title: [Value of (99)Tc(m)-MDP SPECT/CT in clinical decision-making for nasopharyngeal carcinoma and a comparison of the values of different imaging techniques for diagnosing skull-base bone invasion].
abstract: Objective:To analyze the clinical value of SPECT/CT in diagnosis of skull base bone invasion and clinical decision-making for nasopharyngeal carcinoma (NPC), and to compare their diagnostic value with SPECT/CT, CT, MRI, and MRI combined with SPECT (MRI-SPECT) for skull base bone invasion.Methods:Before treatment, among 348 newly diagnosed NPC patients, CT scan was performed in 186 patients (group A) and the remaining 162 patients received MRI scan (group B). Clinical doctors then made clinical management decisions according to the CT or MRI results. After that, all patients underwent (99)Tc(m)-MDP SPECT/CT examination for nasopharyngeal local tomography, and the results were provided to the clinical doctors to make clinical management decisions again. The changes between the two clinical management decisions were scored according to diagnosis, range of lesion, staging, treatment regimens, and auxiliary examination. The diagnostic value of CT scan, MRI scan, SPECT/CT and MRI-SPECT for skull base bone invasion was then evaluated and compared.Results:In terms of changes in scores of clinical management decisions, the score of group A was 1.387 and group B was 0.951, showing a significant difference between the two groups by Wilcoxon test (Z=6.570,P<0.001). Byχ(2) test, there were correlations between CT and SPECT/CT (χ(2) =98.495,P<0.001), and between MRI and SPECT/CT (χ(2) =32.662,P<0.001). The consistency of CT and SPECT/CT (Kappa=0.713) was greater than MRI and SPECT (Kappa=0.449). The sensitivity of CT, MRI, SPECT/CT and MRI-SPECT was 67.1%, 84.5%, 90.8% and 100%, the specificity was 73.3%, 92.3%, 85.6% and 84.6%, and the area under the ROC curve was 0.702, 0.884, 0.882 and 0.923, respectively.Conclusions:SPECT/CT has important impact on clinical management decision for NPC. In the judgement of skull base invasion, the diagnostic value of SPECT/CT is significantly higher than CT and approximately equal to MRI. SPECT/CT should be one of the routine examination methods of nasopharyngeal carcinoma. In addition, in view of its greater diagnostic value, MRI combined with SPECT should be the focus of future imaging studies.
authors.affiliation: Department of Nuclear Medicine, Cancer Hospital of Guangzhou Medical University, Guangzhou 510095, China.
authors.forename: W
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Nuclear Medicine, Cancer Hospital of Guangzhou Medical University, Guangzhou 510095, China.
authors.forename: R S
authors.initials: RS
authors.lastname: Zhang
authors.affiliation: Department of Nuclear Medicine, Cancer Hospital of Guangzhou Medical University, Guangzhou 510095, China.
authors.forename: L Q
authors.initials: LQ
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Cancer Hospital of Guangzhou Medical University, Guangzhou 510095, China.
authors.forename: B G
authors.initials: BG
authors.lastname: Lu
authors.affiliation: Department of Radiology, Cancer Hospital of Guangzhou Medical University, Guangzhou 510095, China.
authors.forename: W H
authors.initials: WH
authors.lastname: Fu
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D009361:Neoplasm Invasiveness; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D019291:Skull Base / Q000000981:diagnostic imaging / Q000473:pathology; D013669:Technetium Tc 99m Medronate; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate
keywords: (99)Tc(m)-MDP; Diagnosis; Nasopharyngeal neoplasms; Neoplasm invasion; Skull base; Tomography, emission-computed, single-photon