الفهرس 
Whole body SPECT/CT images versus planar bone scans in detection of osseous metastases in cancer patients
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Abstract
Objectives: To evaluate the diagnostic performance of Tc99m MDP planar bone scintigraphy and whole-body SPECT/CT images in detection of osseous metastases in cancer patients. Methods: This ongoing prospective study recruited 132 cancer patients referred for bone scintigraphy (Staging/restaging or follow up). 20 patients were excluded due to missed follow up data, 6 patients were excluded due to bad images a result of patient movements that cannot be resolved using the software. Patients underwent both modalities planar bone scintigraphy and SPECT/CT. Studies were anonymized and presented into two nuclear medicine physicians. A 6-point score (0=free, 1=Benign, 2=probably benign, 3=equivocal, 4=probably malignant, 5=malignant) was used to assess the scan overall (patient based analysis). Skeleton was divided into 10 sites the readers was requested to record whether their decision was based on uptake intensity/pattern, CT findings or recombination. The final diagnosis of disease status was made on the basis of subsequent clinical/imaging follow up for at least 6 months. Results: A total of 54/106 patients were having metastases (51%). Sensitivities and specificities for WB SPECT/CT were 98% and 96% for WB SPECT/CT compared to 78% and 94% for WB PBS; respectively. There was statistical difference in sensitivity (P<0.0001). Fifty-Six patients had breast cancer (BC), 50 with other cancers (NBC), of them 25 had uro-genital cancer (UGC). Prevalence of skeletal metastases in these groups were 45%, 58% and 48% respectively In BC patients WB SPECT/CT & PBS showed accuracy of 97% & 90% respectively (P=0.2). These figures were respectively 100%&85% for NBC group (P=0.005) and 100% and 84% for UGC group (P=0.07). Diagnosis was based only on CT findings in 25/131 (19%) positive sites in breast cancer group compared to 23/95 (24%) in NBC and 11/40 (28%) in UGC; respectively (P=0.5) Conclusions: Overall WB SPECT/CT is significantly more accurate compared to PBS. When cancer site is considered, the difference between WB SPECT/CT & PBS was not significant for breast cancer patients. Identification of sub-groups which benefit the most from WB SPECT/CT is warranted.