Institute of Radiology and Nuclear Medicine and PET-CT Center, Johanniter Hospital, Kaiserstraße 19-21, 53113, Bonn, Germany,
Eur J Nucl Med Mol Imaging. 2014 Jan;41(1):59-67. doi: 10.1007/s00259-013-2532-6. Epub 2013 Aug 24.
This study was designed to assess the additional value of SPECT/CT of the trunk used in conjunction with conventional nuclear imaging and its effects on patient management in a large patient series.
In 353 patients, whole-body scintigraphy (WBS), SPECT, and SPECT/CT were prospectively performed for staging and restaging. SPECT/CT of the trunk was performed in all patients. In the 308 evaluable patients (211 with breast cancer, 97 with prostate cancer), clinical follow-up was used as the gold standard. Bone metastases were confirmed in 72 patients and excluded in 236. Multistep analyses per lesion and per patient were performed. Clinical relevance was expressed in terms of downstaging and upstaging rates on a per-patient basis.
In the total patient group, sensitivities, specificities, and negative and positive predictive values on a per-patient basis were 93 %, 78 %, 95 % and 59 % for WBS, 94 %, 71 %, 97 % and 53 % for SPECT, and 97 %, 94 %, 97 % and 88 % for SPECT/CT, respectively. In all subgroups, specificity and positive predictive value were significantly (p<0.01) better with SPECT/CT. Downstaging of metastatic disease in the total, breast cancer and prostate cancer groups using SPECT/CT was possible in 32.1 %, 33.8 % and 29.5 % of patients, respectively. Upstaging in previously negative patients by additional SPECT/CT was observed in three breast cancer patients (2.1 %). Further diagnostic imaging procedures for unclear scintigraphic findings were necessary in only 2.5 % of patients. SPECT/CT improved diagnostic accuracy for defining the extent of multifocal metastatic disease in 34.6 % of these patients.
SPECT/CT significantly improved the specificity and positive predictive value of bone scintigraphy in cancer patients. In breast cancer patients, we found a slight increase in sensitivity. SPECT/CT had a significant effect on clinical management because of correct downstaging and upstaging, better definition of the extent of metastases, and a reduction in further diagnostic procedures.
本研究旨在评估在大型患者系列中，联合常规核成像使用 SPECT/CT 对躯干进行全身评估的附加价值及其对患者管理的影响。
在 353 例患者中，前瞻性地进行全身闪烁扫描（WBS）、SPECT 和 SPECT/CT 进行分期和再分期。所有患者均行 SPECT/CT 胸部检查。在 308 例可评估患者（211 例乳腺癌，97 例前列腺癌）中，采用临床随访作为金标准。72 例患者骨转移得到证实，236 例患者骨转移排除。对每例患者和每例病变进行多步分析。根据每位患者的降期和升期率来表达临床相关性。
在总患者组中，WBS、SPECT 和 SPECT/CT 的患者基础上的敏感性、特异性、阴性预测值和阳性预测值分别为 93%、78%、95%和 59%、94%、71%、97%和 53%、97%、94%、97%和 88%。在所有亚组中，SPECT/CT 的特异性和阳性预测值均显著提高（p<0.01）。在总患者组、乳腺癌和前列腺癌患者中，SPECT/CT 使转移性疾病降期的可能性分别为 32.1%、33.8%和 29.5%。在先前阴性的患者中，通过额外的 SPECT/CT 发现 3 例乳腺癌患者（2.1%）有升期。只有 2.5%的患者需要进一步诊断成像程序来明确闪烁扫描结果。SPECT/CT 提高了 34.6%的这些患者定义多灶性转移性疾病范围的诊断准确性。
SPECT/CT 显著提高了癌症患者骨闪烁扫描的特异性和阳性预测值。在乳腺癌患者中，我们发现敏感性略有提高。SPECT/CT 对临床管理有显著影响，因为它可以正确地降期和升期，更好地定义转移的范围，并减少进一步的诊断程序。
