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Alqahtani MM. Whole-Body SPECT/CT: Protocol Variation and Technical Consideration-A Narrative Review. Diagnostics (Basel) 2024; 14:1827. [PMID: 39202315 PMCID: PMC11353707 DOI: 10.3390/diagnostics14161827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/13/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
Introducing a hybrid imaging approach, such as single-photon emission computerized tomography with X-ray computed tomography (SPECT)/CT, improves diagnostic accuracy and patient management. The ongoing advancement of SPECT hardware and software has resulted in the clinical application of novel approaches. For example, whole-body SPECT/CT (WB-SPECT/CT) studies cover multiple consecutive bed positions, similar to positron emission tomography-computed tomography (PET/CT). WB-SPECT/CT proves to be a helpful tool for evaluating bone metastases (BM), reducing equivocal findings, and enhancing user confidence, displaying effective performance in contrast to planar bone scintigraphy (PBS). Consequently, it is increasingly utilized and might substitute PBS, which leads to new questions and issues concerning the acquisition protocol, patient imaging time, and workflow process. Therefore, this review highlights various aspects of WB-SPECT/CT acquisition protocols that need to be considered to help understand WB-SPECT/CT workflow processes and optimize imaging protocols.
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Affiliation(s)
- Mansour M. Alqahtani
- Department of Radiology and Medical Imaging, Faculty of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia;
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
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Albahiti SK, Khafaji M, Batawil N, Catipay N, Alsafi K. Enhancing Nuclear Medicine Practice in Saudi Arabia: Advocating for Comprehensive Guidelines and Local Diagnostic Reference Levels. Cureus 2024; 16:e54230. [PMID: 38496147 PMCID: PMC10944312 DOI: 10.7759/cureus.54230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Diagnostic reference levels (DRLs) were initially introduced by the International Commission on Radiation Protection (ICRP). It refers to the measured quantity of administered activity (MBq) in nuclear medicine imaging studies and is a type of investigation level. DRL is recommended to prevent excessive radiation exposure to patients while maintaining adequate image quality. It should not be implemented as a dose constraint or dose limit. The Saudi Food and Drug Authority (SFDA) is the primary government body responsible for reporting national diagnostic reference levels (NDRLs) for diagnostic medical imaging technologies in Saudi Arabia. Only NDRLs for computed tomography, general X-ray, and mammography have been published and enforced locally. This study aims to establish local DRLs for nuclear medicine imaging procedures at King Abdulaziz University Hospital, Saudi Arabia, preparing for compliance proof once required by local authorities. METHOD Data were collected from all machines, and six common protocols were studied, with data from 50 patients of standard body size for each identified protocol. The study was conducted retrospectively, and the 50th percentile was then calculated for each scan. RESULTS Both protocols for renal scans administered the lowest doses to patients (130 MBq and 148 MBq), respectively. The highest dose administered to patients was found to be in bone scans (1110 MBq). CONCLUSION The study establishes local DRLs for nuclear medicine imaging in our institution. Median activity dosages in renal, thyroid, and parathyroid imaging were comparable to locally and internationally published DRLs. However, they are higher in cardiac and bone imaging compared to local Saudi DRL and DRL in the European Union and the USA, likely due to the adopted protocols. These highlight the need for modifying the protocols to fulfill optimization efforts. These findings serve as a foundation for compliance with future regulatory requirements, ensuring patient safety and maintaining imaging quality in Saudi healthcare.
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Affiliation(s)
| | - Mawya Khafaji
- Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Norwin Catipay
- Radiology, King Abdulaziz University Hospital, Jeddah, SAU
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Filippi L, Frantellizzi V, De Vincentis G, Schillaci O. The new bone WB-SPECT/CT: hybrid, from head-to-toe and digital! Is it worth the effort? Expert Rev Med Devices 2023; 20:791-795. [PMID: 37623913 DOI: 10.1080/17434440.2023.2252743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION A bone scan (BS) plays a pivotal role in many oncological and non-oncological conditions. The planar BS is characterized by high sensitivity but low specificity. With respect to planar imaging, the implementation of single-photon emission computed tomography (SPECT) has allowed increased image contrast and more accurate tracer localization. AREAS COVERED Recent technological innovations in the field of BS are treated, with a particular focus on multi-field-of-view devices allowing to cover the entire scan length with a 3D acquisition (WB-SPECT/CT). In addition, the applications of cadmium zinc telluride/CzT detectors capable of converting gamma photons directly into electrical impulses (i.e. 'digital SPECT') are discussed. EXPERT OPINION Initial clinical experiences indicate that WB-SPECT/CT is characterized by higher sensitivity, diagnostic accuracy, and increased confidence in image interpretation with respect to the 'old-fashioned' BS (planar images with or without a single field-of-view SPECT). Furthermore, CzT-based detectors, thanks to their superior sensitivity, might be helpful to implement fast acquisition protocols. Further studies are needed to better define the clinical impact of bone CzT WB-SPECT/CT on patients' management and outcome, as well as its cost-benefit ratio.
