RSS-Feed abonnieren
DOI: 10.3413/Nukmed-0973-18-04
Indeterminate solitary vertebral lesions on planar scintigraphy
Added value of hybrid SPECT-CT in patients with nonsmall cell lung cancerUnbestimmte solitäre Wirbelläsionen bei der planaren SzintigraphieMehrwert des hybriden SPECT-CT bei Patienten mit nicht-kleinzelligem Lungenkarzinom Funding This work was supported by the Young Researcher Fund of Science and the Technology Department of Jilin Province (Grant number: 20170520027JH), and the Norman Bethune Youth Program of Jilin University (Grant number: 2015219).Publikationsverlauf
received:
16. April 2018
accepted:
14. September 2018
Publikationsdatum:
18. Dezember 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/201806/lookinside/thumbnails/10-3413-nukmed-0973-18-04-1.jpg)
Summary
Objective: This study aims to evaluate the added value of hybrid SPECT-CT in differential diagnosis of indeterminate solitary vertebral lesion (SVL) on planar scintigraphy in patients with non-small cell lung cancer (NSCLC).
Methods: Sixty-three NSCLC patients with indeterminate “hot spot” SVL on planar scintigraphy were retrospectively included in this study. Pathological confirmation and followup by whole body scintigraphy and SPECT-CT were used as golden standard for the evaluation of diagnostic performance of planar scintigraphy, SPECT, and SPECT-CT. Receiver operating characteristic (ROC) analyses were performed and compared among the three imaging modalities. For subgroup analysis, the performance of each imaging modality in different NSCLC subgroups including age, gender, histology of primary tumor and nature, site and location of SVL were analyzed, respectively. The impact of SPECT-CT on the management of NSCLC patient with SVL was also analyzed.
Results: The sensitivity and specificity of planar scintigraphy, SPECT, and SPECT-CT in differentiating SVL were 41.9 % and 81.2 %, 83.9 % and 71.9 %, and 90.3 % and 90.6 %, respectively. SPECT-CT performed significantly better than both planar scintigraphy (P < 0.0001) and SPECT (P = 0.0027). The sensitivity for planar scintigraphy in nonlytic SVL was significantly higher than in lytic SVL (88.5 % vs. 50.0 %, P = 0.0008). The sensitivity for the planar scintigraphy and SPECT-CT in dorsal SVL was significantly higher than in non-dorsal SVL (55.0 % vs. 18.2 %, P = 0.0029 and 100 % vs. 85.7 %, P = 0.0236, respectively). SPECT-CT had an impact on the clinical management of 52.6 % (20/38) of patients compared to planar scintigraphy and 23.6 % (9/38) of patients compared to SPECT.
Conclusion: Compared to planar scintigraphy and SPECT, hybrid SPECT-CT shows excellent performance in differentiating indeterminate SVL in NSCLC patients, the application of which will significantly impact patient management.
Zusammenfassung
Ziel: Ziel dieser Studie ist es, den Mehrwert der hybriden SPECT-CT in der Differenzialdiagnose der unbestimmten solitären Knochenläsionen der Wirbelsäule (SVL) auf der planaren Szintigraphie bei Patienten mit nichtkleinzelligem Lungenkarzinom (NSCLC) zu untersuchen.
Methode: Retrospektiv wurden 63 NSCLC-Patienten mit unbestimmten solitären „hot spot” Knochenläsionen der Wirbelsäule unter planarer Szintigraphie eingeschlossen. Pathologische Bestätigung und Follow-up durch Ganzkörper-Szintigraphie und SPECTCT wurden als Goldstandard für die Bewertung der diagnostischen Leistung der Planar- Szintigraphie, SPECT und SPECT-CT verwendet. ROC-Analysen (Receiver Operating Characteristic, Beobachterkennlinie) wurden erstellt und zwischen den drei Bildgebungsmodalitäten verglichen. Für die Subgruppenanalyse wurde die Leistung jeder Bildgebungsmodalität in verschiedenen NSCLC-Untergruppen einschließlich Alter, Geschlecht, Histologie des Primärtumors und der Art, Lage und Ort der SVL analysiert. Der Einfluss von SPECT-CT auf das Management von NSCLC-Patienten mit SVL wurde ebenfalls analysiert.
