School of Medicine, King's College London, The Flat, Poundisford Lodge, Poundisford, Taunton, Somerset TA3 7AE, UK.
Eur J Nucl Med Mol Imaging. 2010 Apr;37(4):706-13. doi: 10.1007/s00259-009-1334-3. Epub 2009 Dec 17.
The purpose of this study was to investigate the additional value of single photon emission computed tomography/computed tomography (SPECT/CT) over whole-body planar bone scintigraphy and SPECT in prostate cancer patients in terms of diagnostic confidence, inter-reviewer agreement and the possible impact on the clinical management.
This was a retrospective review of 40 consecutive prostate cancer patients (mean age 71 years) who underwent (99m)Tc-methylene diphosphonate (MDP) whole-body planar bone scintigraphy, SPECT and SPECT/CT between April 2006 and April 2008. The images were evaluated by two independent reviewers; inter-reviewer agreement was evaluated using a weighted kappa score. Each focus of abnormal increased tracer uptake was recorded using a 4-point diagnostic confidence scale. Institutional Review Board approval was obtained.
Fifty lesions on planar bone scintigraphy in the 40 patients were evaluated. On reporting the planar study and SPECT scans, reviewers rated 61% of lesions as equivocal. On reporting the SPECT/CT scans only 8% of lesions were rated as equivocal, 24% were rated as malignant and 68% as benign. Weighted kappa scores for inter-reviewer agreement were 0.43 for bone scintigraphy, 0.56 for SPECT and 0.87 for SPECT/CT. All were significant at p < 0.0001. Follow-up imaging confirmed the SPECT/CT diagnoses in 14 patients.
The addition of SPECT/CT resulted in a significant reduction of equivocal reports; a definitive diagnosis was given in the majority of the patients due to the improved diagnostic confidence compared to planar or SPECT imaging alone in prostate cancer patients with suspected bone metastases.
本研究旨在探讨单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）相对于全身平面骨闪烁扫描和 SPECT 在前列腺癌患者中的附加价值，从诊断信心、复查者间一致性以及对临床管理的可能影响方面进行评估。
这是一项回顾性研究，共纳入 2006 年 4 月至 2008 年 4 月期间连续 40 例前列腺癌患者（平均年龄 71 岁），他们接受了（99m）Tc-亚甲基二膦酸盐（MDP）全身平面骨闪烁扫描、SPECT 和 SPECT/CT 检查。由两名独立的复查者对图像进行评估；使用加权 Kappa 评分评估复查者间的一致性。使用 4 分诊断置信度量表记录每个异常放射性示踪剂摄取焦点。本研究获得机构审查委员会批准。
在 40 例患者的 50 个平面骨闪烁扫描病变中进行了评估。在报告平面研究和 SPECT 扫描时，复查者对 61%的病变的评估结果为不确定。仅在报告 SPECT/CT 扫描时，24%的病变被评估为恶性，68%的病变被评估为良性，有 8%的病变被评估为不确定，与之前相比差异有统计学意义（p < 0.0001）。复查者间一致性的加权 Kappa 评分为骨闪烁扫描 0.43、SPECT 0.56 和 SPECT/CT 0.87，差异均有统计学意义（p < 0.0001）。14 例患者的随访成像证实了 SPECT/CT 诊断。
与单独使用平面或 SPECT 成像相比，SPECT/CT 的应用使可疑骨转移的前列腺癌患者的不确定报告显著减少；由于诊断信心提高，大多数患者都得到了明确的诊断。
