Integrated multislice CT and Tc–99m Sestamibi SPECT–CT evaluation of solitary pulmonary nodules

Abstract

Purpose. The purpose of this study was to evaluate efficacy of multislice computed tomography (MSCT) and single photon emission computed tomography (SPECT)-CT with Tc-99m Sestamibi in the assessment of solitary pulmonary nodules of uncertain significance. Scintigraphy was performed using a 'hybrid' g-camera that allows simultaneous acquisition of SPECT and CT images, with interesting results in diagnostic oncology. Materials and methods. Between September 2003 and August2004, 23 patients with a solitary pulmonary nodule detected on CT underwent SPECT-CT using Tc-99m Sestamibi as a radiotracer. Nodules with positive scintigraphy were immediately subjected to biopsy or surgical resection. Nodules with negative scintigraphy were followed up after 3-4 months by MSCT with automatic segmentation software (Advanced Lung Analysis, ALA) and histological characterisation. Results. Of the 23 nodules (size range 0.8-2 cm) discovered with MSCT, 11 showed intense uptake of Tc-99m Sestamibi. Ten lesions were true positive: seven adenocarcinomas, one squamous cell carcinoma, one large cell carcinoma and one metastasis. The only false positive was histologically classified as a large cell granuloma. Twelve lesions had negative scintigraphy: five fibrous lesions, three hamartomas, three granulomas and one adenocarcinoma (false negative). Benign nodules without tracer uptake underwent another CT scan 3-4 months later, which confirmed stability of the nodule size. Correlation of Sestamibi SPECT with histology showed sensitivity (Se) of 90.9 %, specificity (Sp) of 91.6 %, diagnostic accuracy of 91.3 %, positive predictive value (PPV) of 90.9% and negative predictive value (NPV) of 91.6 %. Conclusions. The integrated use of MSCT and Tc-99m Sestamibi SPECT-CT could be very useful in the management of solitary pulmonary nodules (SPNs). In particular, in our preliminary study, scintigraphy provided significant diagnostic information to differentiate benign from suspicious pulmonary nodules. The use of scintigraphy could be helpful to anticipate histological assessment and surgical treatment of SPNs identified at CT. Radiol med (2006) 111:213-224 DOI 10.1007 Integrated multislice CT and Tc-99m Sestamibi SPECT-CT evaluation of solitary pulmonary nodules TC multistrato e SPECT-TC con Tc-99m Sestamibi: diagnostica integrata nella caratterizzazione del nodulo polmonare solitario Key words

Solitary pulmonary nodule evaluation with99mTc-methoxy isobutyl isonitrile in a tuberculosis-endemic area

“…The high NPV of MIBI in the present study is in line with results from the only two previous studies from Turkey and Italy performed in settings with a relatively high prevalence of benign lesions, which resulted in NPVs of 83 and 92%, respectively [15,16]. In the study from Turkey [15], 37 patients (51% benign lesions) were investigated with MIBI and positive scans indicated malignancy with a sensitivity, specificity, PPV and NPV of 79, 83, 79 and 83%, respectively.…”

“…In the study from Turkey [15], 37 patients (51% benign lesions) were investigated with MIBI and positive scans indicated malignancy with a sensitivity, specificity, PPV and NPV of 79, 83, 79 and 83%, respectively. In the study from Italy [16], 23 SPNs were included, 56% of which were reported to be benign. MIBI positive scans identified all malignant lesions and only one false-positive scan occurred.…”

“…Malignancy was detected with a sensitivity, specificity, PPV and NPV of 91, 92, 91 and 92%, respectively. However, these studies [15,16] were relatively small and follow-up was short for some cases, thus casting doubts on the validity of the negative scans. The present study obtained a tissue diagnosis in a large proportion of participants and negative results were documented with close and complete radiological and clinical follow-up for o2 yrs.…”

Accuracy of early and delayed FDG PET-CT and of contrast-enhanced CT in the evaluation of lung nodules: a preliminary study on 30 patients

“…In fact, the use of msCT in combination with 99m TC sestamibi single photon emission tomography (SPECT-CT) in SPNs has been proposed, with interesting future perspectives in differential diagnosis [10]. Over the last decade, diagnostic imaging of SPNs and staging of lung cancers have rapidly changed with the increasing use of PET scan, which measures the degree of fluorine18-fluorodeoxyglucose ( 18 F-FDG) uptake -or C11-choline [11] -within a lesion.…”

Technological Development and Advances in Single-Photon Emission Computed Tomography/Computed Tomography

“…Clinical Applications of SPECT/CT Cited Anatomical/Disease Site Radiopharmaceutical SPECT/CT Application Adrenal masses 123 I-metaiodobenzylguanidine, 75 Se-cholesterol Anatomical localization [161] Biliary leak 99m Tc-diisopropyl iminodiacetic acid Anatomical localization [141] Bone scintigraphy 99m Tc-methylene diphosphonate, 99m Tc-dicarboxypropane diphosphonate Anatomical localization, attenuation correction [162][163][164][165][166][167][168][169] Brain cancer 99m Tc-tetrofosmin Anatomical localization [170] Breast cancer 99m Tc-sestamibi Anatomical localization [171] Colorectal cancer 99m Tc-labelled macroaggregated albumin Hepatic artery infusion of chemotherapy [172] Coronary artery calcification 99m Tc-tetrofosmin Head/neck cancer L-3-123 I-iodine-alpha-methyl-tyrosine, 123 I-labeled L19(scFv)2 antibody Anatomical localization [175][176][177] Hepatic haemangioma 99m Tc-labelled red blood cells Anatomical localization [178,179] Hepatic carcinoma 99m Tc-macroaggregated albumin Anatomical localization [180] Human immunodeficiency virus (HIV) 99m Tc-sulfur colloid Anatomical localization of microbicide surrogate [138] Infection Gallium-67, 111 In-labeled leukocytes Anatomical localization [133][134][135][136] Left ventricular function 99m Tc-tetrofosmin Regional wall motion evaluation, myocardial muscle mass, ejection fraction, cardiac volumes [118] Lung (ventilation/perfusion) 99m Tc-Technegas, 99m Tc-macroaggregated albumin Anatomical localization and registration of ventilation-perfusion patterns [139,140] Lung cancer 99m Tc-sestamibi, 99m Tc-depreotide Anatomical localization [181][182]…”