Abikhzer Gad, Gourevich Kosta, Kagna Olga, Israel Ora, Frenkel Alex, Keidar Zohar
aDepartment of Nuclear Medicine, Rambam Health Care Campus bB. and R. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Nucl Med Commun. 2016 Mar;37(3):247-53. doi: 10.1097/MNM.0000000000000427.
The aim of the study was to compare the detectability rate of bone metastases in breast cancer patients using whole-body single-photon emission computed tomography (WB-SPECT) performed with a half-time acquisition algorithm with that of planar ± selected field-of-view SPECT [standard bone scintigraphy (BS)].
Ninety-two consecutive breast cancer patients (age range 35-74 years) underwent planar BS followed by WB-SPECT (acquisition time 28 min). Clinical and imaging follow-up data from BS, 18F-FDG-PET/CT and CT were used as composite reference standards. Institutional review board approval was obtained. For a review of standard BS results, data from a selected SPECT field-of-view were extracted from the WB-SPECT when requested by the readers. Diagnostic confidence of interpretation criteria were defined using a five-point level-of-confidence grading scale of lesions.
Bone metastases were diagnosed in 34 of 92 studies (37%). On patient-based analysis, the detectability rate of standard BS was 97% (33/34 patients) as compared with 100% for WB-SPECT (P=NS). On a lesion-based analysis, 268 foci were detected, including 124 metastases. Standard BS detected 195 lesions (73%; 99 metastases and 96 benign) and missed 73 lesions (25 metastases and 48 benign). WB-SPECT detected 266 lesions (99%; 124 metastases and 142 benign) and missed two benign foci because of SPECT reconstruction artefacts. The lesion-based detectability rate of metastases for standard BS was 80% compared with 100% for WB-SPECT (P<0.001). WB-SPECT was associated with a higher level of confidence compared with standard BS for both benign (P<0.01) and malignant lesions (P<0.05).
WB-SPECT is a useful tool for skeletal assessment, showing good performance in comparison with standard BS in breast cancer patients, and may eliminate the need for an initial planar scan.
本研究旨在比较采用半时采集算法进行的全身单光子发射计算机断层扫描（WB-SPECT）与平面±选定视野SPECT[标准骨闪烁显像（BS）]对乳腺癌患者骨转移的检测率。
92例连续的乳腺癌患者（年龄范围35 - 74岁）先进行平面BS检查，随后进行WB-SPECT检查（采集时间28分钟）。来自BS、18F-FDG-PET/CT和CT的临床及影像随访数据用作综合参考标准。获得了机构审查委员会的批准。为了回顾标准BS的结果，读者要求时，从WB-SPECT中提取选定SPECT视野的数据。使用病变的五点置信度分级量表定义解释标准的诊断置信度。
92项研究中有34项（37%）诊断为骨转移。基于患者的分析中，标准BS的检测率为97%（33/34例患者），而WB-SPECT为100%（P = 无显著差异）。基于病变的分析中，共检测到268个病灶，其中包括124个转移灶。标准BS检测到195个病变（73%；99个转移灶和96个良性病灶），漏诊73个病变（25个转移灶和48个良性病灶）。WB-SPECT检测到266个病变（99%；124个转移灶和142个良性病灶），由于SPECT重建伪影漏诊了两个良性病灶。标准BS对转移灶的基于病变的检测率为80%，而WB-SPECT为100%（P < 0.001）。与标准BS相比，WB-SPECT对良性（P < 0.01）和恶性病变（P < 0.05）的置信度更高。
WB-SPECT是一种用于骨骼评估的有用工具，与乳腺癌患者的标准BS相比表现良好，并且可能无需进行初始平面扫描。
