TY - JOUR

T1 - A Prospective Study Comparing 99mTc-Hydroxyethylene-Diphosphonate Planar Bone Scintigraphy and Whole-Body SPECT/CT with 18F-Fluoride PET/CT and 18F-Fluoride PET/MRI for Diagnosing Bone Metastases

AU - Löfgren, Johan

AU - Mortensen, Jann

AU - Rasmussen, Sine H

AU - Madsen, Claus

AU - Loft, Annika

AU - Hansen, Adam E

AU - Oturai, Peter

AU - Jensen, Karl Erik

AU - Mørk, Mette Louise

AU - Reichkendler, Michala

AU - Højgaard, Liselotte

AU - Fischer, Barbara M

N1 - © 2017 by the Society of Nuclear Medicine and Molecular Imaging.

PY - 2017

Y1 - 2017

N2 - We prospectively evaluated and compared the diagnostic performance of99mTc-hydroxyethylene-diphosphonate (99mTc-HDP) planar bone scintigraphy (pBS),99mTc-HDP SPECT/CT,18F-NaF PET/CT, and18F-NaF PET/MRI for the detection of bone metastases.Methods:One hundred seventeen patients with histologically proven malignancy referred for clinical pBS were prospectively enrolled. pBS and whole-body SPECT/CT were performed followed by18F-NaF PET/CT within 9 d.18F-NaF PET/MRI was also performed in 46 patients.Results:Bone metastases were confirmed in 16 patients and excluded in 101, which was lower than expected. The number of equivocal scans was significantly higher for pBS than for SPECT/CT and PET/CT (18 vs. 5 and 6, respectively;P= 0.004 and 0.01, respectively). When equivocal readings were excluded, no statistically significant difference in sensitivity, specificity, positive predictive value, negative predictive value, or overall accuracy were found when comparing the different imaging techniques. In the per-patient analysis, equivocal scans were either assumed positive for metastases ("pessimistic analysis") or assumed negative for metastases ("optimistic analysis"). The percentages of misdiagnosed patients for the pessimistic analysis were 21%, 15%, 9%, and 7% for pBS, SPECT/CT, PET/CT, and PET/MRI, respectively. Corresponding figures for the optimistic analysis were 9%, 12%, 5%, and 7%. In those patients identified as having bone metastases according to the reference standard, SPECT/CT,18F-NaF PET/CT, and PET/MRI detected additional lesions compared with pBS in 31%, 63%, and 71%, respectively.Conclusion:18F-NaF PET/CT and whole-body SPECT/CT resulted in a significant reduction of equivocal readings compared with pBS, which implies an improved diagnostic confidence. However, the clinical benefit of using, for example,18F-NaF PET/CT or PET/MRI as compared with SPECT/CT and pBS in this patient population with a relatively low prevalence of bone metastases (14%) is likely limited. This conclusion is influenced by the low prevalence of patients with osseous metastases. There may well be significant differences in the sensitivity of SPECT/CT, PET/CT, and PET/MRI compared with pBS, but a larger patient population or a patient population with a higher prevalence of bone metastases would have to be studied to demonstrate this.

AB - We prospectively evaluated and compared the diagnostic performance of99mTc-hydroxyethylene-diphosphonate (99mTc-HDP) planar bone scintigraphy (pBS),99mTc-HDP SPECT/CT,18F-NaF PET/CT, and18F-NaF PET/MRI for the detection of bone metastases.Methods:One hundred seventeen patients with histologically proven malignancy referred for clinical pBS were prospectively enrolled. pBS and whole-body SPECT/CT were performed followed by18F-NaF PET/CT within 9 d.18F-NaF PET/MRI was also performed in 46 patients.Results:Bone metastases were confirmed in 16 patients and excluded in 101, which was lower than expected. The number of equivocal scans was significantly higher for pBS than for SPECT/CT and PET/CT (18 vs. 5 and 6, respectively;P= 0.004 and 0.01, respectively). When equivocal readings were excluded, no statistically significant difference in sensitivity, specificity, positive predictive value, negative predictive value, or overall accuracy were found when comparing the different imaging techniques. In the per-patient analysis, equivocal scans were either assumed positive for metastases ("pessimistic analysis") or assumed negative for metastases ("optimistic analysis"). The percentages of misdiagnosed patients for the pessimistic analysis were 21%, 15%, 9%, and 7% for pBS, SPECT/CT, PET/CT, and PET/MRI, respectively. Corresponding figures for the optimistic analysis were 9%, 12%, 5%, and 7%. In those patients identified as having bone metastases according to the reference standard, SPECT/CT,18F-NaF PET/CT, and PET/MRI detected additional lesions compared with pBS in 31%, 63%, and 71%, respectively.Conclusion:18F-NaF PET/CT and whole-body SPECT/CT resulted in a significant reduction of equivocal readings compared with pBS, which implies an improved diagnostic confidence. However, the clinical benefit of using, for example,18F-NaF PET/CT or PET/MRI as compared with SPECT/CT and pBS in this patient population with a relatively low prevalence of bone metastases (14%) is likely limited. This conclusion is influenced by the low prevalence of patients with osseous metastases. There may well be significant differences in the sensitivity of SPECT/CT, PET/CT, and PET/MRI compared with pBS, but a larger patient population or a patient population with a higher prevalence of bone metastases would have to be studied to demonstrate this.

KW - Adult

KW - Aged

KW - Bone Neoplasms/diagnostic imaging

KW - Bone and Bones/diagnostic imaging

KW - Diphosphonates

KW - Female

KW - Fluorine Radioisotopes

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Multimodal Imaging

KW - Organotechnetium Compounds

KW - Positron-Emission Tomography/methods

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Radionuclide Imaging

KW - Radiopharmaceuticals

KW - Reproducibility of Results

KW - Sodium Fluoride

KW - Tomography, Emission-Computed, Single-Photon/methods

KW - Whole Body Imaging/methods

U2 - 10.2967/jnumed.116.189183

DO - 10.2967/jnumed.116.189183

M3 - Journal article

C2 - 28798033

VL - 58

SP - 1778

EP - 1785

JO - The Journal of Nuclear Medicine

JF - The Journal of Nuclear Medicine

SN - 0161-5505

IS - 11

ER -