Diagnosis of bone metastases: a meta-analysis comparing 18FDG PET, CT, MRI and bone scintigraphy

Objective  

To perform a meta-analysis to compare ¹⁸FDG PET, CT, MRI and bone scintigraphy (BS) for the diagnosis of bone metastases.     

Meta分析比较18FDG-PET、CT、MRI及放射性核素骨显像对骨转移的诊断

目的采用Meta分析比较18FDG-PET、CT、MRI及放射性核素骨显像(BS)对骨转移瘤的诊断价值。方法通过MEDLINE、EMBASE数据库检索自1995年—2010年发表的相关原始文献。运用软件进行Meta分析,计算总敏感     

Comparison of SPECT bone scintigraphy with MRI for diagnosis of meniscal tears

BACKGROUND: Scintigraphy has been considered as competitive to MRI, but limited data are available on the accuracy of single photon emission tomography (SPECT) compared with MRI for the assessment of meniscal tears. Our objective was to assess the value of SPECT in comparison to MRI. METHODS: Between January 2003 and March 2004, sixteen patients were studied with both modalities and the accuracy rates of SPECT scan results, and MRI findings in the diagnosis of meniscal tears were compared. Arthroscopy was the gold standard. RESULTS: The respective sensitivity rate, specificity rate, and positive and negative predictive accuracies of MRI were 89%, 94%, 93%, and 79% and for SPECT those were 78%, 94%, 94%, and 88%. There was good agreement on the presence or absence of tears between two modalities (kappa statistic = 0.699). CONCLUSION: SPECT and MRI are both valuable imaging techniques. SPECT is a useful alternative when MRI is unavailable or unsuitable and it is beneficial when more possible accuracy is desired (such as when MRI results are either inconclusive or conflict with other clinical data).     

The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT.

The aim of this study was to compare the detection of bone metastases by 99mTc-methylene diphosphonate (99mTc-MDP) planar bone scintigraphy (BS), SPECT, 18F-Fluoride PET, and 18F-Fluoride PET/CT in patients with high-risk prostate cancer. METHODS: In a prospective study, BS and 18F-Fluoride PET/CT were performed on the same day in 44 patients with high-risk prostate cancer. In 20 of the latter patients planar BS was followed by single field-of-view (FOV) SPECT and in 24 patients by multi-FOV SPECT of the axial skeleton. Lesions were interpreted separately on each of the 4 modalities as normal, benign, equivocal, or malignant. RESULTS: In patient-based analysis, 23 patients had skeletal metastatic spread (52%) and 21 did not. Categorizing equivocal and malignant interpretation as suggestive for malignancy, the sensitivity, specificity, positive predictive value, and negative predictive value of planar BS were 70%, 57%, 64%, and 55%, respectively, of multi-FOV SPECT were 92%, 82%, 86%, and 90%, of (18)F-Fluoride PET were 100%, 62%, 74%, and 100%, and of 18F-Fluoride PET/CT were 100% for all parameters. Using the McNemar test, 18F-Fluoride PET/CT was statistically more sensitive and more specific than planar or SPECT BS (P < 0.05) and more specific than 18F-Fluoride PET (P < 0.001). SPECT was statistically more sensitive and more specific than planar BS (P < 0.05) but was less sensitive than 18F-Fluoride PET (P < 0.05). In lesion-based analysis, 156 lesions with increased uptake of 18F-Fluoride were assessed. Based on the corresponding appearance on CT, lesions were categorized by PET/CT as benign (n = 99), osteoblastic metastasis (n = 46), or equivocal when CT was normal (n = 11). Of the 156 18F-Fluoride lesions, 81 lesions (52%), including 34 metastases, were overlooked with normal appearance on planar BS. SPECT identified 62% of the lesions overlooked by planar BS. 18F-Fluoride PET/CT was more sensitive and more specific than BS (P < 0.001) and more specific than PET alone (P < 0.001). CONCLUSION: 18F-Fluoride PET/CT is a highly sensitive and specific modality for detection of bone metastases in patients with high-risk prostate cancer. It is more specific than 18F-Fluoride PET alone and more sensitive and specific than planar and SPECT BS. Detection of bone metastases is improved by SPECT compared with planar BS and by 18F-Fluoride PET compared with SPECT. This added value of 18F-Fluoride PET/CT may beneficially impact the clinical management of patients with high-risk prostate cancer.     