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Affiliation(s)
- Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza University of Rome, Rome, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
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Isherwood AC, Cabral R, Avery G. Sub 4 minute superfast single-photon emission computed tomography/computed tomography as an add-on for problem-solving in planar bone scintigraphy: a time-saving solution for departments without whole-body single-photon emission computed tomography/computed tomography. Nucl Med Commun 2023; 44:407-413. [PMID: 36862421 DOI: 10.1097/mnm.0000000000001677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Whole-body bone scintigraphy remains widely used in nuclear medicine as it is a relatively inexpensive and quick test in which the whole body can be imaged with good sensitivity. However, one downside of the technique is its lack of specificity. The difficulty comes when there is a single 'hot spot' which usually requires further anatomical imaging to identify the cause and differentiate malignant from benign lesions. In this situation, hybrid imaging with single-photon emission computed tomography/computed tomography (SPECT/CT) can be a useful problem solver. The addition of SPECT/CT can however, be time-consuming, adding up to 15-20 min for every bed position required, a process that can tax the compliance of the patient and reduce the scanning capacity of the department. We report the successful implementation of a new superfast SPECT/CT protocol comprising a 1 s per view over 24 views point and shoot approach, reducing the SPECT scan time to less than 2 min and the whole SPECT/CT to under 4 min while still producing images that allow diagnostic certainty in previously equivocal lesions. This is faster than previously reported ultrafast SPECT/CT protocols. The utility of the technique is demonstrated in a pictorial review of four disparate causes of solitary bone lesions: fracture, metastasis, degenerative arthropathy and Paget's disease. This technique may prove a cost-effective problem-solving adjunct in nuclear medicine departments unable to yet offer whole-body SPECT/CT to every patient, without adding much burden to the department's gamma camera usage and patient throughput.
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Affiliation(s)
| | - Rita Cabral
- Hull University Teaching Hospital NHS Trust, Hull York Medical School, University of Hull, Hull, UK
| | - Ged Avery
- Hull University Teaching Hospital NHS Trust, Hull York Medical School, University of Hull, Hull, UK
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Matsutomo N, Fukami M, Yamamoto T. Impact of bone-equivalent solution density in a thoracic spine phantom on bone single-photon emission computed tomography image quality and quantification. Radiol Phys Technol 2023; 16:195-202. [PMID: 36877399 DOI: 10.1007/s12194-023-00706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/13/2023] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
This study aimed to evaluate the effects of dipotassium hydrogen phosphate (K2HPO4) solution density on single-photon emission computed tomography (SPECT) image quality and quantification. We used a JSP phantom containing six cylinders filled with K2HPO4 solutions of varying densities. Computed tomography (CT) was performed, and CT values and linear attenuation coefficients were measured. Subsequently, SPECT images of an SIM2 bone phantom filled with 99mTc with/without K2HPO4 solution were acquired using a SPECT/CT camera. The full width at half maximum (FWHM), percentage coefficient of variation (%CV), recovery coefficient, and standardized uptake value (SUV) were evaluated to investigate the impact of the K2HPO4 solution density. The CT values and linear attenuation coefficients increased with the K2HPO4 solution density. The CT values for cancellous and cortical bones were reflected by K2HPO4 solution densities of 0.15-0.20 and 1.50-1.70 g/cm3, respectively. FWHM values were significantly lower with the K2HPO4 solution than those with water alone (18.0 ± 0.9 mm with water alone, 15.6 ± 0.2 mm with 0.15 g/cm3 K2HPO4, and 16.1 ± 0.3 mm with 1.49 g/cm3 K2HPO4). Although the %CVs showed no significant differences, the recovery coefficients obtained with water alone tended to be slightly lower than those obtained with the K2HPO4 solution. The SUV obtained using the standard density of the K2HPO4 solution differed from that obtained using the optimized density. In conclusion, SPECT image quality and quantification depends on the presence and concentration of the bone-equivalent solution. The optimal bone-equivalent solution density should be used to evaluate the bone image phantoms.
