Langsteger W, Haim S, Knauer M, Waldenberger P, Emmanuel K, Loidl W, Wolf I, Beheshti M
Department of Nuclear Medicine and Endocrinology, PET - CT Center Linz, Linz, Austria.
Q J Nucl Med Mol Imaging. 2012 Oct;56(5):447-58.
Assessing bone metastases is often beyond the scope of plain - film radiography, and nuclear imaging in particular with bone scintigraphy has proved the mainstay for detection of bony disease for over 40 years. Bone scanning with 99mTechnetium - labeled diphosphonates relies on the detection of pathological osteoblastic response elicited from malignant cells. This technique offers the advantage of whole body examination, low cost, availability and high sensitivity. However, it suffers from relative low specificity. The addition of single-photon emission computed tomography (SPECT) to bone scintigraphy has markedly improved the diagnostic benefit. Although the accuracy of SPECT is significantly higher than that of planar scintigraphy, there is still room for improvement of anatomic localization and morphological characterization, a limitation that has currently been mainly overcome with the upcoming of combined SPECT-CT (computed tomography). Positron emission tomography (PET), a modality with higher spatial resolution than that of SPECT can be particularly helpful in detecting small lesions. Moreover, PET imaging using various specific radiotracers has the advantage of detecting malignant disease in both bone and soft tissues. It is highly sensitive mainly in detecting early bone marrow as well as for diagnosing lytic bony metastases and can be also reliably used to monitor therapy response. In this review, we present the current role of SPECT and PET in the imaging of skeletal metastases from prostate cancer.
评估骨转移通常超出了普通X线摄影的范围，尤其是核成像中的骨闪烁显像在40多年来一直是检测骨病的主要手段。用99m锝标记的二膦酸盐进行骨扫描依赖于检测恶性细胞引发的病理性成骨细胞反应。该技术具有全身检查、成本低、可及性高和灵敏度高的优点。然而，它的相对特异性较低。在骨闪烁显像中添加单光子发射计算机断层扫描（SPECT）显著提高了诊断效益。尽管SPECT的准确性明显高于平面闪烁显像，但在解剖定位和形态特征描述方面仍有改进空间，目前随着SPECT-CT（计算机断层扫描）的出现，这一局限性已基本得到克服。正电子发射断层扫描（PET）是一种空间分辨率高于SPECT的成像方式，对检测小病灶特别有帮助。此外，使用各种特定放射性示踪剂的PET成像具有检测骨和软组织恶性疾病的优势。它在检测早期骨髓以及诊断溶骨性骨转移方面高度敏感，也可可靠地用于监测治疗反应。在本综述中，我们介绍了SPECT和PET在前列腺癌骨转移成像中的当前作用。
