Rager Olivier, Nkoulou René, Exquis Nadia, Garibotto Valentina, Tabouret-Viaud Claire, Zaidi Habib, Amzalag Gaël, Lee-Felker Stephanie Anne, Zilli Thomas, Ratib Osman
Division of Nuclear Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, rue Gabrielle-Perret-Gentil, No. 4, 1211 Geneva, Switzerland.
IMGE (Imagerie Moléculaire Genève), 20 chemin Beau Soleil, 1206 Geneva, Switzerland.
Biomed Res Int. 2017;2017:7039406. doi: 10.1155/2017/7039406. Epub 2017 Jul 24.
The use of SPECT/CT in bone scans has been widespread in recent years, but there are no specific guidelines concerning the optimal acquisition protocol. Two strategies have been proposed: targeted SPECT/CT for equivocal lesions detected on planar images or systematic whole-body SPECT/CT. Our aim was to compare the diagnostic accuracy of the two approaches.
212 consecutive patients with a history of cancer were referred for bone scans to detect bone metastases. Two experienced readers randomly evaluated for each patient either planar images with one-field SPECT/CT targeted on equivocal focal uptakes (targeted SPECT/CT) or a whole-body (two-field) SPECT/CT acquisition from the base of the skull to the proximal femurs (whole-body SPECT/CT). The exams were categorized as "nonmetastatic," "equivocal," or "metastatic" on both protocols. The presence or absence of any extra-axial skeletal lesions was also assessed. The sensitivity and specificity of both strategies were measured using the results of subsequent imaging follow-up as the reference standard.
Whole-body SPECT/CT had a significantly higher sensitivity than targeted SPECT/CT to detect bone metastases ( = 0.0297) and to detect extra-axial metastases ( = 0.0266). There was no significant difference in specificity among the two approaches.
Whole-body SPECT/CT is the optimal modality of choice for metastatic workup, including detection of extra-axial lesions, with improved sensitivity and similar specificity compared to targeted SPECT/CT.
近年来，SPECT/CT在骨扫描中的应用已广泛普及，但对于最佳采集方案尚无具体指南。已提出两种策略：对平面图像上发现的可疑病变进行靶向SPECT/CT检查，或进行系统性全身SPECT/CT检查。我们的目的是比较这两种方法的诊断准确性。
连续212例有癌症病史的患者被转诊进行骨扫描以检测骨转移。两名经验丰富的阅片者对每位患者随机评估，要么评估针对可疑局灶性摄取进行单视野SPECT/CT检查的平面图像（靶向SPECT/CT），要么评估从颅底到股骨近端的全身（双视野）SPECT/CT采集图像（全身SPECT/CT）。两种方案的检查均被分类为“无转移”、“可疑”或“转移”。还评估了是否存在任何轴外骨骼病变。以后续影像随访结果作为参考标准，测量两种策略的敏感性和特异性。
在检测骨转移（P = 0.0297）和检测轴外转移（P = 0.0266）方面，全身SPECT/CT的敏感性显著高于靶向SPECT/CT。两种方法在特异性方面无显著差异。
全身SPECT/CT是转移性检查的最佳选择方式，包括检测轴外病变，与靶向SPECT/CT相比，其敏感性提高且特异性相似。
