Utsunomiya Daisuke, Shiraishi Shinya, Imuta Masanori, Tomiguchi Seiji, Kawanaka Koichi, Morishita Shoji, Awai Kazuo, Yamashita Yasuyuki
Diagnostic Imaging Center, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto 861-4193, Japan.
Radiology. 2006 Jan;238(1):264-71. doi: 10.1148/radiol.2373041358. Epub 2005 Nov 22.
To evaluate retrospectively if there is additional diagnostic value of fused single photon emission computed tomographic (SPECT) and computed tomographic (CT) images in assessing possible bone metastases.
Institutional review board approval was obtained, and each patient provided written informed consent. Bone scintigraphy--including planar and SPECT imaging-and CT were performed with a combined SPECT/CT system in 45 oncologic patients (24 men, 21 women; mean age, 64.7 years +/- 8.7), with a total of 42 metastatic bone foci and 40 benign foci. The reference standard was follow-up radiologic imaging. Two independent readers first analyzed only bone scintigraphic images and next analyzed two separate sets of bone scintigraphic and CT images. They then analyzed bone scintigraphic, CT, and fused images and focused on the additional value of fused images. Diagnostic confidence for each lesion was scored. The three analyses were performed 7 days apart, and the images were presented in random order at each session. The value of additional fused images was assessed by using receiver operating characteristic analysis.
After review of fused images to classify indeterminate lesions, reviewer 1 became more confident in diagnosis of the 15 benign lesions and two metastases, and reviewer 2 became more confident in diagnosis of the seven benign lesions and one metastasis. The area under the receiver operating characteristic curve for reviewer 1 was 0.589 for scintigraphic images, 0.831 for separate data sets of scintigraphic and CT images, and 0.947 for fused images. The corresponding areas under the receiver operating characteristic curve for reviewer 2 were 0.771, 0.885, and 0.968, respectively.
Results demonstrate the increased diagnostic confidence obtained with fused SPECT/CT images compared with separate sets of scintigraphic and CT images in differentiating malignant from benign bone lesions.
回顾性评估融合的单光子发射计算机断层扫描（SPECT）与计算机断层扫描（CT）图像在评估可能的骨转移方面是否具有额外的诊断价值。
获得机构审查委员会批准，每位患者均提供书面知情同意书。45例肿瘤患者（24例男性，21例女性；平均年龄64.7岁±8.7岁）采用SPECT/CT联合系统进行骨闪烁显像（包括平面显像和SPECT显像）及CT检查，共有42个骨转移灶和40个良性病灶。参考标准为随访影像学检查。两名独立阅片者首先仅分析骨闪烁显像图像，然后分析两组单独的骨闪烁显像和CT图像。之后他们分析骨闪烁显像、CT及融合图像，并关注融合图像的额外价值。对每个病灶的诊断信心进行评分。三次分析间隔7天进行，每次检查时图像以随机顺序呈现。采用受试者操作特征分析评估融合图像的额外价值。
在查看融合图像以对不确定病灶进行分类后，阅片者1对15个良性病灶和2个转移灶的诊断更有信心，阅片者2对7个良性病灶和1个转移灶的诊断更有信心。阅片者1的受试者操作特征曲线下面积，骨闪烁显像图像为0.589，骨闪烁显像和CT单独数据集为0.831，融合图像为0.947。阅片者2的相应受试者操作特征曲线下面积分别为0.771、0.885和0.968。
结果表明，与单独的骨闪烁显像和CT图像相比，融合的SPECT/CT图像在鉴别恶性与良性骨病变时能提高诊断信心。
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