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Should SPECT-CT replace SPECT for the evaluation of equivocal bone scan lesions in patients with underlying malignancies?

Ndlovu, Xolania; George, Reenab; Ellmann, Annarea; Warwick, Jamesa

Nuclear Medicine Communications: July 2010 - Volume 31 - Issue 7 - p 659-665
doi: 10.1097/MNM.0b013e3283399107
Original Articles

Introduction Bone scintigraphy is used extensively in evaluating metastatic disease. There are currently no clear recommendations for the use of single photon emission computed tomography (SPECT)/CT in metastatic bone disease. Given its limited availability there is a need to identify the clinical indications for which SPECT/CT is clearly beneficial in influencing patient care and outcome.

Methods Forty-two patients with equivocal lesions on planar scintigraphy were recruited and underwent SPECT/CT imaging. On reading of SPECT alone and then SPECT/CT, lesions were classified as malignant, benign or equivocal. Follow-up clinical information, radiological studies and/or bone scans were used as a gold standard. SPECT and SPECT/CT were compared in terms of the number of equivocal findings and accuracy on a patient-wise and lesion-wise basis.

Results Forty-two patients with 189 skeletal lesions were examined. There was a diverse variety of primary tumours, with the majority being breast (n=22) and prostate cancer (n=8). SPECT/CT resulted in a significant reduction in the proportion of patients (48–14%, P=0.0015) and lesions (31–9%, P<0.0001) with equivocal findings. The overall accuracy of SPECT/CT was significantly higher on both a patient-wise (52–79%, P=0.0026) and lesion-wise basis (67–92%, P<0.0001).

Conclusion SPECT/CT significantly outperforms SPECT alone for the interpretation of skeletal lesions in patients undergoing bone scanning for metastases. When available SPECT/CT is indicated in patients in whom correct classification of equivocal lesions is expected to alter the patient's management.

Departments of aNuclear Medicine

bRadiology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa

Correspondence to Dr Xolani Ndlovu, MBChB, MSc, Mpilo Central Hospital, Vera Road, Mzilikazi, Bulawayo, Zimbabwe

Tel: +263 912 287247; fax: +263 9 205078;


Received 14 December 2009 Revised 12 February 2010 Accepted 9 March 2010

© 2010 Lippincott Williams & Wilkins, Inc.