Comparison of bone scintigraphy and 18F-FDG PET-CT in a prostate cancer patient with osteolytic bone metastases

A 62?year-old male with prostate cancer, recently complaining lumbar pain with elevated PSA level (6.83?ng/ml) was referred for evaluating bone metastases. Bone scintigraphy with (99m)Tc-MDP demonstrated intense uptake on third lumbar vertebra. Postoperative biopsy of the lesion on third lumbar vertebra revealed adenocarcinoma metastasis. For evaluating distant metastases and restaging, (18)F-FDG PET-CT was performed postoperatively. On PET-CT imaging there were cervical and left parailiac lymph nodes with FDG uptake, destruction on third lumbar vertebra level and intense soft tissue mass FDG uptake on the same area. Additionally, FDG uptake was detected on right iliac crest. On the CT images obtained by integrated PET-CT scanner, this uptake was matching with lytic bone metastases. The superiority of (18)F-FDG PET-CT for demonstrating osteolytic bone metastases compared to bone scintigraphy was presented in a case of prostate cancer in a patient with bone and lymph node metastases.     

MRI与骨扫描诊断前列腺癌骨转移的比较

目的 通过比较MRI与核素骨扫描对前列腺癌骨转移的诊断,以选择最优的无创成像手段来明确前列腺癌的分期。材料与方法 回顾性分析2011年1月-2013年6月经病理证实为前列腺癌的病人252例。年龄57~88岁,平均年龄（73±7.98）岁,分别获取并比较MRI和骨扫描对前列腺癌骨转移诊断的敏感度、特异度、准确度、阳性预测值（PPV）、阴性预测值（ＮＰＶ）。结果 54例病人诊断为骨转移（成骨性骨转移48例,混合性骨转移6例）。80%（41/54）的前列腺癌骨转移病人的前列腺特异性抗原（PSA）>50 ng/mL,而92%（182/19８）的前列腺癌无骨转移病人的PSA<50 ng/mL。MRI诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为85.1%、100%、96.8%、100%、96.1%;全身骨扫描诊断前列腺癌骨转移的敏感度、特异度、准确度、PPV、NPV分别为92.5%、84.3%、86.1%、61.7%、97.6%。结论 MRI对前列腺癌骨转移的诊断特异度、准确度及PPV较高,骨扫描的敏感度较高。MRI与骨扫描可以实现优势互补,利于前列腺癌的准确临床分期。     

Comparison of 18F-fluoride PET/CT, 18F-FDG PET/CT and bone scintigraphy (planar and SPECT) in detection of bone metastases of differentiated thyroid cancer: a pilot study

Objective:

We compared the efficacies of ¹⁸F-fluoride positron emission tomography (¹⁸F-fluoride PET)/CT, ¹⁸F-fludeoxyglucose PET (¹⁸F-FDG PET)/CT, and ^99mTc bone scintigraphy [planar and single photon emission CT (SPECT)] for the detection of bone metastases in patients with differentiated thyroid carcinoma (DTC).

Methods:

We examined 11 patients (8 females and 3 males; mean age ± standard deviation, 61.9 ± 8.7 years) with DTC who had been suspected of having bone metastases after total thyroidectomy and were hospitalized to be given ¹³¹I therapy. Bone metastases were verified either when positive findings were obtained on both ¹³¹I scintigraphy and CT or when MRI findings were positive if MRI was performed.

Results:

Metastases were confirmed in 24 (13.6%) of 176 bone segments in 9 (81.8%) of the 11 patients. The sensitivities of ¹⁸F-fluoride PET/CT and ^99mTc bone scintigraphy (SPECT) were significantly higher than those of ¹⁸F-FDG PET/CT and ^99mTc bone scintigraphy (planar) (p < 0.05). The accuracies of ¹⁸F-fluoride PET/CT and ^99mTc bone scintigraphy (SPECT) were significantly higher than that of ^99mTc bone scintigraphy (planar) (p < 0.05).

