Earlier Detection of Bone Metastases From Pleomorphic Liposarcoma in a Pediatric Patient by FDG PET/CT Than Planar 99mTc MDP Bone Scan

Bone scintigraphy using (99m)TC MDP (technetium-99m methylene diphosphonate) is a routine procedure for evaluation of osteoblastic metastases; however, its sensitivity compared with FDG PET/CT in a variety of malignancies remains to be established. We report a case of multiple osseous metastases revealed by FDG PET/CT in an 8-year-old girl with pleomorphic liposarcoma. Many of these osseous lesions were not visualized on the MDP planar bone scintigraphy performed 24 hours after PET/CT scan, becoming evident only on repeat bone scan performed 3 months later. The case suggests that FDG PET/CT has higher sensitivity in detecting osteoblastic metastases in pleomorphic liposarcoma.

Bilan scintigraphique osseux d’une hypercondylie unilatérale

A 10-year-old girl with unilateral condylar hyperplasia was referred to our department for a bone scan. We describe the role of the bone scan in this condition. Unilateral condylar hyperplasia is a rare disease of the mandibular condyle cartilage growth leading to facial deformity. Bone scan demonstrates the active or inactive nature of condylar hyperplasia and orients therapy. A planar bone scan completed by single-photon emission computed tomography (SPECT) combined with CT was performed. Increased uptake of the left mandibular condyle, particularly well demonstrated on SPECT images, was seen. This was confirmed by relative quantification and helped decision making to surgical treatment.

Combined 18F‐fluorocholine and 18F‐fluoride positron emission tomography/computed tomography imaging for staging of high‐risk prostate cancer

To investigate how often positron emission tomography/computed tomography (PET/CT) scans, with both (18)F-fluorocholine and (18)F-fluoride as markers, add clinically relevant information for patients with prostate cancer who have high-risk tumours and a normal or inconclusive planar bone scan. Patients with prostate cancer with prostate specific antigen (PSA) levels between 20 and 99 ng/mL and/or Gleason score 8-10 tumours, planned for treatment with curative intent based on routine staging with a negative or inconclusive bone scan, were further investigated with a (18)F-fluorocholine and a (18)F-fluoride PET/CT. None of the patients received hormonal therapy before the staging procedures were completed. For 50 of the 90 included patients (56%) one or both PET/CT scans indicated metastases. (18)F-fluorocholine PET/CT indicated lymph node metastases and/or bone metastases in 35 patients (39%). (18)F-fluoride PET/CT was suggestive for bone metastases in 37 patients (41%). In 18 patients (20%) the PET/CT scans indicated widespread metastases, leading to a change in therapy intent from curative to non-curative. Of the patients with positive scans, 74% had Gleason score 8-10 tumours. Of the patients with Gleason score 8-10 tumours, 64% had positive scans. PET/CT scans with (18)F-fluorocholine and (18)F-fluoride commonly detect metastases in patients with high-risk prostate cancer and a negative or inconclusive bone scan. For 20% of the patients the results of the PET/CT scans changed the treatment plan.

The Incremental Value of SPECT/CT in Characterizing Solitary Spine Lesions

The purpose of this study was to investigate the incremental value and diagnostic impact of SPECT/CT in patients who had a solitary spinal lesion on a bone scan. A prospective study was performed on 80 patients (50 with known cancer) who underwent (99m)Tc-methylene diphosphonate whole-body planar bone scintigraphy and had a solitary spinal lesion. These lesions were then further evaluated using SPECT/CT. Lesions were localized to the vertebral body in 38 patients (47.5%), pedicle in 15 (18.8%), facet joint in 15 (18.8%), transverse process in 2 (2.5%), spinous process in 2 (2.5%), lamina in 3 (3.8%), and end plates in 5 (6.2%). Although the specificity of planar bone scans was excellent (100%), sensitivity was only 6.1% but increased to 78.8% after the addition of SPECT/CT. The results provide evidence of a substantial incremental increase in diagnostic accuracy using SPECT/CT over planar imaging alone for patients in whom a solitary spinal lesion is noted. The addition of SPECT/CT significantly reduced the number of false-negative results and increased the number of true-positive results. SPECT/CT also reduced the number of equivocal reports. A definitive diagnosis was given for most patients, indicating improved diagnostic confidence with the addition of SPECT/CT, compared with planar imaging alone, in patients with solitary spinal lesions.