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

• Published in: BioMed research international Vol. 2017; no. 2017; pp. 1 - 8
• Main Authors: Ratib, Osman, Zilli, Thomas, Amzalag, Gaël, Zaidi, Habib, Tabouret-Viaud, Claire, Garibotto, Valentina, Exquis, Nadia, Nkoulou, René, Rager, Olivier, Lee-Felker, Stephanie Anne
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01-01-2017; Hindawi; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bone cancer; Bone Neoplasms - diagnosis; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - pathology; Bone Neoplasms - secondary; Cameras; Cancer; Computed tomography; Development and progression; Diagnostic systems; Drug dosages; Female; Humans; Image detection; Lesions; Male; Medical imaging; Metastases; Metastasis; Methods; Middle Aged; Neoplasm Metastasis; Neoplasms - diagnosis; Neoplasms - diagnostic imaging; Neoplasms - pathology; Nuclear medicine; Observations; Patients; Prostate; Radiopharmaceuticals - therapeutic use; Readers; Sensitivity; Sensitivity analysis; Single photon emission computed tomography; Single Photon Emission Computed Tomography Computed Tomography - methods; SPECT imaging; Tomography; Los Angeles California; United States > US; Switzerland
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2017/7039406

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.