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Affiliation(s)
- Norikazu Matsutomo
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-524, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan.
| | - Mitsuha Fukami
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-524, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
| | - Tomoaki Yamamoto
- Department of Medical Radiological Technology, Faculty of Health Sciences, Kyorin University, B-524, 5-4-1 Shimorenjaku Mitaka-shi, Tokyo, 181-8612, Japan
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Whole-body single photon emission computed tomography/computed tomography for assessment of oncological bone disease - is an extended field of view (from vertex to toes) of clinical value? Nucl Med Commun 2023; 44:131-136. [PMID: 36524763 DOI: 10.1097/mnm.0000000000001647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Whole-body single photon emission computed tomography/computed tomography (WB-SPECT/CT) is useful for diagnosing bone metastases. When performed on a dual-headed gamma camera, this may cover from clavicles to proximal femurs due to time constraints. In contrast, the novel 360 o cadmium-zinc-telluride scanner can perform WB-SPECT/CT (from vertex to toes) in approximately 20 min. The aim was to assess the prevalence of additional findings above the clavicles and below the lesser trochanters and the prevalence of incidental findings in the CT component. METHODS Retrospective study of 117 WB-SPECT/CT scans for oncological bone assessment over a 4-month-period. Scan analysis was performed by two independent experienced radionuclide radiologists. RESULTS The male:female ratio was 71:46 and the mean patient age was 68 years. The primary malignancies were predominantly prostate 65/117 (55.6%) and breast 40/117 (34.2%). There were additional findings of malignancy above the clavicles in 16/116 scans (13.8%) and below the lesser trochanters in 16/117 scans (13.7%). Two cases in the 'above the clavicles' group were suspected solitary metastases, whereas four cases in the 'below lesser trochanters' group were bone metastases at risk of pathological fracture. Incidental findings of clinical significance included suspected new malignancy in 11/117 (9.4%). CONCLUSION A WB-SPECT/CT (from vertex to toes) oncological bone protocol is useful for the detection of additional findings of clinical significance above the clavicles and below the lesser trochanters. Reviewing and reporting the CT findings in SPECT/CT is important.
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Arvola S, Seppänen M, Timonen KL, Rautio P, Ettala O, Anttinen M, Boström PJ, Noponen T. Detection of prostate cancer bone metastases with fast whole-body 99mTc-HMDP SPECT/CT using a general-purpose CZT system. EJNMMI Phys 2022; 9:85. [PMID: 36508016 PMCID: PMC9743860 DOI: 10.1186/s40658-022-00517-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We evaluated the effects of acquisition time, energy window width, and matrix size on the image quality, quantitation, and diagnostic performance of whole-body 99mTc-HMDP SPECT/CT in the primary metastasis staging of prostate cancer. METHODS Thirty prostate cancer patients underwent 99mTc-HMDP SPECT/CT from the top of the head to the mid-thigh using a Discovery NM/CT 670 CZT system with list-mode acquisition, 50-min acquisition time, 15% energy window width, and 128 × 128 matrix size. The acquired list-mode data were resampled to produce data sets with shorter acquisition times of 41, 38, 32, 26, 20, and 16 min, narrower energy windows of 10, 8, 6, and 4%, and a larger matrix size of 256 × 256. Images were qualitatively evaluated by three experienced nuclear medicine physicians and quantitatively evaluated by noise, lesion contrast and SUV measurements. Diagnostic performance was evaluated from the readings of two experienced nuclear medicine physicians in terms of patient-, region-, and lesion-level sensitivity and specificity. RESULTS The originally acquired images had the best qualitative image quality and lowest noise. However, the acquisition time could be reduced to 38 min, the energy window narrowed to 8%, and the matrix size increased to 256 × 256 with still acceptable qualitative image quality. Lesion contrast and SUVs were not affected by changes in acquisition parameters. Acquisition time reduction had no effect on the diagnostic performance, as sensitivity, specificity, accuracy, and area under the receiver-operating characteristic curve were not significantly different between the 50-min and reduced acquisition time images. The average patient-level sensitivities of the two readers were 88, 92, 100, and 96% for the 50-, 32-, 26-, and 16-min images, respectively, and the corresponding specificities were 78, 84, 84, and 78%. The average region-level sensitivities of the two readers were 55, 58, 59, and 56% for the 50-, 32-, 26-, and 16-min images, respectively, and the corresponding specificities were 95, 98, 96, and 95%. The number of equivocal lesions tended to increase as the acquisition time decreased. CONCLUSION Whole-body 99mTc-HMDP SPECT/CT can be acquired using a general-purpose CZT system in less than 20 min without any loss in diagnostic performance in metastasis staging of high-risk prostate cancer patients.
