Clinical impact of targeted single-photon emission computed tomography/computed tomography (SPECT/CT) bone scintigraphy on the assessment of bone metastasis in cancer patients

Abstract

Objectives We investigated the clinical impact of single-photon emission computed tomography/computed tomography (SPECT/CT) bone scintigraphy combined with 16-slice CT on metastatic workup and treatment planning in a large cancer patient series. Methods Between January 2019 and January 2020, a total of 600 cancer patients were prospectively evaluated with whole-body planar bone scan (wbPBS) for staging or restaging purposes. 272/600 had equivocal lesions on wbPBS and 265/272 underwent additionally a targeted SPECT/CT bone scintigraphy on designated regions. Findings were classified as benign (score 1), metastatic (score 2) and inconclusive (score 3). Findings from SPECT/CT bone scintigraphy were compared with the results of wbPBS. Results A total of 668 lesions were considered as unclear οn wbPBS and were re-evaluated through targeted SPECT/CT bone scintigraphy. Definite diagnostic findings on SPECT/CT bone scintigraphy were obtained in 227/265 (85.7%) patients and in 592/668 (88.6%) lesions vs. 15.4% of wbPBS alone. On per-patient analyses, 38.9% of patients were considered definitely nonmetastatic and 46.8% as definitely metastatic. On per lesion analyses using SPECT/CT bone scintigraphy, corresponding diagnostic rates were 47.5 and 41.2%. Although the addition of SPECT/CT bone scintigraphy significantly reduced the rate of equivocal wbPBS results (83.1%), it failed to provide a conclusive diagnosis in a relatively small proportion of lesions 76/668 (11.4%) in 38 patients. Conclusions SPECT/CT bone scintigraphy afforded a significant reduction of the number of patients with equivocal findings who needed further evaluation with other imaging modalities, preventing unnecessary delays in diagnosis and potential changes in disease staging and treatment planning. Moreover, SPECT/CT bone scintigraphy slightly increased diagnostic sensitivity.

Transition to Fast Whole-Body SPECT/CT Bone Imaging: An Assessment of Image Quality

“…In this study, their findings showed that WB-SPECT/CT had a diagnostic superiority over PBS. As a result, they recommended the WB-SPECT/CT protocol for all oncology patients [ 24 ]. However, the process was time-consuming as the acquisition time by 15–20 min per bed position.…”

Single-Photon Emission Computed Tomography/Computed Tomography Image-Based Radiomics for Discriminating Vertebral Bone Metastases From Benign Bone Lesions in Patients With Tumors

“…99 m Tc-labeled methylene diphosphonate ( 99 m Tc-MDP) whole-body scan (WBS) was frequently used in patients with bone lesions and had high sensitivity but low specificity. The radioactive tracer 99 m Tc-MDP was deposited in the bone by chemisorption and ion exchange, the abnormal uptake of the tracer reflected the osteogenic activity and local blood flow of the lesion ( 3 ). Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) combined anatomic and metabolic functions to improve the accuracy of anatomic localization of lesions and the specificity of bone imaging ( 4 , 5 ).…”