title: The added value of SPECT/spiral CT in patients with equivocal bony metastasis from hepatocellular carcinoma.
abstract: The aim of this study was to evaluate the incremental value provided by single-photon emission computed tomography (SPECT)/spiral computed tomography (CT) over SPECT alone for the evaluation of equivocal bone lesions in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  This was a retrospective study of 65 patients (61 men and 4 women; mean age, 53.1 ± 10.1 years; age range, 31-78 years) with HCC confirmed by pathology who underwent planar whole body scintigraphy and SPECT/CT. Each lesion was scored visually using a 5-point scale (0, negative; 1, benign; 2, likely benign; 3, likely bone metastasis; 4, bone metastasis). Lesions in which diagnostic confidence was scored as 3 or 4 were categorized into metastases.The final diagnosis of each lesion was based on pathological confirmation or follow-up by whole body scintigraphy and SPECT/spiral CT conducted two or more times. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SPECT alone and SPECT/CT were computed.
  
  
  RESULTS
  The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of SPECT alone were 78.4, 70.9%, 94.9%, 96.8% and 59.7%, respectively. Moreover, for agreement of SPECT alone and the final results, the kappa value was 0.567 (p < 0.001), which was considered to be moderate agreement. The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of SPECT/CT were 99.2%, 100%, 97.4%, 98.9% and 100 %, respectively. Furthermore, for agreement of SPECT/CT and the final results, the kappa value was 0.981 (p < 0.001), which was considered to be nearly perfect agreement.
  
  
  CONCLUSIONS
  SPECT/spiral CT is more accurate and valuable than SPECT alone in the differential diagnosis of equivocal bone lesions in patients with HCC.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Hongcheng Shi, Department of Nuclear Medicine, Zhongshan Hospital, Fudan University; Nuclear Medicine Institute of Fudan University; Shanghai Institute of Medical Imaging, Shanghai, 200032, China, Tel. +86/21 64 04 19 90 20 64, Fax +86/21 64 03 84 72, shi.hongcheng@zs-hospital.sh.cn.
authors.forename: H
authors.initials: H
authors.lastname: Shi
authors.forename: B
authors.initials: B
authors.lastname: Li
authors.forename: L
authors.initials: L
authors.lastname: Cai
authors.forename: Y
authors.initials: Y
authors.lastname: Gu
authors.forename: Y
authors.initials: Y
authors.lastname: Xiu
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000556:secondary*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008113:Liver Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D036542:Tomography, Spiral Computed / Q000379:methods*; D051598:Whole Body Imaging / Q000379:methods
keywords: Single photon emission computed tomography / computed tomography; bone; hepatocellular carcinoma; neoplasm metastasis