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Affiliation(s)
- Samuli Arvola
- grid.410552.70000 0004 0628 215XDepartment of Clinical Physiology, Nuclear Medicine and Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, P.O. Box 52, 20521 Turku, Finland
| | - Marko Seppänen
- grid.410552.70000 0004 0628 215XDepartment of Clinical Physiology, Nuclear Medicine and Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, P.O. Box 52, 20521 Turku, Finland
| | - Kirsi L. Timonen
- grid.513298.4Department of Clinical Physiology and Nuclear Medicine, Hospital Nova of Central Finland, Jyväskylä, Finland
| | - Pentti Rautio
- grid.416446.50000 0004 0368 0478Department of Clinical Physiology, North Karelia Central Hospital, Joensuu, Finland
| | - Otto Ettala
- grid.1374.10000 0001 2097 1371Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Mikael Anttinen
- grid.1374.10000 0001 2097 1371Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J. Boström
- grid.1374.10000 0001 2097 1371Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tommi Noponen
- grid.410552.70000 0004 0628 215XDepartment of Clinical Physiology, Nuclear Medicine and Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, P.O. Box 52, 20521 Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Medical Physics, Turku University Hospital, Turku, Finland
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Alqahtani M, Willowson K, Fulton R, Constable C, Kench P. Transition to Fast Whole-Body SPECT/CT Bone Imaging: An Assessment of Image Quality. Diagnostics (Basel) 2022; 12:2938. [PMID: 36552946 PMCID: PMC9776819 DOI: 10.3390/diagnostics12122938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/20/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the impact of reduced SPECT acquisition time on reconstructed image quality for diagnostic purposes. METHOD Data from five patients referred for a routine bone SPECT/CT using the standard multi-bed SPECT/CT protocol were reviewed. The acquisition time was 900 s using gating technique; SPECT date was resampled into reduced data sets of 480 s, 450 s, 360 s and 180 s acquisition duration per bed position. Each acquisition time was reconstructed using a fixed number of subsets (8 subsets) and 4, 8, 12, and 16 iterations, followed by a post-reconstruction 3D Gaussian filter of 8 mm FWHM. Two Nuclear Medicine physicians analysed all images independently to score image quality, noise and diagnostic confidence based on a pre-defined 4-point scale. RESULTS Our result showed that the most frequently selected categories for 480 s and 450 s images were good image quality, average noise and fair confidence, particularly at lower iteration numbers 4 and 8. For the shortened acquisition time of 360 s and 180 s, statistical significance was observed in most reconstructed images compared with 900 s. CONCLUSION The SPECT/CT can significantly shorten the acquisition time with maintained image quality, noise and diagnostic confidence. Therefore, acquiring data over 480 s and 450 s is feasible for WB-SPECT/CT bone scans to provide an optimal balance between acquisition time and image quality.
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Affiliation(s)
- Mansour Alqahtani
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Department of Radiology and Medical Imaging, Faculty of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia
| | - Kathy Willowson
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
- Institute of Medical Physics, Faculty of Science, The University of Sydney, Sydney, NSW 2006, Australia
| | - Roger Fulton
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Department of Medical Physics, Westmead Hospital, Sydney, NSW 2145, Australia
| | - Chris Constable
- HERMES Medical Solutions, Strandbergsgatan 16, 112 51 Stockholm, Sweden
| | - Peter Kench
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
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Filippi L, Palumbo B, Frantellizzi V, Nuvoli S, De Vincentis G, Spanu A, Schillaci O. Prostate-specific membrane antigen-directed imaging and radioguided surgery with single-photon emission computed tomography: state of the art and future outlook. Expert Rev Med Devices 2022; 19:815-824. [PMID: 36370108 DOI: 10.1080/17434440.2022.2146999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Prostate-specific membrane antigen (PSMA) has emerged as a highly relevant target for prostate cancer (PC) diagnosis and therapy. PSMA inhibitors targeting PSMA-enzymatic domain have been successfully labeled with radionuclides emitting positrons or gamma-photons, thus obtaining tracers suitable for imaging with positron emission computed tomography (PET/CT) or single-photon emission tomography (SPECT). AREAS COVERED The different approaches for obtaining PSMA-ligands labeled with gamma-emitting nuclides (99mTc or111In) are reviewed. Furthermore, the applications of 99mTc/111In-PSMA SPECT for the imaging of PC patients in different clinical settings (staging or biochemical recurrence) are covered. Lastly, the employment of PSMA-targeted SPECT tracers for radioguided surgery (RGS) during primary or salvage lymphadenectomy is discussed. EXPERT OPINION RGS provided satisfying preliminary results in both primary and salvage lymphadenectomy, allowing to discriminate between pathological and non-pathological nodes with high accuracy, although prospective studies with larger cohorts are needed to further validate this surgical approach. The potential of PSMA-targeted SPECT/CT has not been fully explored yet, but it might represent a relatively cost-effective alternative to PSMA PET/CT in limited resource environments. In this perspective, the implementation of novel SPECT technologies or algorithms, such as semiconductor-ionization detectors or resolution recovery reconstruction, will be topic of future investigation.
