Diagnostic Performance of CT Compared to PET/CT in Evaluating Bone Metastasis - An Initial Experience from Nepal (original) (raw)
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Annals of Nuclear Medicine, 2006
18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has become widely available and an important oncological technique. To evaluate the influence of PET on detection of bone metastasis, we compared the diagnostic accuracy of PET and conventional bone scintigraphy (BS) in a variety of cancer patients. Methods: Consecutive ninety-five patients with various cancers, who received both PET and BS within one month, were retrospectively analyzed. A whole-body PET (from face to upper thigh) and a standard whole body BS were performed and these images were interpreted by two experienced nuclear medicine physicians with and without patient information using monitor diagnosis. Each image interpretation was performed according to 8 separate areas (skull, vertebra, upper limbs, sternum and clavicles, scapula, ribs, pelvis, and lower limbs) using a 5-point-scale (0: definitely negative, 1: probably negative, 2: equivocal, 3: probably positive, 4: definitely positive for bone metastasis). Results: Twenty-one of 95 patients (22.1%) with 43 of 760 areas (5.7%) of bone metastases were finally confirmed. In untreated patients, 12 of 14 bone metastasis positive patients were detected by PET, while 9 of 14 were detected by BS. Three cases showed true positive in PET and false negative in BS due to osteolytic type bone metastases. In untreated cases, PET with and without clinical information showed better sensitivity than BS in patient-based diagnosis. For the purpose of treatment effect evaluation, PET showed better results because of its ability in the evaluation of rapid response of tumor cells to chemotherapy. Out of 10 cases of multiple-area metastases, 9 cases included vertebrae. There was only one solitary lesion located outside of FOV of PET scan in the femur, but with clinical information that was no problem for PET diagnosis. Conclusion: Diagnostic accuracy of bone metastasis was comparable in PET and BS in the present study. In a usual clinical condition, limited FOV (from face to upper thigh) of PET scan may not be a major drawback in the detection of bone metastases because of the relatively low risk of solitary bone metastasis in skull bone and lower limbs.
Nuclear Medicine Communications, 2010
Tamer Ö zü lker, Aysun Kü ç ü kö z Uzun, Filiz Ö zü lker and Tevfik Ö zpaç acı Purpose We tried to assess the efficacy of fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography (PET/CT) (18 F-FDG-PET/CT) scan in detecting bone metastases in cancer patients and to compare the results with bone scan (BS) findings. Materials and methods Seventy patients with a variety of neoplastic diseases, who had undergone both 18 F-FDG-PET/CT and BS and were eventually diagnosed as having metastatic bone disease, were enrolled in this study. The confirmation of the final diagnosis of bone metastasis was made by histopathological findings or clinical follow-up for 11 months, on average, including magnetic resonance imaging, 18 F-FDG-PET/CT or BS findings, showing progression of the lesions or their disappearance after therapy. Results 18 F-FDG-PET/CT imaging detected bone involvement in 68 out of 70 patients with a sensitivity of 97.1%. In contrast, BS showed the presence of metastases in 60 patients (85.7%). PET/CT detected 666 out of 721 metastatic lesions correctly (92.3%), whereas BS detected 506 lesions totally (70.1%). PET/CT revealed organ metastases in 24 patients and in seven patients with unknown primary; PET/CT also depicted primary tumor. Conclusion 18 F-FDG-PET/CT is more sensitive than BS in detecting bone metastasis in patients with neoplastic diseases. 18 F-FDG-PET/CT has the advantage of detecting unknown primary cancers and visceral metastases besides bone metastases. Nucl Med Commun
Frontiers in oncology, 2016
The aim of our study is to assess the frequency of detection of PET-positive computed tomography (CT)-negative skeletal metastases (SM) and determine the impact of such detection on staging and/or management in patients who had FDG PET/CT as part of the cancer work-up. We retrospectively reviewed 2000 18F-FDG PET/CT scans of known cancer patients. A log was kept to record cases of suspected SM with or without bone changes from the low-dose non-contrast CT. The presence or absence of SM was evaluated based on available pathological and clinical data. The impact of detection of such lesions on cancer staging and/or management was evaluated by a board certified oncologist. Of the 2000 cases, 18F-FDG PET/CT suggested SM in 146/2000 (7.3%). Of those 146 cases, 105 (72%) were positive on both PET and CT. The remaining 41 (28%) had PET-positive CT-negative bone lesions. SM was confirmed in 36/41 (88%) PET-positive/CT-negative cases. This was based on biopsy, imaging, or clinical follow-up....
Acta radiologica (Stockholm, Sweden : 1987), 2014
Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is commonly performed for cancer staging, as it can detect metastatic disease in multiple organ systems. However, there has been some controversy in the scientific literature when comparing FDG PET/CT and technetium-99 m-bone scintigraphy (bone scan) for the detection of skeletal metastases. To compare the accuracy of FDG PET/CT with bone scan for the detection of skeletal metastases. The study group comprised 202 adult cancer patients who underwent both FDG PET/CT and bone scan within 31 days for staging. Bone scans and FDG PET/CT were evaluated by two musculoskeletal radiologists for the presence and location of skeletal metastatic disease. Confirmation of the final diagnosis was based on the CT or magnetic resonance imaging (MRI) appearance, follow-up imaging, or histology. The sensitivity, specificity, and accuracy for detecting skeletal metastatic disease of FDG PET/CT were 97%, 98%, an...
