Multislice SPECT/CT in Benign and Malignant Bone Disease: When the Ordinary Turns Into the Extraordinary

Gnanasegaran, Gopinath; Barwick, Tara; Adamson, K. L.; Mohan, Hosahalli; Sharp, David E.; Fogelman, Ignac

doi:10.1053/j.semnuclmed.2009.07.005

Cited by 70 publications

(31 citation statements)

References 36 publications

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“…In general, images are obtained by a low-dose CT area valuable for anatomical localization and attenuation correction purposes, but morphology detail is better demonstrated by diagnostic quality (i.e. multislice) CT [13]. This could be especially important in the musculoskeletal system, where CT characterisation rather than mere localisation may provide valuable supplementary information to the radionuclide data.…”

Section: Technique and Basic Sciencementioning

confidence: 99%

SPECT-CT: applications in musculoskeletal radiology

Saha

Burke²,

Desai³

et al. 2013

BJR

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This article reviews the technique, basic science principles and applications of integrated single photon emission CT (SPECT)-CT in musculoskeletal radiology. A review of the current evidence on the topic was undertaken, and selected clinical cases from the authors' institution have been used for illustration. SPECT-CT is a technology with emerging applications that offers technical advantages to image fusion of separately acquired SPECT and CT studies. The prevailing evidence indicates that there may be benefit in adding SPECT-CT to conventional imaging algorithms during the evaluation of some malignant and benign musculoskeletal conditions. SPECT-CT can improve both sensitivity and specificity by reducing equivocal interpretation in comparison to planar scintigraphy or SPECT alone. The evidence base for SPECT-CT in musculoskeletal radiology is still evolving. There is a lack of evidence comparing SPECT-CT with MRI in many key indications, and further research is required in these areas.A wide range of pathological conditions may affect the musculoskeletal system, including infection, trauma and malignant disease. Advances in MRI, multidetector CT (MDCT) and high-frequency ultrasound have provided considerable improvements in imaging musculoskeletal disease over the past decade. There are, however, limitations associated with each of these techniques. MRI image acquisition remains relatively time consuming and, particularly in musculoskeletal radiology, image quality can be degraded significantly by metal artefact from internal fixation and prostheses. MDCT offers exquisite characterisation of bone and can rapidly generate highquality three-dimensional reconstructions; however, the contrast resolution for soft tissues is limited and the modality can also suffer metal-related artefact, although like MRI, imaging parameters can be adjusted to reduce this artefact. High-frequency ultrasound, although operator dependent, provides excellent spatial and contrast resolution for superficial structures but is suboptimal for deeper structures and is unable to penetrate cortical bone.Bone scintigraphy remains an important and highly sensitive tool to the musculoskeletal radiologist but this is frequently criticized for its lack of specificity. Radionuclide imaging, however, may be the only modality to demonstrate pathology before it becomes evident on anatomical imaging. Developments in gamma camera technology now allow high-resolution imaging with shortened scan times, and single photon emission CT (SPECT) imaging has become commonplace in the UK. SPECT is able to increase sensitivity further and improves lesion localisation, but the paucity of anatomical markers on radionuclide imaging remains a constant challenge. Thus, the importance of correlating anatomical and functional imaging has become increasingly recognised [1].Use of a combined SPECT/CT system allows for sequential acquisition of both anatomical and functional information with a high degree of image fusion accuracy.

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Section: Technique and Basic Sciencementioning

confidence: 99%

SPECT-CT: applications in musculoskeletal radiology

Saha

Burke²,

Desai³

et al. 2013

BJR

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“…Accurate image fusion, although relatively easy in the brain and extremities because of the rigid structures, is more challenging in the thorax and abdomen (7). Patient motion, organ motion, and, particularly in the context of bone imaging, differences in the curvature and shape of imaging tables may lead to differences in positioning of the spine and other structures.…”