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Affiliation(s)
- Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, Latina, Italy
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Medicine and Surgery, Università Degli Studi di Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza University of Rome, 00161 Rome, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
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Comparison of reprojected bone SPECT/CT and planar bone scintigraphy for the detection of bone metastases in breast and prostate cancer. Nucl Med Commun 2022; 43:510-517. [PMID: 35081092 DOI: 10.1097/mnm.0000000000001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare reprojected bone SPECT/CT (RBS) against planar bone scintigraphy (BS) in the detection of bone metastases in breast and prostate cancer patients. METHODS Twenty-six breast and 105 prostate cancer patients with high risk for bone metastases underwent 99mTc-HMDP BS and whole-body SPECT/CT, 1.5-T whole-body diffusion-weighted MRI and 18F-NaF or 18F-PSMA-1007 PET/CT within two prospective clinical trials (NCT01339780 and NCT03537391). Consensus reading of all imaging modalities and follow-up data were used to define the reference standard diagnosis. The SPECT/CT data were reprojected into anterior and posterior views to produce RBS images. Both BS and RBS images were independently double read by two pairs of experienced nuclear medicine physicians. The findings were validated against the reference standard diagnosis and compared between BS and RBS on the patient, region and lesion levels. RESULTS All metastatic patients detected by BS were also detected by RBS. In addition, three metastatic patients were missed by BS but detected by RBS. The average patient-level sensitivity of two readers for metastases was 75% for BS and 87% for RBS, and the corresponding specificity was 79% for BS and 39% for RBS. The average region-level sensitivity of two readers was 64% for BS and 69% for RBS, and the corresponding specificity was 96% for BS and 87% for RBS. CONCLUSION Whole-body bone SPECT/CT can be reprojected into more familiar anterior and posterior planar images with excellent sensitivity for bone metastases, making additional acquisition of planar BS unnecessary.
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Ichikawa H, Kawakami K, Onoguchi M, Shibutani T, Nagatake K, Hosoya T, Ito T, Kato T, Tsuchikame H, Shimada H. Automatic quantification package (Hone Graph) for phantom-based image quality assessment in bone SPECT: computerized automatic classification of detectability. Ann Nucl Med 2021; 35:937-946. [PMID: 34028702 DOI: 10.1007/s12149-021-01631-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/12/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We previously developed a custom-design thoracic bone scintigraphy-specific phantom ("SIM2 bone phantom") to assess image quality in bone single-photon emission computed tomography (SPECT). We aimed to develop an automatic assessment system for imaging technology in bone SPECT and demonstrate the validity of this system. METHODS Four spherical lesions of 13-, 17-, 22-, and 28-mm diameters in the vertebrae of SIM2 bone phantom simulating the thorax were filled with radioactivity (target-to-background ratio: 4). Dynamic SPECT acquisitions were performed for 15 min; reconstructions were performed using ordered subset expectation maximization at 3-15-min timepoints. Consequently, 216 lesions (54 SPECT images) were obtained: 120 and 96 lesions were used for software development and validation, respectively. The developed software used statistical parametric mapping to rigidly register and automatically calculate quantitative indexes (contrast-to-noise ratio, % coefficient of variance, % detectability equivalence volume, recovery coefficient, target-to-normal bone ratio, and full width at half maximum). A detectability score (DS) was used to define the four observation types (4, excellent; 3, adequate; 2, average; 1, poor) to score hot spherical lesions. The gold standard for DSs was independently classified by three experienced board-certified nuclear medicine technologists using the four observation types; thereafter, a consensus regarding the gold standard for DSs was reached. Using 120 lesions for development, decision tree analysis was performed to determine DS based on the quantitative indexes. We verified the validation of the quantitative indexes and their threshold values for automatic classification using 96 lesions for validation. RESULTS The trends in the automatically calculated quantitative indices were consistent. Decision tree analysis produced four terminal groups; two quantitative indexes (% detectability equivalence volume and contrast-to-noise ratio) were used to classify DS. The automatically classified DSs exhibited an almost perfect agreement with the gold standard. The percentage agreement and kappa coefficient were 91.7% and 0.93, respectively, in 96 lesions for validation. CONCLUSIONS The developed software automatically classified the detectability of hot lesions in the SIM2 bone phantom using the automatically calculated quantitative indexes, suggesting that this software could provide a means to automatically perform detectability analysis after data input that is excellent in reproducibility and accuracy.
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Affiliation(s)
- Hajime Ichikawa
- Department of Radiology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 4418570, Japan
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Kazunori Kawakami
- Diagnostic Products Marketing Dept, FUJIFILM Toyama Chemical Co, Ltd. 14-1, Kyobashi 2-Chome, Chuo-Ku, Tokyo, 1040031, Japan
| | - Masahisa Onoguchi
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan.
