title: Diagnostic value of 18F-FDG PET/CT in comparison to bone scintigraphy, CT and 18F-FDG PET for the detection of bone metastasis.
abstract: OBJECTIVE
  To evaluate the diagnostic value of 18F-FDG PET/CT for detection of bone metastasis in comparison with the efficacies of 18F-FDG PET/CT, CT, 18F-FDG PET and conventional planar bone scintigraphy in a series of cancer patients.
  
  
  METHODS
  Five hundred and thirty patients who underwent both 18F-FDG PET/CT and bone scintigraphy within 1 month were retrospectively analyzed. The skeletal system was classified into 10 anatomic segments and interpreted blindly and separately. For each modality, the sensitivity, specificity, accuracy, PPV and NPV were calculated and the results were statistically analyzed.
  
  
  RESULTS
  Bone metastases were confirmed in 117 patients with 459 positive segments. On patient-based analysis, the sensitivity, specificity, accuracy, PPV and NPV of 18F-FDG PET/CT were significantly higher than bone scintigraphy, CT and 18F-FDG PET (P<0.05). On segment-based analysis, the sensitivity of CT, bone scintigraphy, 18F-FDG PET and 18F-FDG PET/CT were 70.4%, 89.5%, 89.1% and 97.8%, respectively (P<0.05, compared with 18F-FDG PET/CT). The overall specificity and accuracy of the four modalities were 89.1%, 91.8%, 90.3%, 98.2% and 90.3%, 90.9%, 89.8%, 98.0%, respectively (P<0.05, compared with 18F-FDG PET/CT). The PPV and NPV were 89.8%, 87.6%, 85.6%, 97.2% and 85.6%, 93.2%, 92.8%, 98.6%, respectively. Three hundred and twelve lesions or segments were presented as lytic or sclerotic changes on CT images at the corresponding sites of increased 18F-FDG uptake. In lytic or mixed lesions, the sensitivity of 18F-FDG PET/CT and 18F-FDG PET were better than bone scintigraphy, while in osteoblastic lesions bone scintigraphy had a similar performance with 18F-FDG PET/CT but better than 18F-FDG PET alone.
  
  
  CONCLUSIONS
  Our data allow the conclusion that 18F-FDG PET/CT is superior to planar bone scintigraphy, CT or 18F-FDG PET in detecting bone metastasis. 18F-FDG PET/CT may enhance our diagnosis of tumor bone metastasis and provide more information for cancer treatment.
authors.affiliation: Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
authors.forename: Ning-Bo
authors.initials: NB
authors.lastname: Liu
authors.forename: Lei
authors.initials: L
authors.lastname: Zhu
authors.forename: Ming-Huan
authors.initials: MH
authors.lastname: Li
authors.forename: Xiao-Rong
authors.initials: XR
authors.lastname: Sun
authors.forename: Man
authors.initials: M
authors.lastname: Hu
authors.forename: Zong-Wei
authors.initials: ZW
authors.lastname: Huo
authors.forename: Wen-Gui
authors.initials: WG
authors.lastname: Xu
authors.forename: Jin-Ming
authors.initials: JM
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology; D049268:Positron-Emission Tomography; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18