Even-Sapir Einat, Metser Ur, Mishani Eyal, Lievshitz Gennady, Lerman Hedva, Leibovitch Ilan
Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
J Nucl Med. 2006 Feb;47(2):287-97.
The aim of this study was to compare the detection of bone metastases by 99mTc-methylene diphosphonate (99mTc-MDP) planar bone scintigraphy (BS), SPECT, 18F-Fluoride PET, and 18F-Fluoride PET/CT in patients with high-risk prostate cancer.
In a prospective study, BS and 18F-Fluoride PET/CT were performed on the same day in 44 patients with high-risk prostate cancer. In 20 of the latter patients planar BS was followed by single field-of-view (FOV) SPECT and in 24 patients by multi-FOV SPECT of the axial skeleton. Lesions were interpreted separately on each of the 4 modalities as normal, benign, equivocal, or malignant.
In patient-based analysis, 23 patients had skeletal metastatic spread (52%) and 21 did not. Categorizing equivocal and malignant interpretation as suggestive for malignancy, the sensitivity, specificity, positive predictive value, and negative predictive value of planar BS were 70%, 57%, 64%, and 55%, respectively, of multi-FOV SPECT were 92%, 82%, 86%, and 90%, of (18)F-Fluoride PET were 100%, 62%, 74%, and 100%, and of 18F-Fluoride PET/CT were 100% for all parameters. Using the McNemar test, 18F-Fluoride PET/CT was statistically more sensitive and more specific than planar or SPECT BS (P < 0.05) and more specific than 18F-Fluoride PET (P < 0.001). SPECT was statistically more sensitive and more specific than planar BS (P < 0.05) but was less sensitive than 18F-Fluoride PET (P < 0.05). In lesion-based analysis, 156 lesions with increased uptake of 18F-Fluoride were assessed. Based on the corresponding appearance on CT, lesions were categorized by PET/CT as benign (n = 99), osteoblastic metastasis (n = 46), or equivocal when CT was normal (n = 11). Of the 156 18F-Fluoride lesions, 81 lesions (52%), including 34 metastases, were overlooked with normal appearance on planar BS. SPECT identified 62% of the lesions overlooked by planar BS. 18F-Fluoride PET/CT was more sensitive and more specific than BS (P < 0.001) and more specific than PET alone (P < 0.001).
18F-Fluoride PET/CT is a highly sensitive and specific modality for detection of bone metastases in patients with high-risk prostate cancer. It is more specific than 18F-Fluoride PET alone and more sensitive and specific than planar and SPECT BS. Detection of bone metastases is improved by SPECT compared with planar BS and by 18F-Fluoride PET compared with SPECT. This added value of 18F-Fluoride PET/CT may beneficially impact the clinical management of patients with high-risk prostate cancer.
本研究的目的是比较99m锝-亚甲基二膦酸盐（99mTc-MDP）平面骨闪烁显像（BS）、单光子发射计算机断层扫描（SPECT）、18F-氟化物正电子发射断层显像（PET）以及18F-氟化物PET/CT在高危前列腺癌患者中对骨转移的检测情况。
在一项前瞻性研究中，对44例高危前列腺癌患者在同一天进行了BS和18F-氟化物PET/CT检查。在其中20例患者中，平面BS检查后进行了单视野（FOV）SPECT检查；在另外24例患者中，对轴向骨骼进行了多视野SPECT检查。分别在4种检查方式下将病变解释为正常、良性、可疑或恶性。
在基于患者的分析中，23例患者有骨骼转移扩散（52%），21例没有。将可疑和恶性解释归类为提示恶性，平面BS的敏感性、特异性、阳性预测值和阴性预测值分别为70%、57%、64%和55%；多视野SPECT分别为92%、82%、86%和90%；18F-氟化物PET分别为100%、62%、74%和100%；18F-氟化物PET/CT的所有参数均为100%。使用McNemar检验，18F-氟化物PET/CT在统计学上比平面或SPECT BS更敏感、更具特异性（P<0.05），且比18F-氟化物PET更具特异性（P<0.001）。SPECT在统计学上比平面BS更敏感、更具特异性（P<0.05），但比18F-氟化物PET敏感性更低（P<0.05）。在基于病变的分析中，评估了156个18F-氟化物摄取增加的病变。根据CT上的相应表现，PET/CT将病变分类为良性（n = 99）、成骨性转移（n = 46）或CT正常时可疑（n = 11）。在156个18F-氟化物病变中，81个病变（52%），包括34个转移灶，在平面BS上表现正常而被漏诊。SPECT识别出平面BS漏诊病变的62%。18F-氟化物PET/CT比BS更敏感、更具特异性（P<0.001），且比单独的PET更具特异性（P<0.001）。
18F-氟化物PET/CT是检测高危前列腺癌患者骨转移的一种高度敏感和特异的检查方式。它比单独的18F-氟化物PET更具特异性，比平面和SPECT BS更敏感、更具特异性。与平面BS相比，SPECT可提高骨转移的检测率；与SPECT相比，18F-氟化物PET可提高检测率。18F-氟化物PET/CT的这一附加价值可能对高危前列腺癌患者的临床管理产生有益影响。