| | - Takayuki Shibutani
- Department of Quantum Medical Technology, Graduate School of Medical Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 9200942, Japan
| | - Kazuki Nagatake
- Quality Assurance Department, FUJIFILM Toyama Chemical Co., Ltd, 14-1, Kyobashi 2-Chome, Chuo-Ku, Tokyo, 1040031, Japan
| | - Tetsuo Hosoya
- Quality Assurance Department, FUJIFILM Toyama Chemical Co., Ltd, 14-1, Kyobashi 2-Chome, Chuo-Ku, Tokyo, 1040031, Japan
| | - Toshimune Ito
- Department of Radiological Technology, Faculty of Medical Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Toyohiro Kato
- Department of Radiology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 4418570, Japan
| | - Hirotatsu Tsuchikame
- Department of Radiology, Saiseikai Yokohamashi Tobu Hospital, Tsurumi Ward, 3-6-1 Shimosueyoshi, Yokohama, Kanagawa, 2300012, Japan
| | - Hideki Shimada
- Department of Radiology, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-Cho, Toyohashi, Aichi, 4418570, Japan
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Mostafa R, Abdelhafez YG, Abougabal M, Nardo L, Elkareem MA. Two-bed SPECT/CT versus planar bone scintigraphy: prospective comparison of reproducibility and diagnostic performance. Nucl Med Commun 2021; 42:360-368. [PMID: 33346602 DOI: 10.1097/mnm.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Rehab Mostafa
- Nuclear Medicine Unit, Department of Radiation Oncology and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Yasser G Abdelhafez
- Nuclear Medicine Unit, Department of Radiation Oncology and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
- Department of Radiology, University of California Davis, Sacramento, California, USA
| | - Mahasen Abougabal
- Nuclear Medicine Unit, Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lorenzo Nardo
- Department of Radiology, University of California Davis, Sacramento, California, USA
| | - Maha A Elkareem
- Nuclear Medicine Unit, Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Pesapane F, Downey K, Rotili A, Cassano E, Koh DM. Imaging diagnosis of metastatic breast cancer. Insights Imaging 2020; 11:79. [PMID: 32548731 PMCID: PMC7297923 DOI: 10.1186/s13244-020-00885-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
Numerous imaging modalities may be used for the staging of women with advanced breast cancer. Although bone scintigraphy and multiplanar-CT are the most frequently used tests, others including PET, MRI and hybrid scans are also utilised, with no specific recommendations of which test should be preferentially used. We review the evidence behind the imaging modalities that characterise metastases in breast cancer and to update the evidence on comparative imaging accuracy.
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Affiliation(s)
- Filippo Pesapane
- Breast Imaging Division, IEO - European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milano, MI, Italy.
| | - Kate Downey
- Department of Breast Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Anna Rotili
- Breast Imaging Division, IEO - European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milano, MI, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO - European Institute of Oncology IRCCS, Via Giuseppe Ripamonti, 435, 20141, Milano, MI, Italy
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK.,Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
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14
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Israel O, Pellet O, Biassoni L, De Palma D, Estrada-Lobato E, Gnanasegaran G, Kuwert T, la Fougère C, Mariani G, Massalha S, Paez D, Giammarile F. Two decades of SPECT/CT - the coming of age of a technology: An updated review of literature evidence. Eur J Nucl Med Mol Imaging 2019; 46:1990-2012. [PMID: 31273437 PMCID: PMC6667427 DOI: 10.1007/s00259-019-04404-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was introduced as a hybrid SPECT/CT imaging modality two decades ago. The main advantage of SPECT/CT is the increased specificity achieved through a more precise localization and characterization of functional findings. The improved diagnostic accuracy is also associated with greater diagnostic confidence and better inter-specialty communication. METHODS This review presents a critical assessment of the relevant literature published so far on the role of SPECT/CT in a variety of clinical conditions. It also includes an update on the established evidence demonstrating both the advantages and limitations of this modality. CONCLUSIONS For the majority of applications, SPECT/CT should be a routine imaging technique, fully integrated into the clinical decision-making process, including oncology, endocrinology, orthopaedics, paediatrics, and cardiology. Large-scale prospective studies are lacking, however, on the use of SPECT/CT in certain clinical domains such as neurology and lung disorders. The review also presents data on the complementary role of SPECT/CT with other imaging modalities and a comparative analysis, where available.
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Affiliation(s)
- Ora Israel
- Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel.
