Can 16-detector multislice CT exclude skeletal lesions during tumour staging? Implications for the cancer patient

Abstract

Current imaging guidelines recommend that many cancer patients undergo soft-tissue staging by computed tomography (CT) whilst the bones are imaged by skeletal scintigraphy (bone scan). New CT technology has now made it feasible, for the first time, to perform a detailed whole-body skeletal CT. This advancement could save patients from having to undergo duplicate investigations. Forty-three patients with known malignancy were investigated for bone metastasis using skeletal scintigraphy and 16-detector multislice CT. Both studies were performed within six weeks of each other. Whole-body images were taken 4 h after injection of 500 Mbq (99m)Tc-MDP using a gamma camera. CT was performed on a 16-detector multislice CT machine from the vertex to the knee. The examinations were reported independently and discordant results were compared at follow-up. Statistical equivalence between the two techniques was tested using the Newcombe-Wilson method within the pre-specified equivalence limits of +/-20%. Scintigraphy detected bone metastases in 14/43 and CT in 13/43 patients. There were seven discordances; four cases were positive on scintigraphy, but negative on CT; three cases were positive on CT and negative on scintigraphy. There was equivalence between scintigraphy and CT in detecting bone metastases within +/-19% equivalence limits. Patients who have undergone full whole-body staging on 16-detector CT may not need additional skeletal scintigraphy. This should shorten the cancer patient's diagnostic pathway.

Diagnostic value of whole‐body magnetic resonance imaging for bone metastases: a systematic review and meta‐analysis

“…Recently, multislice CT has been proposed as an alternative to bone scintigraphy for whole-body screening of the skeletal system. Groves et al (39) found equivalence between scintigraphy and CT in detecting bone metastases. They suggested that patients undergoing whole-body staging with CT may not need the additional skeletal scintigraphy and consequently have a shorter diagnostic pathway (39).…”

“…Groves et al (39) found equivalence between scintigraphy and CT in detecting bone metastases. They suggested that patients undergoing whole-body staging with CT may not need the additional skeletal scintigraphy and consequently have a shorter diagnostic pathway (39). However, another recent study comparing multislice CT with MRI in the detection of metastases to the spine found that the sensitivity of MRI (98.5%) was considerably greater than that of CT (66%),with equivalent specificities (40).…”

Staging of Primary Breast Cancer Is not Indicated in Asymptomatic Patients with Early Tumor Stages

“…This is also true for bone metastases if the chest, abdomen and pelvis are examined at the same time [22,23,24]. The 13 patients in our study with osseous metastases had at least 1 metastasis in an area (thorax, abdomen, pelvis) that would have been detected by means of CT [3].…”

Validation of Therapeutic Response Assessment by Bone Scintigraphy in Patients With Bone-Only Metastatic Breast Cancers During Zoledronic Acid Treatment: Comparison With Computed Tomography Assessment

“…Although CT as well as BS could detect bone metastases, our results indicate the superiority of BS over CT in terms of monitoring response in patients under treatment with ZA 38) . In cases of bone -only metastatic patients with normal ranges of TM, BS may therefore be the only reliable tool for monitoring responses to therapy.…”