Conclusion:

The sensitivity and accuracy of ¹⁸F-fluoride PET/CT for the detection of bone metastases of DTC are significantly higher than those of ^99mTc bone scintigraphy (planar). However, the sensitivity and accuracy of ^99mTc bone scintigraphy (planar) are improved near to those of ¹⁸F-fluoride PET/CT when SPECT is added to a planar scan. The sensitivity of ¹⁸F-FDG PET/CT is significantly lower than that of ¹⁸F-fluoride PET/CT or ^99mTc bone scintigraphy (SPECT).

Advances in knowledge:

This article has demonstrated first the high efficacy of ¹⁸F-fluoride PET/CT for the detection of bone metastases of DTC.Differentiated thyroid carcinoma (DTC) shows a relatively good prognosis compared with carcinomas of other organs, and the 10-year survival rate of DTC is >80% because of treatments such as total thyroidectomy and ablation of remnants with radioiodine.¹ However, metastases of DTC develop in 7–23% of patients; the distant metastases occur commonly in the lungs, bones and brain, and the bones are the second most common site of metastases of DTC.² Bone scintigraphy using ^99mTc-labelled phosphate compounds [^99mTc-methylene diphosphonate (^99mTc-MDP) or ^99mTc-hydroxymethylene diphosphonate (^99mTc-HMDP)] has been widely used for detecting and evaluating bone metastases of various kinds of carcinomas because of its overall high sensitivity and the easy evaluation of the entire skeleton.³ However, there were often false-positive cases in ^99mTc bone scintigraphy, because degenerative or inflammatory foci were often confused with metastatic lesions. The addition of single photon emission CT (SPECT) to planar acquisition of ^99mTc bone scintigraphy has been shown to exhibit a beneficial effect on the detection and evaluation of bone metastases.^4–6 Skeletal imaging by ¹⁸F-fludeoxyglucose positron emission tomography (¹⁸F-FDG PET)/CT has been shown to be useful in the detection of bone metastases of various carcinomas including DTC.⁷Previously, we compared the efficacies of ¹⁸F-FDG PET and planar ^99mTc bone scintigraphy for the detection of bone metastases in patients with DTC.⁸ We found that the specificity and the overall accuracy of ¹⁸F-FDG PET for the detection of bone metastases in patients with DTC were higher than those of planar ^99mTc bone scintigraphy, whereas the difference in the sensitivity of both examinations was not statistically significant, and concluded that ¹⁸F-FDG PET is superior to planar ^99mTc bone scintigraphy because of its lower incidence of false-positive results in the detection of bone metastases of DTC.⁸¹⁸F-fluoride is a positron-emitting bone-seeking radiotracer, which has a similar uptake mechanism to ^99mTc-MDP and ^99mTc-HMDP. As the availability of PET systems was increasing, ¹⁸F-fluoride has been used for skeletal PET imaging since 1990s. PET or PET/CT with ¹⁸F-fluoride have been shown to be more sensitive than planar ^99mTc bone scintigraphy for the detection of bone metastases of lung,⁹ breast,^10,11 hepatocellular,¹² prostate,^11,13,14 colon and bladder¹¹ cancers. However, to the best of our knowledge, there have been no systematic comparative studies on the efficacies of ¹⁸F-fluoride PET/CT, ¹⁸F-FDG PET/CT and ^99mTc bone scintigraphy (planar and SPECT) for the detection of bone metastases of DTC. This study was conducted to compare ¹⁸F-fluoride PET/CT, ¹⁸F-FDG PET/CT and ^99mTc bone scintigraphy (planar and SPECT) in the detection of bone metastases of DTC.     

Diagnostic performance of whole-body bone scintigraphy in combination with SPECT/CT for detection of bone metastases

Annals of Nuclear Medicine - This retrospective study investigated the performance of whole-body bone scintigraphy combined with SPECT/CT and established a grading diagnostic criterion for bone...     

A meta-analysis of <Superscript>18</Superscript>FDG-PET,MRI and bone scintigraphy for diagnosis of bone metastases in patients with breast cancer

Objective  

To perform a meta-analysis comparing the diagnostic value of ¹⁸FDG-PET, MRI, and bone scintigraphy (BS) in detecting bone metastases in patients with breast cancer.     