mentioning

confidence: 99%

The Incremental Value of SPECT/CT in Characterizing Solitary Spine Lesions

Iqbal¹,

Currie

Wheat³

et al. 2011

Journal of Nuclear Medicine Technology

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The purpose of this study was to investigate the incremental value and diagnostic impact of SPECT/CT in patients who had a solitary spinal lesion on a bone scan. Methods: A prospective study was performed on 80 patients (50 with known cancer) who underwent 99m Tc-methylene diphosphonate whole-body planar bone scintigraphy and had a solitary spinal lesion. These lesions were then further evaluated using SPECT/CT. Results: Lesions were localized to the vertebral body in 38 patients (47.5%), pedicle in 15 (18.8%), facet joint in 15 (18.8%), transverse process in 2 (2.5%), spinous process in 2 (2.5%), lamina in 3 (3.8%), and end plates in 5 (6.2%). Although the specificity of planar bone scans was excellent (100%), sensitivity was only 6.1% but increased to 78.8% after the addition of SPECT/CT. The results provide evidence of a substantial incremental increase in diagnostic accuracy using SPECT/CT over planar imaging alone for patients in whom a solitary spinal lesion is noted. Conclusion: The addition of SPECT/CT significantly reduced the number of false-negative results and increased the number of true-positive results. SPECT/CT also reduced the number of equivocal reports. A definitive diagnosis was given for most patients, indicating improved diagnostic confidence with the addition of SPECT/CT, compared with planar imaging alone, in patients with solitary spinal lesions.

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“…The introduction of multimodality hybrid imaging, mainly SPECT/CT, into clinical routine has multiplied the clinical value of nuclear medicine imaging in orthopaedics (Amarasekera et al 2011 ;Biersack et al 2012 ;Breunung et al 2008 ;Gnanasegaran et al 2009 ;Graute et al 2010 ;Hirschmann et al 2010a , b ;2011a , b , c , d ;2012b , c ;Horger et al 2007 ;Konala et al 2010 ;Lee et al 2008 ;Madsen 2008 ;Mohan et al 2010 ;Pagenstert et al 2009 ;Scharf 2009 ;Strobel et al 2012 ). It is not only the sensitivity but also the specifi city and along with these the diagnostic confidence in detecting and interpreting bone and joint pathologies that has been significantly increased (Amarasekera et al 2011 ;Biersack et al 2012 ;Breunung et al 2008 ;Gnanasegaran et al 2009 ;Graute et al 2010 ;Hirschmann et al 2010a , b ;2011a , b , c , d ;2012b , c ;Horger et al 2007 ;Konala et al 2010 ;Lee et al 2008 ;Madsen 2008 ;Mohan et al 2010 ;Pagenstert et al 2009 ;Scharf 2009 ;Strobel et al 2012 ).…”

Section: Introductionmentioning

confidence: 97%

“…In the last decades, nuclear medicine imaging has undergone a signifi cant technical evolution (Bybel et al 2008 ;Collier et al 1985 ;Cook and Fogelman 1996 ;Delbeke et al 2009 ;Dorchak et al 1993 ;Dye and Chew 1993 ;Dye and Boll 1986 ;Franc et al 2012 ;Gnanasegaran et al 2009 ;Gregory et al 2004 ;Hart et al 2008 ;Hogervorst et al 2000a , b ;Jeer et al 2006 ;Kim et al 2008 ;Lorberboym et al 2003 ;Madsen 2007 ;Murray et al 1990 ;Naslund et al 2005 ;O'Connor and Kemp 2006 ;Petersson et al 1998 ;Scharf 2009 ). First, there was a clear diagnostic shift from conventional planar scintigraphic imaging (bone scans), which only offered 2D images of a 3D pathology, to 3D scintigraphic imaging and single-photon emission computerized tomography (SPECT) (Dorchak et al 1993 ;Dye and Chew 1993 ;Dye and Boll 1986 ;Hart et al 2008 ;Hogervorst et al 2002 ;Hogervorst et al 2000a , b ;Jeer et al 2006 ;Kim et al 2008 ;Lorberboym et al 2003 ;Murray et al 1990 ;Petersson et al 1998 ;Van Den Eeckhaut et al 2003 ;Vellala et al 2004 ;Yildirim et al 2004 ).…”

Section: Introductionmentioning

confidence: 98%