Ergebnisse: Die Sensitivität und Spezifität der planaren Szintigraphie, SPECT und SPECT-CT bei der Differenzierung von SVL waren 41,9 % und 81,2 %, 83,9 % und 71,9 % bzw. 90,3 % und 90,6 %. Die SPECT-CT zeigte eine signifikant bessere Leistung als die planare Szintigraphie (P < 0,0001) und die SPECT (P = 0,0027). Die Sensitivität für die planare Szintigraphie bei nicht-lytischer SVL war signifikant höher als bei der lytischen SVL (88,5 % vs. 50,0 %, p = 0,0008). Die Sensitivität für die planare Szintigraphie und SPECT-CT in der dorsalen SVL war signifikant höher als in nicht-dorsalen SVL (55,0 % gegenüber 18,2 %, P = 0,0029 und 100 % gegenüber 85,7 %, P = 0,0236). SPECT-CT beeinflusste das klinische Management von 52,6 % (20/38) der Patienten im Vergleich zur planaren Szintigraphie und 23,6 % (9/38) der Patienten im Vergleich zur SPECT.
Schlussfolgerung: Im Vergleich zur Planar-Szintigraphie und SPECT zeigt die hybride SPECT-CT eine hervorragende Leistung bei der Differenzierung unbestimmter SVL bei NSCLC-Patienten, deren Anwendung das Patientenmanagement signifikant beeinflussen wird.
Keywords
Non-small cell lung cancer - solitary vertebral lesion - planar scintigraphy - SPECT-CT - patient managementSchlüsselwörter
Nicht-kleinzelliges Lungenkarzinom - solitäre Wirbelläsion - planare Szintigraphie - SPECTCT - Patientenmanagement* Xie Qian and Zhang Wenqi contributed equally to this work.
-
References
- 1 Agrawal K, Marafi F, Gnanasegaran G. et al. Pitfalls and limitations of radionuclide planar and hybrid bone imaging. Seminars in nuclear medicine 2015; 45 (05) 347-372.
- 2 Bollen L, Jacobs WCH, Van der Linden YM. et al. A systematic review of prognostic factors predicting survival in patients with spinal bone metastases. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2018; 27 (04) 799-805.
- 3 Brenner AI, Koshy J, Morey J. et al. The bone scan. Seminars in nuclear medicine 2012; 42 (01) 11-26.
- 4 Fukuchi K, Yamaguchi M, Hayashida K. et al. Discrepancy between Tc-99m HMDP bone scan and F-18 FDG positron emission tomographic images in a patient with small cell lung cancer. Clinical nuclear medicine 2003; 28 (03) 232-233.
- 5 Garcia JR, Simo M, Perez G. et al. 99mTc-MDP bone scintigraphy and 18F-FDG positron emission tomography in lung and prostate cancer patients: different affinity between lytic and sclerotic bone metastases. European journal of nuclear medicine and molecular imaging 2003; 30 (12) 1714.
- 6 Guezennec C, Keromnes N, Robin P. et al. Incremental diagnostic utility of systematic double-bed SPECT/CT for bone scintigraphy in initial staging of cancer patients. Cancer imaging: the official publication of the International Cancer Imaging Society 2017; 17 (01) 16.
- 7 Helyar V, Mohan HK, Barwick T. et al. The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma of the prostate. European journal of nuclear medicine and molecular imaging 2010; 37 (04) 706-713.
- 8 Horger M, Eschmann SM, Pfannenberg C. et al. Evaluation of combined transmission and emission tomography for classification of skeletal lesions. AJR American journal of roentgenology 2004; 183 (03) 655-661.
- 9 Iqbal B, Currie GM, Wheat JM. et al. The incremental value of SPECT/CT in characterizing solitary spine lesions. Journal of nuclear medicine technology 2011; 39 (03) 201-207.
- 10 Jambor I, Kuisma A, Ramadan S. et al. Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1.5T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial. Acta oncologica (Stockholm, Sweden) 2016; 55 (01) 59-67.
- 11 Jiang L, Han L, Tan H. et al. Diagnostic value of (9)(9)mTc-MDP SPECT/spiral CT in assessing indeterminate spinal solitary lesion of patients without malignant history. Annals of nuclear medicine 2013; 27 (05) 460-467.
