Transitioning to whole-body SPECT/CT in prostate cancer staging: a new concept for a better imaging workflow

Abstract

Aim Whole-body bone scan (BS) is the clinical standard in detecting bone metastases in prostate cancer patients. Additional SPECT/CT has allowed to significantly increase its diagnostic accuracy. However, performing both planar and additional SPECT/CT prolongs the total examination time and lowers patient throughput. In this study we aim to assess the diagnostic performance of a SPECT/CT-only protocol compared to the traditional procedure that is BS with a facultative SPECT/CT in case of unclear findings.

Methods 50 patients with high-risk prostate cancer and suspected bone metastases were enrolled in this retrospective study. All patients received a whole-body Tc-99m-DPD BS followed by a 3 field-of-view (FOV) SPECT/CT (GE Discovery 670 Pro^®) covering an area from the vertex to the mid-femur. Metastatic lesions were evaluated visually on BS and SPECT/CT and correlated to PSA-levels.

Results Detection rate was up to 50 % higher in SPECT/CT than in BS (n = 2829 vs. n = 1942; p < 0.001), but 31/1942 (1.5 %) lesions detected on BS were located out of the SPECT/CT field-of-view. In our analysis a PSA-level of > 80 µg/l could be defined as a cut-off-value for metastatic spread beyond mid-thigh, as no patient with PSA< 80 µg/l had localizations outside the SPECT/CT field-of-view (AUCPSA = 0.95, p < 0.001 sensitivity: 100 %, specificity: 77 %, NPV: 100 %, PPV: 67 %). The SPECT/CT-only protocol did not prolong acquisition time significantly as compared to BS.

Conclusions In patients with high-risk prostate cancer presenting with PSA < 80 µg/l and absent clinical symptoms, vertex to mid-thighs 3-FOV-SPECT/CT was representative for the entire skeletal system and was able to detect more lesions than planar acquisition. This procedure did not prolong patient handling time significantly.

Zusammenfassung

Ziel Die Knochenszintigraphie (GKS) bildet den Goldstandard für das Staging ossärer Metastasen bei Patienten mit Prostatakarzinom (PCA). Zusätzliche SPECT/CT-Aufnahmen unklarer Befunde verbessern hierbei die diagnostische Genauigkeit signifikant, verlängern jedoch die Untersuchungszeit deutlich. Ziel dieser Studie war deshalb die Untersuchung der diagnostischen Leistungsfähigkeit eines reinen SPECT/CT-Protokolls im Vergleich zum traditionellen Vorgehen aus planarer GKS mit fakultativem SPECT/CT.

Material und Methoden Die retrospektive Analyse umfasste 50 Patienten mit histologisch gesichertem high risk PCA und V.a. Knochenmetastasen. Alle Patienten erhielten eine planare GKS gefolgt von einer low-dose SPECT/CT (GE Discovery 670 Pro^®) von Schädel bis Mitte Femur (3 FOV). Herdbefunde wurden durch einen erfahrenen Nuklearmediziner visuell ausgewertet und mit dem PSA-Spiegel korreliert.

Ergebnisse Die Detektionsrate des SPECT/CT übertraf die GKS um knapp 50 % (SPECT n = 2829 vs. GKS n = 1942; p < 0,001), jedoch lagen 31/1942 (1,5 %) Läsionen außerhalb des vom 3-FOV-SPECT/CT erfassten Untersuchungsfelds. Als unabhängiger Prädiktor für eine Metastasierung caudal des proximalen Femurs, und somit außerhalb des FOV, zeigte der PSA-Spiegel mit einer AUC von 0,95 (p < 0,001) einen sehr guten Vorhersagewert (Cut-off PSA = 80 µg/l: SEN: 100 %, SPE: 77 %, NPV: 100 %, PPV:67 %). Ein reines SPECT/CT-Protokoll verlängert hierbei die Untersuchungszeit für den Patienten nicht wesentlich.

Schlussfolgerung Für das Knochenstaging von high-risk Prostatakarzinompatienten mit einem PSA-Spiegel < 80 µg/l und fehlender klinischer Symptomatik war ein reines SPECT/CT-Protokoll, welches den Körper von Schädel bis Mitte Oberschenkel umfasste, für das komplette Skelettsystem repräsentativ. Zudem konnten so im Vergleich zur planaren Ganzkörperszintigraphie signifikant mehr Knochenläsionen detektiert werden ohne die Untersuchungszeit für den Patienten wesentlich zu verlängern.

Key words

SPECT/CT - prostate cancer - bone scan - bone metastasis - acquisition protocol

Schlüsselwörter

SPECT/CT - Prostatakarzinom - Knochenszintigraphie - Knochenmetastasen - Aufnahmeprotokoll

^* Both authors contributed equally.

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