Panagiotidis Emmanouil, Pant Vineet, Vinjamuri Sobhan
Nuclear Medicine Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK.
Nucl Med Commun. 2023 Mar 1;44(3):219-225. doi: 10.1097/MNM.0000000000001659. Epub 2022 Dec 27.
The purpose of the study was to compare the diagnostic accuracy and relative usefulness of MRI and 18 F-NaF (sodium fluoride) PET/computed tomography (CT) for detection of spinal bone metastases in a cohort of patients with high-risk breast cancer (BrCa).
A retrospective study was conducted of patient and lesion-based analyses on 66 consecutive patients (median age, 62.5 years; age range, 33-91 years) who underwent Spinal MRI as well as 18 F-NaF PET-CT for restaging of newly diagnosed recurrent BrCa with no previous bone metastases. Both scans were performed within 20 days of each other. Review of prior images, clinical decisions, multi-disciplinary team discussions and decisions as well as follow-up information including scans and definitive tests was performed at least 12 months after the initial scans.
Of the 66 patients reviewed, 26 patients had documented spinal bone metastases on one or both modalities, while 40 patients were considered bone disease free on both modalities and this was confirmed on follow-up. On lesion-based analysis, the findings of 18 F-NaF PET-CT and spinal MRI were concordant in 51 patients (77.3%). In the remaining patients, 18 F-NaF PET/CT detected more lesions in 4 patients (7.6%) and MRI detected more lesions in 10 patients (15.1%). Interestingly, there was a very high, 97 % concordance (64 patients) between spinal MRI and 18 F-NaF PET-CT when staging of spinal bone metastasis was taken into consideration. In one patient MRI identified two spinal bone metastases which were not seen on 18 F-NaF PET/CT; and, in one patient 18 F-NaF PET/CT showed few spinal bone metastases when no lesion was seen on MRI.
Our study showed a high level of concordance between 18 F NaF PET-CT and spinal MRI within the setting of detection of bone lesions in the spine in a cohort of patients with high-risk BrCa. In our opinion, this high level of concordance negates the need to perform both tests although each test may be indicated for slightly different reasons. Further longitudinal studies across a longer duration and more centres may provide more definitive answers.
本研究旨在比较磁共振成像（MRI）和18F-氟化钠（NaF）正电子发射断层扫描/计算机断层扫描（PET/CT）在一组高危乳腺癌（BrCa）患者中检测脊柱骨转移的诊断准确性和相对实用性。
对66例连续患者（中位年龄62.5岁；年龄范围33 - 91岁）进行了一项基于患者和病变的回顾性研究，这些患者因新诊断的复发性BrCa且既往无骨转移而接受了脊柱MRI以及18F-NaF PET-CT检查以进行再分期。两次扫描在彼此20天内完成。在初次扫描后至少12个月对先前图像、临床决策、多学科团队讨论及决策以及包括扫描和确诊检查在内的随访信息进行了回顾。
在66例接受评估的患者中，26例患者在一种或两种检查方式中被记录有脊柱骨转移，而40例患者在两种检查方式中均被认为无骨疾病，且随访证实了这一点。基于病变的分析显示，18F-NaF PET-CT和脊柱MRI的结果在51例患者中一致（77.3%）。在其余患者中，18F-NaF PET/CT在4例患者（7.6%）中检测到更多病变，MRI在10例患者（15.1%）中检测到更多病变。有趣的是，当考虑脊柱骨转移分期时，脊柱MRI和18F-NaF PET-CT之间存在非常高的一致性，为97%（64例患者）。在1例患者中，MRI发现了2处18F-NaF PET/CT未显示的脊柱骨转移；在另1例患者中，当MRI未发现病变时，18F-NaF PET/CT显示了少量脊柱骨转移。
我们的研究表明，在一组高危BrCa患者的脊柱骨病变检测中，18F NaF PET-CT与脊柱MRI之间具有高度一致性。我们认为，这种高度一致性使得无需同时进行两项检查，尽管每项检查可能因略有不同的原因而被采用。进一步在更长时间和更多中心开展的纵向研究可能会提供更确切的答案。
