Two-bed SPECT/CT versus planar bone scintigraphy: prospective comparison of reproducibility and diagnostic performance

Abstract

Objective To evaluate the reproducibility and diagnostic performance of two-bed single-photon emission computed tomography/computed tomography (SPECT/CT) images (TBSCT), compared to conventional planar bone scintigraphy (PBS) for the diagnosis of osseous metastasis. Methods Patients with known solid tumor, referred to perform PBS, were included in this prospective study. PBS acquisition was followed by TBSCT images, covering at least the chest, abdomen and pelvis. Each modality was interpreted during a separate session by two independent nuclear medicine physicians with 12- and 3-year experience. Reference standard was formulated on the basis of subsequent clinical/imaging/histopathological evidence. Results One-hundred and six patients were finally included in our study. A moderate agreement between the two physicians was seen for PBS readings [k = 0.74; 95% confidence interval (CI), 0.61–0.86] which increased to 0.87 (95% CI, 0.77–0.96) for TBSCT. PBS readings were inconclusive in 29/106, compared to 6 for TBSCT. For each reader, TBSCT showed significantly greater sensitivity and accuracy compared to PBS. There was no significant difference in the sensitivity, specificity or accuracy of both modalities in patients with the breast cancer group, whereas TBSCT images have shown significant higher sensitivity and accuracy compared to PBS (P = 0.02 and 0.002, respectively) in nonbreast cancer patients. Conclusion TBSCT demonstrated higher reproducibility and significantly decreased the proportion of inconclusive readings of PBS. TBSCT resulted in significant gain in sensitivity and accuracy in the unselected group of patients with solid tumors. However, that gain may be better appreciated in patients with nonbreast cancer.

Inter-observer variability between readers in detection of bone metastases comparing different modalities; PET/CT, SPECT/CT and planar bone scintigraphy

“…Similar results were achieved by other studies [2,7–11] that showed significant improvement in inter-observer variability for SPECT/CT (whatever the technique used) compared to planar BS or SPECT alone, with a kappa value ranging from 0.78 to 91 for SPECT/CT. Beck et al .…”

“…In our study, we found that the inter-observer agreement between readers significantly improved by addition of SPECT/CT to Planar BS from fair 0.372 to perfect agreement 0.847. Similar results were achieved by other studies [2,[7][8][9][10][11] that showed significant improvement in inter-observer variability for SPECT/CT (whatever the technique used) compared to planar BS or SPECT alone, with a kappa value ranging from 0.78 to 91 for SPECT/CT. Beck et al [9].…”

“…It is crucial to early diagnose and treat patient with bone metastases to avoid serious complications [1]. Bone scintigraphy (BS) using technetium-99m methylene diphosphonate (Tc-99m MDP) is the conventional and traditional method for detecting bone metastases as it is simple, available, cost-effective, and highly sensitive, but it has low specificity [2,3]. Single photon emission computed tomography/computed tomography (SPECT/CT) has greater sensitivity and specificity than BS due to better localization and characterization of equivocal osseous lesions [2,4].…”

“…Bone scintigraphy (BS) using technetium-99m methylene diphosphonate (Tc-99m MDP) is the conventional and traditional method for detecting bone metastases as it is simple, available, cost-effective, and highly sensitive, but it has low specificity [2,3]. Single photon emission computed tomography/computed tomography (SPECT/CT) has greater sensitivity and specificity than BS due to better localization and characterization of equivocal osseous lesions [2,4]. Flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) (F-18 FDG PET/CT) is not routinely used for the detection of bone metastases but as a part of a whole-body survey for metastases [3].…”

Deep learning enhanced ultra-fast SPECT/CT bone scan in patients with suspected malignancy: quantitative assessment and clinical performance

“…The diagnostic performance of the 20 min and 3 min DL SPECT/CT images was not significantly different according to both reviewers in our study. These results are similar to those reported in traditional SPECT/CT bone scans studies (Zhang et al 2020, Mostafa et al 2021. Although the sensitivity of the 3 min DL SPECT/CT images was 10% lower than that of the 20 min images, this different was not statistically significant and would be considered acceptable in clinical practice.…”