A Study Of The Diagnostic Value Of SPECT/spiral CT In Patients With Bone Metastasis

Part I Differential diagnostic value of SPECT/CT in patients with spinal bone tumor and tumor-like lesions using 99mTc-MDPObjective:To investigate the differential diagnostic value of SPECT/CT in patients with spinal bone tumor and tumor-like lesions using 99mTc-MDP over SPECT in terms of diagnostic confidence, inter-reviewer agreement.Methods:This was a retrospective review of 52 patients with spinal bone defects who underwent 99mTc-methylene diphosphonate (MDP) whole-body planar bone scintigraphy, SPECT and SPECT/CT between April 2008 and February 2010. All patients had pathology diagnosis by way of spinal bone defects surgical resection or lesion biopsy. The images were evaluated by two independent reviewers; inter-reviewer agreement was evaluated using a weighted kappa score. Each focus of abnormal increased tracer uptake was recorded using a 4-point diagnostic confidence scale:benign,possibly benign, possibly malignant and malignant.Results:Pathology results revealed 36 malignant bone tumors and 16 benign lesions. In the malignant cases,19 cases were metastasis tumor and 17 cases were non metastasis tumor. On reporting the SPECT scans, reviewers rated 69.2% of lesions as equivocal (possibly benign, possibly malignant). On reporting the SPECT/CT scans only 15.4% of lesions were rated as equivocal. Inter-reviewer agreement were 63.5% (weighted kappa scores=0.62)for SPECT and 78.9%(weighted kappa scores=0.81) for SPECT/CT. Agreement rate of pathology results with SPECT or SPECT/CT was 76.9% and 94.23% respectively. Conclusion:SPECT/CT resulted in a significant reduction of equivocal reports. A definitive diagnosis was given in the majority of the patients due to the improved diagnostic confidence compared to SPECT imaging alone. The SPECT/CT could differential spinal bone malignancy tumor well from benign and the results were correlated well with pathology. PartⅡThe differential diagnostic value of SPECT/CT for spinal solitary lesions in patients with malignant tumorObjective:The study is to evaluate the added value of SPECT/CT in identifying metastases from benign lesions of the spinal solitary hot spot in patients with extraskeletal malignancy.Methods: We selected 57 cases with malignancy, whose bone scintigraphy demonstrated a solitary hot spot in the spine. SPECT/CT was undergone for those lesions. SPECT and SPECT/CT imaging was analyzed by two experienced nuclear medicine physicians separately. Each lesion was rated using a 3-point diagnostic confidence scale:metastasis, benign or uncertainty. The analysed items were divided into two groupes (certainty to diagnose and uncertainty to diagnose). The percentage and its 95% confidence intervals of each group were calculated.Results:The degree of certainty to diagnose on SPECT images was 45.6% (26/57), its 95% confidence intervals range from 32.7% to 58.5%. The degree of uncertainty to diagnose on SPECT images was 54.4% (31/57), its 95% confidence intervals range from 41.4% to 67.3%.The degree of certainty to diagnose on SPECT/CT images was 91.2%%(52/57), its 95% confidence intervals range from 83.9% to 98.6%. The degree of uncertainty to diagnose on SPECT/CT images was 8.8% (5/57), its 95% confidence intervals range from 1.4% to 16.1%. The accuracy diagnostic rate markedly improved(χ2=27.20, P<0.05) by SPECT/CT images.Conclusion:The added value of SPECT/CT fusion imaging resulted in a significant reduction of uncertainty, a definitive diagnosis was given in the majority of the patients due to the improved diagnostic confidence compared to SPECT imaging alone in patients with extraskeletal malignancies with the spinal solitary lesion. Part III Diagnostic value of SPECT/CT in patients with bone metastasis from hepatocellular carcinomaObjective:To evaluate the diagnostic value of SPECT/CT in patients with bone metastasis from hepatocellular carcinoma.Methods:One