Background/Objectives: This study aimed to assess the diagnostic capability of quantitative parameters from whole-body bone single-photon emission computed tomography/computed tomography (SPECT/CT) in detecting bone metastases in prostate cancer patients; Methods: We retrospectively analyzed 82 prostate cancer patients who underwent staging bone scintigraphy with a full-ring 360° Cadmium-Zinc-Telluride (CZT) SPECT/CT system. From the SPECT/CT images, we measured the maximum (SUVmax) and mean (SUVmean) standardized uptake values at six normal bone sites (skull, humerus, thoracic spine, lumbar spine, iliac bone, and femur), and the SUVmax for both metastatic and benign bone lesions. Ratios of lesion SUVmax-to-maximum and mean uptake values at the skull, humerus, and femur were computed for each lesion; Results: SUVmax and SUVmean at the skull and femur exhibited significantly lower variance compared to those at the thoracic spine, lumbar spine, and iliac bone, and revealed no significant differences between patients with and without bone metastasis. In receiver operating characteristic curve analysis for detecting bone metastasis among 482 metastatic lesions, 132 benign bone lesions, and 477 normal bone sites, the lesion-to-femur mean uptake ratio demonstrated the highest area under the curve value (0.955) among SPECT/CT parameters. Using a cut-off value of 5.38, the lesion-to-femur mean uptake ratio achieved a sensitivity of 94.8% and a specificity of 86.5%; Conclusions: The bone lesion-to-femur mean uptake ratio was the most effective quantitative bone SPECT/CT parameter for detecting bone metastasis in prostate cancer patients. Quantitative analysis of bone SPECT/CT images could thus play a crucial role in diagnosing bone metastasis.
