Role of SPECT in differentiating malignant from benign lesions in the lower thoracic and lumbar vertebrae.

Even-Sapir, Einat; Martin, Robert H.; Barnes, David; Pringle, Christopher; Iles, Sian; Mitchell, Michael J.

doi:10.1148/radiology.187.1.8451412

Cited by 128 publications

(51 citation statements)

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“…Atypical patterns of uptake and coexisting benign bone pathologies present a challenge in differentiating benign from malignant disease with planar bone scintigraphy alone. Several studies have reported improved diagnostic accuracy with the addition of SPECT, particularly in the vertebral column through improved tracer localisation [20][21][22]. As a general rule, uptake in the vertebral body or the pedicle alone is more likely to represent malignant disease than a pattern of uptake isolated to the vertebral body periphery or at the facet joints [23,24].…”

Section: Applications In Musculoskeletal Radiologymentioning

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: Applications In Musculoskeletal Radiologymentioning

confidence: 99%

SPECT-CT: applications in musculoskeletal radiology

Saha

Burke²,

Desai³

et al. 2013

BJR

View full text Add to dashboard Cite

show abstract

“…According to the diagnostic method described by Even-Sapir et al (11), the results of the bone scans were interpreted as metastatic bone lesions under these circumstances: i) Vertebral lesions of increased uptake involved the posterior aspect of the vertebral body and pedicle, or involved the vertebrae extensively (12,13); ii) rib lesions of increased uptake exhibited the strip form (14); iii) the lesions of increased uptake exhibited the lamellar form with or without corroding multiple adjacent bones (14); iv) the lesions of decreased uptake were confirmed to not be bone cysts and ischemic bone necrosis, or accompanied progressive osteodynia symptoms; v) the lesions of markedly increased uptake were confirmed to not be benign bone diseases, or exhibited multiple sites and scrambled arrangement; vi) the bone lesions, of increased or decreased uptake, were confirmed to be bone metastases by X-ray, CT or MRI; vii) by comparing the result of bone scans that were performed at different times, the new bone lesions could not be interpreted as benign diseases, or the lesions presented 'flare phenomenon' (15). The results of bone scans were considered negative under the following circumstances: i) no abnormal radiotracer uptake was detected; ii) there was indeterminate decreased radioactivity in local bones; iii) the bone lesions of increased or decreased radiotracer uptake were characterized as benign disease.…”

Section: Diagnostic Criteria Of Bone Metastasis the Interpretations mentioning

confidence: 99%

Comparison of distribution characteristics of metastatic bone lesions between breast and prostate carcinomas

Wang

Shen

et al. 2012

Oncology Letters

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Abstract. The purpose of the present study was to investigate the distribution characteristics of bone metastases in breast and prostate carcinomas. Bone scintigraphies were performed in 504 cancer patients. We studied the correlation between the distribution and total number of metastatic bone lesions, and compared the distribution of metastatic bone lesions between breast and prostate carcinomas. In the early stage, the distribution in the thoracic vertebrae, lumbar vertebrae and pelvis of the metastatic lesions of the prostate carcinoma (81.0%, 47/58) was significantly higher than that of the breast carcinoma (41.7%, 63/151; χ 2 =27.6, P=0.000). The distribution of the lesions in the thoracic skeleton in the cases of the breast carcinoma (65.6%, 99/151) was significantly higher than that of the prostate carcinoma (27.6%, 16/58; χ 2 =24.8, P=0.000); however, the distributions in the advanced cases were not markedly different. The differences in the proportions of the metastatic lesions in the lumbar vertebrae (χ 2 =56.1, P=0.000) and ribs (χ 2 =39.1, P=0.000) in the cases of the prostate carcinoma, and in the sternum (χ 2 =31.2, P=0.000), skull (χ 2 =26.5, P=0.000) and femur (χ 2 =13.6, P=0.001) in the cases of the breast carcinoma were significant. Between the breast and prostate carcinomas, the differences in the proportions of the metastatic lesions of certain bones were also significant. In cases with few bone metastases, the proportion of sternum metastases of patients with breast carcinoma (17.9%) was significantly higher than that of patients with prostate carcinoma (1.7%; χ 2 =12.7, P=0.000); the proportion of metastases in the lumbar vertebrae of prostate carcinoma (39.7%) was significantly higher than that of breast carcinoma (13.9%; χ 2 =15.4, P=0.000); the proportion of rib metastases of breast carcinoma (27.2%) was significantly higher than that of prostate carcinoma (8.6%; χ 2 =9.6, P=0.002). In cases with extensive bone metastases, the proportions of metastatic lesions in the sternum and lumbar vertebrae in breast and prostate carcinomas were not significantly different (P>0.05). In conclusion, the distribution of bone metastases is correlated with the total number of metastatic bone lesions in breast and prostate carcinoma patients, and has different characteristics in different lesions.

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“…This increased software complexity was partially accomplished by means of incorporation of newer techniques for 2D candidate merging, as well as by means of SVM classifier training on 3D features (compared with 2D SVM feature training, performed in the prior lytic lesion work). Ten patients without sclerotic spinal metastases were used in the software training and testing phases of this work spread to the vertebrae are in the vertebral body and pedicles, and most of the volume of each vertebra is constituted by these regions (38)(39)(40). Bounding box inclusion of the vertebral body and pedicles thus assesses the most likely regions of early metastatic tumor involvement.…”

Section: Discussionmentioning

confidence: 99%

Automated Detection of Sclerotic Metastases in the Thoracolumbar Spine at CT

Burns

Yao²,

Wiese³

et al. 2013

Radiology

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Purpose:To design and validate a computer system for automated detection and quantitative characterization of sclerotic metastases of the thoracolumbar spine on computed tomography (CT) images. Materials and Methods:This retrospective study was approved by the institutional review board and was HIPAA compliant; informed consent was waived. The data set consisted of CT examinations in 49 patients (14 female, 35 male patients; mean age, 57.0 years; range, 12-77 years), demonstrating a total of 532 sclerotic lesions of the spine of greater than 0.3 cm 3 in volume, and in 10 control case patients (four women, six men; mean age, 55.2 years; range, 19-70 years) without spinal lesions. CT examinations were divided into training and test sets, and images were analyzed according to prototypical fully-automated computer-aided detection (CAD) software. Free-response receiver operating characteristic analysis was performed. Results:Lesion detection sensitivity on images in the training set was 90%, relative to reference-standard marked lesions (95% confidence interval [CI]: 83%, 97%), at a false-positive rate (FPR) of 10.8 per patient (95% CI: 6.6, 15.0). For images in the testing set, sensitivity was 79% (95% CI: 74%, 84%), with an FPR of 10.9 per patient (95% CI: 8.5, 13.3). Conclusion:This CAD system successfully identified and segmented sclerotic lesions in the thoracolumbar spine.q RSNA, 2013

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Role of SPECT in differentiating malignant from benign lesions in the lower thoracic and lumbar vertebrae.

Cited by 128 publications

References 0 publications

SPECT-CT: applications in musculoskeletal radiology

SPECT-CT: applications in musculoskeletal radiology

Comparison of distribution characteristics of metastatic bone lesions between breast and prostate carcinomas

Automated Detection of Sclerotic Metastases in the Thoracolumbar Spine at CT

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