| | - O Pellet
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - L Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D De Palma
- Nuclear Medicine Unit, Circolo Hospital, ASST-Settelaghi, Varese, Italy
| | - E Estrada-Lobato
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - G Gnanasegaran
- Department of Nuclear Medicine, Royal Free NHS Foundation Trust, London, UK
| | - T Kuwert
- Clinic of Nuclear Medicine, University Hospital, Erlangen, Germany
| | - C la Fougère
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital, Tubingen, Germany
| | - G Mariani
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - S Massalha
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Department of Nuclear Medicine, Rambam Healthcare Campus, Haifa, Israel
| | - D Paez
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - F Giammarile
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
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15
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Fleury V, Ferrer L, Colombié M, Rusu D, Le Thiec M, Kraeber-Bodéré F, Campion L, Rousseau C. Advantages of systematic trunk SPECT/CT to planar bone scan (PBS) in more than 300 patients with breast or prostate cancer. Oncotarget 2018; 9:31744-31752. [PMID: 30167091 PMCID: PMC6114966 DOI: 10.18632/oncotarget.25860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/18/2018] [Indexed: 01/03/2023] Open
Abstract
PROPOSE The aim of our study was to evaluate the potential benefit of a systematic trunk SPECT/CT associated with a Planar Bone Scan (PBS) in breast cancer (BC) and prostate cancer (PCa) patients at initial staging or recurrence. RESULTS In 328 patients, sensitivities and specificities were between 74.4-93% and 78.8-97.5% for PBS and 97.7-100% and 96.8-98.6% for SPECT/CT respectively. PBS was considered equivocal for 67 compared to only 6 patients for trunk SPECT/CT. Regardless of "optimistic" or "pessimistic" analysis of equivocal trunk SPECT/CT lesions, the trunk SPECT/CT was almost perfect, allowing to rely on this result for excluding metastatic disease which was corroborated by ROC curve analysis. The trunk SPECT/CT allowed downstaging for 62 patients (19%) and upstaging for 11 patients. MATERIALS AND METHODS PBS and a trunk SPECT/CT were systematically performed in all patients. Independent review of PBS and trunk SPECT/CT was performed for each patient and an abnormality interpretative score (Sc) with 3 levels was built: Sc 1: metastatic or probably metastatic pattern, Sc 2: equivocal pattern, Sc 3: benign or probably benign pattern or no abnormality. The bone pattern status was defined by at least 1 year follow-up. The clinical impact was evaluated in terms of down and upstaging in patient analysis. CONCLUSIONS Trunk SPECT/CT improves the performance of PBS in BC and PCa assessments and results in improvements in both the detection performance of bone metastases as well as a better characterization of equivocal lesions.
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Affiliation(s)
- Vincent Fleury
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, France
| | - Ludovic Ferrer
- Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France
- Medical Physics Unit, ICO Cancer Center, Saint Herblain, France
| | | | - Daniéla Rusu
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, France
| | - Maëlle Le Thiec
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, France
| | - Françoise Kraeber-Bodéré
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, France
- Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France
| | - Loïc Campion
- Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France
- Biometrics Unit, ICO Gauducheau Cancer Center, Saint Herblain, France
| | - Caroline Rousseau
- Nuclear Medicine Unit, ICO Cancer Center, Saint Herblain, France
- Nantes-Angers Cancer Research Center, INSERM U892, CNRS UMR 6299, University of Nantes, Nantes, France
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Rathke H, Afshar-Oromieh A, Giesel FL, Kremer C, Flechsig P, Haufe S, Mier W, Holland-Letz T, De Bucourt M, Armor T, Babich JW, Haberkorn U, Kratochwil C. Intraindividual Comparison of 99mTc-Methylene Diphosphonate and Prostate-Specific Membrane Antigen Ligand 99mTc-MIP-1427 in Patients with Osseous Metastasized Prostate Cancer. J Nucl Med 2018; 59:1373-1379. [PMID: 29371410 DOI: 10.2967/jnumed.117.200220] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/09/2018] [Indexed: 12/19/2022] Open
Abstract
The objective of this study was to evaluate the rate of detection of bone metastases obtained with the prostate-specific membrane antigen (PSMA)-targeting tracer 99mTc-MIP-1427, as opposed to conventional bone scanning with 99mTc-methylene diphosphonate (99mTc-MDP), in a collective of patients with known advanced-stage osseous metastasized prostate cancer. Methods: Twenty-one patients with known metastatic disease were staged with both conventional bone scanning and PSMA ligand scintigraphy within a time frame of less than 10 d. Imaging included planar whole-body scanning and SPECT or SPECT/CT with 2 bed positions 3 h after injection of either 500-750 MBq of 99mTc-MIP-1427 or 600-750 MBq of 99mTc-MDP. Lesions were scored as typical tumor, equivocal (benign/malignant), or normal within a standard reporting schema divided into defined anatomic regions. Masked and consensus readings were performed with sequential unmasking: planar scans first, then SPECT/CT, the best evaluable comparator (including MRI), PET/CT, and follow-up examinations. Results: Eleven patients had PSMA-positive visceral metastases that were predictably not diagnosed with conventional bone scanning. However, SPECT/CT was required to distinguish between soft-tissue uptake and overlapping bone. Four patients had extensive 99mTc-MDP-negative bone marrow lesions. Seven patients had superscan characteristics on bone scans; in contrast, the extent of red marrow involvement was more evident on PSMA scans. Only 3 patients had equivalent results on bone scans and PSMA scans. In 16 patients, more suspect lesions were detected with PSMA scanning than with bone scanning. In 2 patients (10%), a PSMA-negative tumor phenotype was present. Conclusion: PSMA scanning provided a clear advantage over bone scanning by reducing the number of equivocal findings in most patients. SPECT/CT was pivotal for differentiating bone metastases from extraosseous tumor lesions.