Journal of Chitwan Medical College
Background: Fluorodeoxyglucose (FDG) PET (Positron Emission Tomography) is used for the evaluation of different solid cancers as well as characterization of solitary pulmonary nodules. This study was conducted with objectives to determine the prevalence of various types of cancer; to assess the status of cancer in terms of progression, regression, or static; and for metastatic workup by PET-CT scan. Methods: A retrospective cross-sectional study involving 545 patients of different cancers from all over Nepal was performed at Kundalini Diagnostic Center from July 2019 to March 2020. The data were analyzed using IBM SPSS version 22. Results: The mean age of study participants was 53.91±16.63 years. Out of total 545 participants, (499, 91.56%) tested positive for cancer with PET-CT scan with a higher proportion belonging to 50-59 years age group. Half of the participants (275, 50.46%) had disease progression and one-fifth of the participants (144, 26.42%) had static disease. Majority o...
International journal of health sciences
Purpose: To assess the role of 18F-NaF PET/CT in the detection of metastatic bone disease compared to 99mTc-MDP bone scan (+/-SPECT/CT). Methods: 64 adult patients with locally advanced primary tumor were enrolled in this study. All patients underwent pretherapy 18F-NaF PET/CT and 99mTc-MDP bone scan. Results: Among the 64 patients 18F-NaF PET/CT revealed positive bone metastases in 26 patients, only 19 of them have positive results in 99mTc-MDP bone scan, while the remaining 7 patients were falsely negative in 99mTc-MDP bone scan. On the other hand 18F-NaF PET/CT diagnosed 38 patients free of osseous metastases, 5 patients of them were falsely diagnosed having osseous metastases by 99mTc-MDP bone scan. None of patient has positive bone metastases by 99mTc-MDP & negative 18F-NaF PET/CT for bone metastases in our study group. The overall results revealed significant higher sensitivity for 18F-NaF PET/CT (100%) compared to 99mTc-MDP bone scan (73.08%) (P<0.05) as well as higher spe...
Journal of Nuclear Medicine
See an invited perspective on this article on page 1776. We prospectively evaluated and compared the diagnostic performance of 99m Tc-hydroxyethylene-diphosphonate (99m Tc-HDP) planar bone scintigraphy (pBS), 99m Tc-HDP SPECT/CT, 18 F-NaF PET/CT, and 18 F-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 by 18 F-NaF PET/CT within 9 d. 18 F-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 5 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, 18 F-NaF PET/CT, and PET/MRI detected additional lesions compared with pBS in 31%, 63%, and 71%, respectively. Conclusion: 18 F-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, 18 F-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.
Diagnostic performance of PET/CT in primary malignant bone tumors
Egyptian Journal of Radiology and Nuclear Medicine, 2021
Background Nowadays, PET/CT plays a substantial role in the diagnosis of different types of tumor by its ability to provide combined functional and anatomic imaging in the same session. The purpose of this study is to evaluate the added value of PET/CT in staging and re-staging of primary malignant bone tumors. Results Out of the studied 40 patients, 7 patients were referred for primary staging of different types of histologically proven primary malignant bone tumors, their FDG-PET/CT studies yielded additional diagnostic information in 28.6% of them. Thirty three patients were referred either for assessment of treatment response or for follow-up to detect any viable lesions; FDG-PET/CT was more sensitive and specific than CT in follow-up and assessment of treatment response with PET/CT sensitivity 94.4%, specificity 86.7%, and total accuracy 90.9% and CT sensitivity 88.2%, specificity 81.2%, and total accuracy 84.8%. Conclusions PET/CT was an accurate imaging modality in evaluation...
Clinical Oncology, 2011
Radiological and nuclear medicine imaging modalities used for assessing bone metastases treatment response include plain and digitalised radiography (XR), skeletal scintigraphy (SS), dual-energy X-ray absorptiometry (DEXA), computed tomography (CT), magnetic resonance imaging (MRI), [ 18 F] fluorodeoxyglucose positron emission tomography (FDG-PET) and PET/CT. Here we discuss the advantages and disadvantages of these assessment modalities as evident through different clinical trials. Additionally, we present the more established response criteria of the International Union Against Cancer and the World Health Organization and compare them with newer MD Anderson criteria. Even though serial XR and SS have been used to assess the therapeutic response for decades, several months are required before changes are evident. Newer techniques, such as MRI or PET, may allow an earlier evaluation of response that may be quantified through monitoring changes in signal intensity and standard uptake value, respectively. Moreover, the application of PET/CT, which can follow both morphological and metabolic changes, has yielded interesting and promising results that give a new insight into the natural history of metastatic bone disease. However, only a few studies have investigated the application of these newer techniques and further clinical trials are needed to corroborate their promising results and establish the most suitable imaging parameters and evaluation time points. Last, but not least, there is an absolute need to adopt uniform response criteria for bone metastases through an international consensus in order to better assess treatment response in terms of accuracy and objectivity.