- 12 Liu T, Wang S, Liu H. et al. Detection of vertebral metastases: a meta-analysis comparing MRI, CT, PET, BS and BS with SPECT. Journal of cancer research and clinical oncology 2017; 143 (03) 457-465.
- 13 Lofgren J, Mortensen J, Rasmussen SH. et al. A Prospective Study Comparing (99m)Tc-Hydroxyethylene-Diphosphonate Planar Bone Scintigraphy and Whole-Body SPECT/CT with (18)F-Fluoride PET/CT and (18)F-Fluoride PET/MRI for Diagnosing Bone Metastases. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2017; 58 (11) 1778-1785.
- 14 Mahaletchumy T, AbAziz A. Incremental Value of Single-photon Emission Computed Tomographycomputed Tomography for Characterization of Skeletal Lesions in Breast Cancer Patients. World journal of nuclear medicine 2017; 16 (04) 303-310.
- 15 Ndlovu X, George R, Ellmann A. et al. Should SPECT-CT replace SPECT for the evaluation of equivocal bone scan lesions in patients with underlying malignancies?. Nuclear medicine communications 2010; 31 (07) 659-665.
- 16 Palmedo H, Marx C, Ebert A. et al. Whole-body SPECT/CT for bone scintigraphy: diagnostic value and effect on patient management in oncological patients. European journal of nuclear medicine and molecular imaging 2014; 41 (01) 59-67.
- 17 Romer W, Nomayr A, Uder M. et al. SPECTguided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 2006; 47 (07) 1102-1106.
- 18 Sciubba DM, Nguyen T, Gokaslan ZL. Solitary vertebral metastasis. The Orthopedic clinics of North America 2009; 40 (01) 145-154 viii.
- 19 Sharma P, Dhull VS, Reddy RM. et al. Hybrid SPECT-CT for characterizing isolated vertebral lesions observed by bone scintigraphy: comparison with planar scintigraphy, SPECT, and CT. Diagnostic and interventional radiology (Ankara, Turkey) 2013; 19 (01) 33-40.
- 20 Sharma P, Kumar R, Singh H. et al. Indeterminate lesions on planar bone scintigraphy in lung cancer patients: SPECT, CT or SPECT-CT?. Skeletal radiology 2012; 41 (07) 843-850.
- 21 Sharma P, Singh H, Kumar R. et al. Bone scintigraphy in breast cancer: added value of hybrid SPECT-CT and its impact on patient management. Nuclear medicine communications 2012; 33 (02) 139-147.
- 22 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA: a cancer journal for clinicians 2018; 68 (01) 7-30.
- 23 Tang Y, Qu J, Wu J. et al. Effect of Surgery on Quality of Life of Patients with Spinal Metastasis from Non-Small-Cell Lung Cancer. The Journal of bone and joint surgery American volume 2016; 98 (05) 396-402.
- 24 Toloza EM, Harpole L, McCrory DC. Noninvasive staging of non-small cell lung cancer: a review of the current evidence. Chest 2003; 123 (Suppl. 01) 137s-146s.
- 25 Utsunomiya D, Shiraishi S, Imuta M. 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 (01) 264-271.
- 26 Zhang Y, Li B, Shi H. et al. Added value of SPECT/ spiral CT versus SPECT or CT alone in diagnosing solitary skeletal lesions. Nuklearmedizin Nuclear medicine 2017; 56 (04) 139-145.
- 27 Zhang Y, Shi H, Cheng D. et al. Added value of SPECT/spiral CT versus SPECT in diagnosing solitary spinal lesions in patients with extraskeletal malignancies. Nuclear medicine communications 2013; 34 (05) 451-458.
- 28 Zhang Y, Shi H, Gu Y. et al. Differential diagnostic value of single-photon emission computed tomography/spiral computed tomography with Tc-99m-methylene diphosphonate in patients with spinal lesions. Nuclear medicine communications 2011; 32 (12) 1194-1200.
- 29 Zhang Y, Shi H, Li B. et al. The added value of SPECT/spiral CT in patients with equivocal bony metastasis from hepatocellular carcinoma. Nuklearmedizin Nuclear medicine 2015; 54 (06) 255-261.
- 30 Zhao Z, Li L, Li F. et al. Single photon emission computed tomography/spiral computed tomography fusion imaging for the diagnosis of bone metastasis in patients with known cancer. Skeletal radiology 2010; 39 (02) 147-153.