Comparison of bone single-photon emission tomography and planar imaging in the detection of vertebral metastases in patients with back pain |
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Authors: | L J Han T K Au-Yong W C M Tong K S Chu L T Szeto C P Wong |
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Institution: | (1) Department of Nuclear Medicine, KLG, Queen Elizabeth Hospital, Kowloon, Hong Kong, HK |
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Abstract: | Bone scan has long been considered to be an important diagnostic test in searching for bone metastases. However, considerable
difficulty is encountered in the vertebral region due to the complexity of structures and the fact that other benign lesions,
especially degenerative changes, are very common there. Single-photon emission tomography (SPET) has been reported to be useful
in the differentiation of benign from malignant conditions. Here we report our experience with bone SPET in the diagnosis
of vertebral metastases. This is a retrospective study of technetium-99m methylene diphosphonate (MDP) bone scans in 174 consecutive
patients who were referred for the investigation of back pain in our department. MDP planar and SPET images were obtained.
Of teh 174 patients, 98 had a known history of malignant tumours. The diagnosis of vertebral metastasis was made on the basis
of the patients’ clinical histories and the findings with other imaging techniques such as magnetic resonance imaging, computed
tomography or follow-up bone scan. We found that the presence of pedicle involvement as seen on SPET was an accurate diagnostic
criterion of vertebral metastasis. SPET had a sensitivity of 87%, a specificity of 91%, a positive predictive value of 82%,
a negative predictive value of 94% and an accuracy of 90%. On the other hand, planar study had a sensitivity of 74%, a specificity
of 81%, a positive predictive value of 64%, a negative predictive value of 88% and an accuracy of 79% in diagnosing vertebral
metastasis. Except with regard to the negative predictive value, SPET performed statistically better than planar imaging.
Only 9/147 (6.4%) lesions involving the vertebral body alone and 3/49 (6.1%) lesions involving facet joints alone were subsequently
found to be metastases. We conclude that bone SPET is an accurate diagnostic test for the detection of vertebral metastases
and is superior to planar imaging in this respect.
Received 20 December 1997 and in revised form 16 March 1998 |
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Keywords: | : Vertebral metastases Bone scan Single-photon emission tomography Planar imaging |
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