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Affiliation(s)
- Hendrik Rathke
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Frederik Lars Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Christophe Kremer
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine Haufe
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Walter Mier
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Tim Holland-Letz
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | | | - Thomas Armor
- Progenics Pharmaceuticals Inc., New York, New York
| | - John W Babich
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Cornell Medical College, New York, New York; and
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Whole-Body SPECT/CT versus Planar Bone Scan with Targeted SPECT/CT for Metastatic Workup. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7039406. [PMID: 28812019 PMCID: PMC5546128 DOI: 10.1155/2017/7039406] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/14/2017] [Accepted: 06/22/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE The use of SPECT/CT in bone scans has been widespread in recent years, but there are no specific guidelines concerning the optimal acquisition protocol. Two strategies have been proposed: targeted SPECT/CT for equivocal lesions detected on planar images or systematic whole-body SPECT/CT. Our aim was to compare the diagnostic accuracy of the two approaches. METHODS 212 consecutive patients with a history of cancer were referred for bone scans to detect bone metastases. Two experienced readers randomly evaluated for each patient either planar images with one-field SPECT/CT targeted on equivocal focal uptakes (targeted SPECT/CT) or a whole-body (two-field) SPECT/CT acquisition from the base of the skull to the proximal femurs (whole-body SPECT/CT). The exams were categorized as "nonmetastatic," "equivocal," or "metastatic" on both protocols. The presence or absence of any extra-axial skeletal lesions was also assessed. The sensitivity and specificity of both strategies were measured using the results of subsequent imaging follow-up as the reference standard. RESULTS Whole-body SPECT/CT had a significantly higher sensitivity than targeted SPECT/CT to detect bone metastases (p = 0.0297) and to detect extra-axial metastases (p = 0.0266). There was no significant difference in specificity among the two approaches. CONCLUSION Whole-body SPECT/CT is the optimal modality of choice for metastatic workup, including detection of extra-axial lesions, with improved sensitivity and similar specificity compared to targeted SPECT/CT.
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18
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Abikhzer G, Srour S, Fried G, Drumea K, Kozlener E, Frenkel A, Israel O, Fogelman I, Kagna O. Prospective comparison of whole-body bone SPECT and sodium 18F-fluoride PET in the detection of bone metastases from breast cancer. Nucl Med Commun 2017; 37:1160-8. [PMID: 27536906 DOI: 10.1097/mnm.0000000000000568] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The superiority of sodium F-fluoride PET (F-PET)/computed tomography (CT) over planar and single field-of-view single-photon emission computed tomography (SPECT) bone scintigraphy with Tc-methylene diphosphonate in bone metastases detection has been established. The present study prospectively compares whole-body Tc-methylene diphosphonate SPECT (WB-SPECT) and F-PET performance indices for the detection of bone metastases in breast cancer. METHODS A total of 41 pairs of studies in female breast cancer patients (average age 58 years, range 30-75) were included. Half-time WB-SPECT and F-PET/CT were performed at a 4-day average interval (range 0-36 days), with subsequent fusion of CT to WB-SPECT. Two readers independently interpreted the studies, with differences resolved by consensus. Composite gold standard included the CT component of the F-PET/CT study with follow-up CT, MRI, F-fluoro-deoxyglucose-PET/CT, and bone scans. RESULTS On patient-based analysis, metastases were diagnosed in 21 patients, with 19 patients detected by WB-SPECT and 21 with F-PET, the latter being the only modality to detect a single metastasis in two patients. The sensitivity of WB-SPECT and F-PET was 90 and 100% (P=NS), and the specificity were 95 and 85%, respectively (P=NS). On lesion-based analysis, 284 total sites of increased uptake were found. WB-SPECT detected 171/284 (60%) and F-PET 268/284 (94%) lesions, with good interobserver agreement for WB-SPECT (κ=0.679) and excellent agreement for F-PET (κ=0.798). The final analysis classified 204 lesions as benign and 80 as metastases. WB-SPECT identified 121 benign and 50 malignant sites compared with 192 and 76, respectively, for F-PET. WB-SPECT and F-PET had a sensitivity of 63 vs. 95%, P-value of less than 0.001, and a specificity of 97 vs. 96% (P=NS), respectively, on lesion-based analysis. CONCLUSION F-PET had higher sensitivity for the diagnosis of bone metastases from breast cancer compared with WB-SPECT, showing a statistically significant 32% increase on lesion-based analysis.
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Affiliation(s)
- Gad Abikhzer
- Departments of aNuclear Medicine bRadiology cOncology, Rambam Health Care Campus dTechnion - Israel Institute of Technology, B. and R. Rapaport Faculty of Medicine, Haifa eDepartment of Radiology, MRI Unit, Ziv Medical Center fFaculty of Medicine in the Galilee, Bar Ilan University, Zefat, Israel gDepartment of Nuclear Medicine, McGill University Health Centre hFaculty of Medicine, McGill University, Montreal, Quebec, Canada iDepartment of Nuclear Medicine, Guy's Hospital, King's College, London, UK
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