title: Whole-body SPECT/CT for bone scintigraphy: diagnostic value and effect on patient management in oncological patients.
abstract: OBJECTIVE
  This study was designed to assess the additional value of SPECT/CT of the trunk used in conjunction with conventional nuclear imaging and its effects on patient management in a large patient series.
  
  
  METHODS
  In 353 patients, whole-body scintigraphy (WBS), SPECT, and SPECT/CT were prospectively performed for staging and restaging. SPECT/CT of the trunk was performed in all patients. In the 308 evaluable patients (211 with breast cancer, 97 with prostate cancer), clinical follow-up was used as the gold standard. Bone metastases were confirmed in 72 patients and excluded in 236. Multistep analyses per lesion and per patient were performed. Clinical relevance was expressed in terms of downstaging and upstaging rates on a per-patient basis.
  
  
  RESULTS
  In the total patient group, sensitivities, specificities, and negative and positive predictive values on a per-patient basis were 93 %, 78 %, 95 % and 59 % for WBS, 94 %, 71 %, 97 % and 53 % for SPECT, and 97 %, 94 %, 97 % and 88 % for SPECT/CT, respectively. In all subgroups, specificity and positive predictive value were significantly (p<0.01) better with SPECT/CT. Downstaging of metastatic disease in the total, breast cancer and prostate cancer groups using SPECT/CT was possible in 32.1 %, 33.8 % and 29.5 % of patients, respectively. Upstaging in previously negative patients by additional SPECT/CT was observed in three breast cancer patients (2.1 %). Further diagnostic imaging procedures for unclear scintigraphic findings were necessary in only 2.5 % of patients. SPECT/CT improved diagnostic accuracy for defining the extent of multifocal metastatic disease in 34.6 % of these patients.
  
  
  CONCLUSIONS
  SPECT/CT significantly improved the specificity and positive predictive value of bone scintigraphy in cancer patients. In breast cancer patients, we found a slight increase in sensitivity. SPECT/CT had a significant effect on clinical management because of correct downstaging and upstaging, better definition of the extent of metastases, and a reduction in further diagnostic procedures.
authors: Institute of Radiology and Nuclear Medicine and PET-CT Center, Johanniter Hospital, Kaiserstraße 19-21, 53113, Bonn, Germany, holger.palmedo@gmx.de.
authors: H
authors: H
authors: Palmedo
authors: C
authors: C
authors: Marx
authors: A
authors: A
authors: Ebert
authors: B
authors: B
authors: Kreft
authors: Y
authors: Y
authors: Ko
authors: A
authors: A
authors: Türler
authors: R
authors: R
authors: Vorreuther
authors: U
authors: U
authors: Göhring
authors: H H
authors: HH
authors: Schild
authors: T
authors: T
authors: Gerhardt
authors: U
authors: U
authors: Pöge
authors: S
authors: S
authors: Ezziddin
authors: H-J
authors: HJ
authors: Biersack
authors: H
authors: H
authors: Ahmadzadehfar
mesh_terms: D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D012372:ROC Curve; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D051598:Whole Body Imaging
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