~(11)C-CHO PET/CT显像与全身骨显像在前列腺癌复发患者骨转移中诊断价值

目的探讨~(11)C-CHO PET/CT显像与全身骨显像在前列腺癌复发患者骨转移中的诊断价值。方法回顾性分析自2011年5月至2015年5月沈阳军区总医院核医学科收治的前列腺癌复发患者96例(PSA:2.5-56.0 mg/L)。所有患者均在2周内行~(11)C-CHO PET/CT显像与全身骨显像,以活检、18F-FDG PET/CT、增强CT、MRI、临床随访等综合评价为诊断标准,比较两者诊断的灵敏度、特异度。结果 96例患者中,~(11)C-CHO PET/CT显像与全身骨显像,共发现57个阳性病灶,其中,46个病灶经后续确诊为转移瘤。~(11)C-CHO PET/CT显像与全身骨显像诊断转移灶灵敏度分别为93.3%、69.6%,特异度分别为90.9%、36.4%。~(11)C-CHO PET/CT显像发现骨外转移26处:局部复发10处、膈下淋巴结4处、膈上淋巴结2处、局部复发合并膈下淋巴结5处、膈上合并膈下淋巴结4处以及膈上淋巴结合并肺转移1处。结论在诊断前列腺癌复发患者骨转移方面,~(11)C-CHO PET/CT显像的诊断灵敏度和特异度优于传统全身骨显像,并且~(11)C-CHO PET/CT显像能够发现局部复发、淋巴结和远处器官转移病灶,获得更加准确的临床分期,有助于选择合适的治疗方案。     

99Tcm-MDP SPECT/CT骨显像诊断恶性肿瘤骨转移的价值

目的探讨^99Tc^m-亚甲基二膦酸盐（MDP）SPECT／CT骨显像诊断恶性肿瘤骨转移的临床价值。方法73例恶性肿瘤或不明原因骨痛患者行^99Tc^m-MDP SPECT／CT全身骨平面和局部显像。获得全身骨平面、SPECT断层和CT图像及SPECT与CT融合图像后，结合病史、临床表现进行回顾性分析。结果SPECT／CT骨显像可提供精确的解剖定位，发现脊柱（31处）、肋骨（11处）、胸骨（4处）、锁骨（3处）、肩胛骨（1处）、骶骨（1处）、坐骨（3处）、骶髂关节（1处）和骨外（20处）有异常放射性浓聚灶。骨骼病变的性质与病灶部位有关，如病变累及椎体和（或）椎弓根，常提示肿瘤骨转移；累及椎小关节或椎体，呈“唇样”放射性浓聚，可考虑为良性病变。若平面显像呈“热区”，CT图像表现正常者，可考虑肿瘤骨转移。结论SPECT／CT骨显像诊断骨转移灶有较高临床价值。     

Comparison of whole-body MRI with automatic moving table technique and bone scintigraphy for screening for bone metastases in patients with breast cancer

The aim of this study was presentation of a whole-body MRI technique with a moving table as a screening tool for bone metastases in patients with breast cancer. Twenty-two patients with breast carcinoma underwent both a planar whole-body bone scintigraphy and whole-body MRI at 1.5 T. The MRI images were acquired with a moving table at six different anatomical positions within a measurement time of 20 min. Coronal images were acquired using a short-tau inversion recovery sequence, accomplished by an axial T2-weighted turbo-spin-echo sequence through the head, and a T1-weighted opposed-phase sagittal 2D fast low-angle shot sequence covering the whole spine. The MRI findings indicating bone metastases were compared with findings from bone scintigraphy. Metastatic lesions were confirmed by follow-up examinations over 1 year. Twelve patients showed bone metastases. Whole-body MRI was superior to bone scintigraphy in predicting lesion origin with a sensitivity of 92% (bone scintigraphy 83%), a specificity of 90% (scintigraphy 80%) and an accuracy of 91% (scintigraphy 82%). The MRI showed additional findings such as metastases of the lung and liver. Whole-body MRI with moving table technique may be an effective method of total body screening for bone in selected patients with breast carcinoma and a high risk of distant metastases, although with the higher costs of MRI bone scintigraphy must still be considered as the first method for screening patients with breast cancer.     

Comparison of diffusion-weighted whole body MRI and skeletal scintigraphy for the detection of bone metastases in patients with prostate or breast carcinoma

Purpose

To prospectively compare the diagnostic accuracy of diffusion-weighted whole body imaging with background whole body signal suppression (DWIBS) with skeletal scintigraphy for the diagnosis and differentiation of skeletal lesions in patients suffering from prostate or breast cancer.

