title: Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1.5T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial.
abstract: OBJECTIVE
  Detection of bone metastases in breast and prostate cancer patients remains a major clinical challenge. The aim of the current trial was to compare the diagnostic accuracy of (99m)Tc-hydroxymethane diphosphonate ((99m)Tc-HDP) planar bone scintigraphy (BS), (99m)Tc-HDP SPECT, (99m)Tc-HDP SPECT/CT, (18)F-NaF PET/CT and whole body 1.5 Tesla magnetic resonance imaging (MRI), including diffusion weighted imaging, (wbMRI+DWI) for the detection of bone metastases in high risk breast and prostate cancer patients.
  
  
  METHODS
  Twenty-six breast and 27 prostate cancer patients at high risk of bone metastases underwent (99m)Tc-HDP BS, (99m)Tc-HDP SPECT, (99m)Tc-HDP SPECT/CT, (18)F-NaF PET/CT and wbMRI+DWI. Five independent reviewers interpreted each individual modality without the knowledge of other imaging findings. The final metastatic status was based on the consensus reading, clinical and imaging follow-up (minimal and maximal follow-up time was 6, and 32 months, respectively). The bone findings were compared on patient-, region-, and lesion-level.
  
  
  RESULTS
  (99m)Tc-HDP BS was false negative in four patients. In the region-based analysis, sensitivity values for (99m)Tc-HDP BS, (99m)Tc-HDP SPECT, (99m)Tc-HDP SPECT/CT, (18)F-NaF PET/CT, and wbMRI+DWI were 62%, 74%, 85%, 93%, and 91%, respectively. The number of equivocal findings for (99m)Tc-HDP BS, (99m)Tc-HDP SPECT, (99m)Tc-HDP SPECT/CT, (18)F-NaF PET/CT and wbMRI+DWI was 50, 44, 5, 6, and 4, respectively.
  
  
  CONCLUSIONS
  wbMRI+DWI showed similar diagnostic accuracy to (18)F-NaF PET/CT and outperformed (99m)Tc-HDP SPECT/CT, and (99m)Tc-HDP BS.
authors.affiliation: a Department of Diagnostic Radiology , University of Turku , Turku , Finland.
authors.forename: Ivan
authors.initials: I
authors.lastname: Jambor
authors.affiliation: b Department of Oncology and Radiotherapy , University of Turku , Turku , Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Kuisma
authors.affiliation: b Department of Oncology and Radiotherapy , University of Turku , Turku , Finland.
authors.forename: Susan
authors.initials: S
authors.lastname: Ramadan
authors.affiliation: b Department of Oncology and Radiotherapy , University of Turku , Turku , Finland.
authors.forename: Riikka
authors.initials: R
authors.lastname: Huovinen
authors.affiliation: c Medical Imaging Centre of Southwest Finland, Turku University Hospital , Turku , Finland.
authors.forename: Minna
authors.initials: M
authors.lastname: Sandell
authors.affiliation: d Turku PET Centre , Turku , Finland.
authors.forename: Sami
authors.initials: S
authors.lastname: Kajander
authors.affiliation: d Turku PET Centre , Turku , Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Kemppainen
authors.affiliation: e Department of Clinical Physiology and Nuclear Medicine , North-Karelia Central Hospital , Joensuu , Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Kauppila
authors.affiliation: c Medical Imaging Centre of Southwest Finland, Turku University Hospital , Turku , Finland.
authors.forename: Joakim
authors.initials: J
authors.lastname: Auren
authors.affiliation: d Turku PET Centre , Turku , Finland.
authors.forename: Harri
authors.initials: H
authors.lastname: Merisaari
authors.affiliation: c Medical Imaging Centre of Southwest Finland, Turku University Hospital , Turku , Finland.
authors.forename: Jani
authors.initials: J
authors.lastname: Saunavaara
authors.affiliation: f Department of Clinical Physiology and Nuclear Medicine , Turku University Hospital , Turku , Finland.
authors.forename: Tommi
authors.initials: T
authors.lastname: Noponen
authors.affiliation: b Department of Oncology and Radiotherapy , University of Turku , Turku , Finland.|d Turku PET Centre , Turku , Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Minn
authors.affiliation: a Department of Diagnostic Radiology , University of Turku , Turku , Finland.|c Medical Imaging Centre of Southwest Finland, Turku University Hospital , Turku , Finland.
authors.forename: Hannu J
authors.initials: HJ
authors.lastname: Aronen
authors.affiliation: d Turku PET Centre , Turku , Finland.|f Department of Clinical Physiology and Nuclear Medicine , Turku University Hospital , Turku , Finland.
authors.forename: Marko
authors.initials: M
authors.lastname: Seppänen
mesh_terms: D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D001842:Bone and Bones / Q000000981:diagnostic imaging; D001943:Breast Neoplasms; D004164:Diphosphonates; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D000072078:Positron Emission Tomography Computed Tomography; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D011471:Prostatic Neoplasms; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D017556:Technetium Compounds
chemical_list: D004164:Diphosphonates; D017556:Technetium Compounds; D019788:Fluorodeoxyglucose F18; C029285:hydroxymethanediphosphonic acid