Should SPECT-CT replace SPECT for the evaluation of equivocal bone scan lesions in patients with underlying malignancies?

• DOI: 10.1097/mnm.0b013e3283399107
• Publication Date: 2010-04-15T11:00:20Z
• Authors: Xolani Ndlovu; Reena George; Annare Ellmann; James Warwick
• Keywords: tumor classification; Adult; Male; radiodiagnosis; single photon emission computer tomography; 610; Bone Neoplasms; Bone and Bones; computer assisted tomography; 03 medical and health sciences; breast cancer; primary tumor; 0302 clinical medicine; male; benign tumor; image analysis; 616; follow up; Humans; controlled study; human; Prospective Studies; intermethod comparison; Tomography; bone scintiscanning; bone metastasis; Aged; Tomography, Emission-Computed, Single-Photon; clinical article; adult; article; clinical trial; medical information; Middle Aged; prostate cancer; medronate technetium tc 99m; X-Ray Computed; 3. Good health; aged; female; malignant neoplastic disease; bone disease; diagnostic accuracy; Female; Emission-Computed; Tomography, X-Ray Computed; Single-Photon

Bone scintigraphy is used extensively in evaluating metastatic disease. There are currently no clear recommendations for the use of single photon emission computed tomography (SPECT)/CT in metastatic bone disease. Given its limited availability there is a need to identify the clinical indications for which SPECT/CT is clearly beneficial in influencing patient care and outcome.Forty-two patients with equivocal lesions on planar scintigraphy were recruited and underwent SPECT/CT imaging. On reading of SPECT alone and then SPECT/CT, lesions were classified as malignant, benign or equivocal. Follow-up clinical information, radiological studies and/or bone scans were used as a gold standard. SPECT and SPECT/CT were compared in terms of the number of equivocal findings and accuracy on a patient-wise and lesion-wise basis.Forty-two patients with 189 skeletal lesions were examined. There was a diverse variety of primary tumours, with the majority being breast (n=22) and prostate cancer (n=8). SPECT/CT resulted in a significant reduction in the proportion of patients (48-14%, P=0.0015) and lesions (31-9%, P<0.0001) with equivocal findings. The overall accuracy of SPECT/CT was significantly higher on both a patient-wise (52-79%, P=0.0026) and lesion-wise basis (67-92%, P<0.0001).SPECT/CT significantly outperforms SPECT alone for the interpretation of skeletal lesions in patients undergoing bone scanning for metastases. When available SPECT/CT is indicated in patients in whom correct classification of equivocal lesions is expected to alter the patient's management.