Material and Methods

A diagnostic cohort of 36 patients was included in skeletal scintigraphy and 1.5 T DWIBS MRI. Based on morphology and signal intensity patterns, two readers each identified and classified independently, under blinded conditions, all lesions into three groups: (1) malignant, (2) unclear if malignant or benign and (3) benign. Finally, for the definition of the gold standard all available imaging techniques and follow-up over a minimum of 6 months were considered.

Results

Overall, 45 circumscribed bone metastases and 107 benign lesions were found. DWIBS performed significantly better in detecting malignant skeletal lesions in patients with more than 10 lesions (sensitivity: 0.97/0.91) compared to skeletal scintigraphy (sensitivity: 0.48/0.42). No statistical difference could be found between DWIBS (0.58/0.33) and skeletal scintigraphy (0.67/0.58) in the sensitivity values for malignant skeletal lesions in patients with less than 5 lesions. For benign lesions, scintigraphy scored best with a sensitivity of 0.93/0.87 compared to 0.20/0.13 for DWIBS. Interobserver agreement with Cohen’s kappa coefficient was calculated as 0.784 in the case of scintigraphy and 0.663 for DWIBS.

Conclusion

With respect to staging, in prostate and breast carcinoma, the DWIBS technique is not superior to skeletal scintigraphy, but ranks equally. However, in the cases with many bone lesions, markedly more metastases could be discovered using the DWIBS technique than skeletal scintigraphy.     

SPECT/低剂量CT融合显像技术在肺癌骨转移诊断中的应用

目的探讨SPECT/低剂量CT融合显像在肺癌骨转移诊断中的应用价值。方法选取59例肺癌疑似骨转移患者行99m Tc-MDP全身骨显像及SPECT/低剂量CT融合显像,以随访结果或活检病理学检查结果为诊断标准,比较两种检查方式诊断骨转移的灵敏度,特异度,准确率,阴性、阳性预测值,并分析肺癌骨转移影像学表现。结果1)59例肺癌患者疑似骨转移病灶146处,经随访确诊肺癌骨转移病灶115处,其中发生于脊椎51处,占44.35%,胸廓30处,26.09%,骨盆16处,占13.91%,四肢11处,占9.56%,颅骨7处,占6.09%;2)SPECT/低剂量CT融合显像诊断肺癌骨转移灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为:99.13%、93.55%、98.28%、93.55%、97.95%,均高于SPECT全身显像的97.39%、67.74%、91.80%、87.5%、91.10%,其中特异度、阳性预测值及准确率差异有统计学意义(Fisher=10.144、5.688、7.101,P<0.05);3)鳞癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为42.86%、28.57%、14.29%、7.14%、7.14%;溶骨性、成骨性骨破坏分别为75.00%、25.00%;腺癌:脊椎、胸廓、骨盆、四肢、颅骨转移率分别为46.34%、26.83%、13.41%、7.32%、6.10%;溶骨性、成骨性骨破坏分别为68.29%、30.49%,鳞癌、腺癌骨转移部位及骨破坏类型差异无统计学意义(P>0.05)。结论SPECT/低剂量CT融合显像在鉴别诊断肺癌骨转移方面具有良好临床价值,肺腺癌骨转移发生率较高。     

[11C]Choline PET/CT detection of bone metastases in patients with PSA progression after primary treatment for prostate cancer: comparison with bone scintigraphy

Purpose  

The aim of this study was to evaluate the clinical usefulness of [¹¹C]choline positron emission tomography (PET)/CT in comparison with bone scintigraphy (BS) in detecting bone metastases (BM) of patients with biochemical progression after radical treatment for prostate cancer (PCa).     

SPECT/CT同机融合显像对肿瘤患者骨转移灶的诊断价值

目的:评价SPECT/CT同机融合显像对单独SPECT难于确诊良恶性的骨病灶的鉴别诊断价值.方法:SPECT骨扫描难于确诊的对53例肿瘤患者的84个病灶行局部SPECT/CT同机融合断层显像.所有患者转移灶确诊以临床病理、MRI、CT、骨扫描复查或PET/CT检查为依据.结果:①SPECT显像无法确诊的84个病灶,经S...