hundred and seventy eight patients with hepatocellular carcinoma (HCC) confirmed by pathology underwent bone scintigraphy. Of 97 patients underwent single-photon emission computed tomography imaging /multislice computed tomography (SPECT/CT)scanning among them. Bone scintigraphy imaging and SPECT/CT fusion imaging were analyzed by two experienced nuclear medicine physicians together. Each patient was rated using a 3-point diagnostic confidence scale:metastasis, benign and uncertainty. The analysed items were divided into two groupes [certainty to diagnose (metastasis and benign) and uncertainty to diagnose]. The percentage and its 95% confidence intervals of each group were calculated. The coincidence rate of bone metastases compared with the final diagnosis and its 95% confidence interval were calculated.Results:The degree of certainty to diagnose on bone scintigraphy was 32.0%(31/97), its 95% confidence intervals range from 22.7% to 41.3%. The degree of uncertainty to diagnose on bone scintigraphy was 68.0%(66/97), its 95% confidence intervals range from 63.3% to 72.7%. The coincidence rate of bone metastases was 41.7%(20/48), its 95% confidence intervals range from 27.8% to 55.6%. The degree of certainty to diagnose on SPECT/CT fusion images was 81.4% (79/97), its 95% confidence intervals range from 73.7% to 89.1%. The degree of uncertainty to diagnose on SPECT/CT fusion images was 18.6%(18/97), its 95% confidence intervals range from 10.9% to 26.3%. The coincidence rate of bone metastases was 95.8%(46/48), its 95% confidence intervals range from 90.1% to 100.0%. The accuracy diagnostic rate markedly improved(χ2=48.13, P<0.05) by SPECT/CT images.Conclusion:SPECT/CT fusion images provide more information than bone scintigraphy in differentiating metastases from benign lesions in patients with HCC, increase the degree of certainty to diagnose, especially increase the diagnostic accuracy in some false-negative cases diagnosed by bone scintigraphy. Part IV Differential diagnostic value of bone metastases in patients with lung cancer using SPECT/CT fusion imagingObjective:To evaluate the value of differentiating metastases from benign of bone lesions in patients with lung cancer using SPECT/CT fusion imaging.Methods:One hundred and forty six patients with lung cancer confirmed by pathology underwent bone scintigraphy and SPECT/CT scanning. Bone scintigraphy imaging and SPECT/CT fusion imaging were analyzed by two experienced nuclear medicine physicians together. Each patient was rated using a 3-point diagnostic confidence scale:metastasis, benign and uncertainty. The analysed items were divided into two groupes (certainty to diagnose and uncertainty to diagnose). The percentage and its 95% confidence intervals of each group were calculated. The coincidence rate of bone metastases compared with the final diagnosis and its 95% confidence interval were calculated.Results:The degree of certainty to diagnose on bone scintigraphy was 40.4% (59/146), its 95% confidence intervals range from 32.5% to 48.4%. The degree of uncertainty to diagnose on bone scintigraphy was 59.6% (87/146), its 95% confidence intervals range from 51.6% to 67.5%. The coincidence rate of bone metastases was 51.1% (23/45), its 95% confidence intervals range from 36.5% to 65.7%. The degree of certainty to diagnose on SPECT/CT fusion images was 89.7%(131/146), its 95% confidence intervals range from 84.8% to 94.7%. The degree of uncertainty to diagnose on SPECT/CT fusion images was 10.3％(15/146), its 95% confidence intervals range from 5.3% to 15.2%. The coincidence rate of bone metastases was 93.3% (42/45), its 95% confidence intervals range from 86.0% to 100.0%. The accuracy diagnostic rate markedly improved(χ2=77.84, P<0.05) by SPECT/CT images.Conclusion:SPECT/ spiral CT images provide more information than bone scintigraphy in differentiating metastases from benign lesions in patients with lung cancer and increase the diagnostic accuracy.