title: Can 16-detector multislice CT exclude skeletal lesions during tumour staging? Implications for the cancer patient.
abstract: Current imaging guidelines recommend that many cancer patients undergo soft-tissue staging by computed tomography (CT) whilst the bones are imaged by skeletal scintigraphy (bone scan). New CT technology has now made it feasible, for the first time, to perform a detailed whole-body skeletal CT. This advancement could save patients from having to undergo duplicate investigations. Forty-three patients with known malignancy were investigated for bone metastasis using skeletal scintigraphy and 16-detector multislice CT. Both studies were performed within six weeks of each other. Whole-body images were taken 4 h after injection of 500 Mbq (99m)Tc-MDP using a gamma camera. CT was performed on a 16-detector multislice CT machine from the vertex to the knee. The examinations were reported independently and discordant results were compared at follow-up. Statistical equivalence between the two techniques was tested using the Newcombe-Wilson method within the pre-specified equivalence limits of +/-20%. Scintigraphy detected bone metastases in 14/43 and CT in 13/43 patients. There were seven discordances; four cases were positive on scintigraphy, but negative on CT; three cases were positive on CT and negative on scintigraphy. There was equivalence between scintigraphy and CT in detecting bone metastases within +/-19% equivalence limits. Patients who have undergone full whole-body staging on 16-detector CT may not need additional skeletal scintigraphy. This should shorten the cancer patient's diagnostic pathway.
authors.affiliation: Department of Radiology, Addenbrooke's Hospital NHS Trust and the University of Cambridge, Hills Rd, Box 218, Cambridge, CB2 2QQ, UK. drashleygroves@hotmail.com
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Groves
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Beadsmoore
authors.forename: Heok K
authors.initials: HK
authors.lastname: Cheow
authors.forename: Kottekkattu K
authors.initials: KK
authors.lastname: Balan
authors.forename: Helen M
authors.initials: HM
authors.lastname: Courtney
authors.forename: Stephen
authors.initials: S
authors.lastname: Kaptoge
authors.forename: Thida
authors.initials: T
authors.lastname: Win
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Harish
authors.forename: Philip W P
authors.initials: PW
authors.lastname: Bearcroft
authors.forename: Adrian K
authors.initials: AK
authors.lastname: Dixon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D013669:Technetium Tc 99m Medronate; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
chemical_list: D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate