Abstract
Objective
The objective of the present study was to compare the role of single photon emission computed tomography (SPECT), computed tomography (CT) and SPECT-CT of selected volume in lung cancer patients with indeterminate lesions on planar bone scintigraphy (BS).
Methods
The data of 50 lung cancer patients (53 ± 10.3 years; range 30–75; male/female 38/12) with 65 indeterminate lesions on planar BS (January 2010 to November 2010) were retrospectively evaluated. All of them underwent SPECT-CT of a selected volume. SPECT, CT and SPECT-CT images were independently evaluated by two experienced readers (experience in musculoskeletal imaging, including CT: 5 and 7 years) in separate sessions. A scoring scale of 1 to 5 was used, in which 1 is definitely metastatic, 2 is probably metastatic, 3 is indeterminate, 4 is probably benign and 5 is definitely benign. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each modality, taking a score ≤2 as metastatic. With receiver operating characteristic (ROC) curve analysis, areas under the curve (AUC) were calculated for each modality and compared. Clinical and imaging follow-up and/or histopathology were taken as reference standard.
Results
For both readers SPECT was inferior to CT (P = 0.004, P = 0.022) and SPECT-CT (P = 0.003, P = 0.037). However, no significant difference was found between CT and SPECT-CT for reader 1 (P = 0.847) and reader 2 (P = 0.592). The findings were similar for lytic as well as sclerotic lesions. Moderate inter-observer agreement was seen for SPECT images (к = 0.426), while almost perfect agreement was seen for CT (к = 0.834) and SPECT-CT (к = 0.971).
Conclusion
CT alone and SPECT-CT are better than SPECT for accurate characterisation of indeterminate lesions on planar BS in lung cancer patients. CT alone is not inferior to SPECT-CT for this purpose and might be preferred because of shorter acquisition time and wider availability.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman DCA. Global cancer statistics. Cancer J Clin. 2011;61:69–90.
Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest. 2003;123:137S–46S.
Jacobson AF, Fogelman I. Bone scanning in clinical oncology: does it have a future? Eur J Nucl Med. 1998;25:1219–23.
Gayed I, Vu T, Johnson M, et al. Comparison of bone and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography in the evaluation of bony metastases in lung cancer. Mol Imaging Biol. 2003;5:26–31.
Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ. Radionuclide bone imaging: an illustrative review. RadioGraphics. 2003;23:341–58.
Even-Sapir E. Imaging of malignant bone involvement by morphologic, scintigraphic and hybrid modalities. J Nucl Med. 2005;46:1356–67.
Reinartz P, Schaffeldt J, Sabri O, Zimny M, Nowak B, Ostwald E. Benign versus malignant osseous lesions in the lumbar vertebrae: differentiation by means of bone SPECT. Eur J Nucl Med. 2000;27:721–6.
Kalemkerian GP, Akerley W, Bogner P. NCCN clinical practice guidelines in oncology, version 2.2012. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 30.6.2011.
Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology. 2006;238:264–71.
Ndlovua X, Georgeb R, Ellmanna A, Warwicka J. Should SPECT-CT replace SPECT for the evaluation of equivocal bone scan lesions in patients with underlying malignancies? Nucl Med Commun. 2010;31:659–65.
Cook GJ, Fogelman I. The role of positron emission tomography in the management of bone metastases. Cancer. 2000;88:2927–33.
Even-Sapir E, Metser U, Flusser G, et al. Assessment of malignant skeletal disease: initial experience with 18F-fluoride PET/CT and comparison between 18F-fluoride PET and 18F-fluoride PET/CT. J Nucl Med. 2004;45:272–8.
Metz CE. Basic principles of ROC analysis. Semin Nucl Med. 1978;8:283–98.
Svanholm H, Starklint H, Gundersen HJ, Fabricius J, Barlebo H, Olsen S. Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic. APMIS. 1989;97:689–98.
Hamaoka T, Madewell JE, Podoloff DA, Hortobagyi GN, Ueno NT. Bone imaging in metastatic breast cancer. J Clin Oncol. 2005;22:2924–53.
Savelli G, Maffioli L, Maccauro M, De Deckere E, Bombardieri E. Bone scintigraphy and the added value of SPECT (single photon emission tomography) in detecting skeletal lesions. Q J Nucl Med. 2001;45:27–37.
Schillaci O, Danieli R, Manni C, Simonetti G. Is SPECT/CT with a hybrid camera useful to improve scintigraphic imaging interpretation? Nucl Med Commun. 2004;25:705–10.
Bristow AR, Agrawal A, Evans AJ, Burrell HC, Cornford EJ, James JJ, et al. Can computerised tomography replace bone scintigraphy in detecting bone metastases from breast cancer? A prospective study. Breast. 2008;17:98–103.
Conflict of interest
The authors declare that there is no conflict of interest. No financial assistance was received from any organisation for this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sharma, P., Kumar, R., Singh, H. et al. Indeterminate lesions on planar bone scintigraphy in lung cancer patients: SPECT, CT or SPECT-CT?. Skeletal Radiol 41, 843–850 (2012). https://doi.org/10.1007/s00256-011-1304-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-011-1304-2