Single photon emission computed tomography/spiral computed tomography fusion imaging for the diagnosis of bone metastasis in patients with known cancer

To evaluate single photon emission computed tomography (SPECT)/spiral computed tomography (CT) fusion imaging for the diagnosis of bone metastasis in patients with known cancer and to compare the diagnostic efficacy of SPECT/CT fusion imaging with that of SPECT alone and with SPECT + CT.

One hundred forty-one bone lesions of 125 cancer patients (with nonspecific bone findings on bone scintigraphy) were investigated in the study. SPECT, CT, and SPECT/CT fusion images were acquired simultaneously. All images were interpreted independently by two experienced nuclear medicine physicians. In cases of discrepancy, consensus was obtained by a joint reading. The final diagnosis was based on biopsy proof and radiologic follow-up over at least 1 year.

The final diagnosis revealed 63 malignant bone lesions and 78 benign lesions. The diagnostic sensitivity of SPECT, SPECT + CT, and SPECT/CT fusion imaging for malignant lesions was 82.5%, 93.7%, and 98.4%, respectively. Specificity was 66.7%, 80.8%, and 93.6%, respectively. Accuracy was 73.8%, 86.5%, and 95.7%, respectively. The specificity and accuracy of SPECT/CT fusion imaging for the diagnosis malignant bone lesions were significantly higher than those of SPECT alone and of SPECT + CT (P < 0.05). Among 37 equivocal lesions revealed with SPECT, the diagnostic accuracy of bone lesions was 45.9% for SPECT + CT and 81.1% for SPECT/CT fusion imaging (χ² = 9.855, P = 0.002). The numbers of equivocal lesions were 37, 18, and 5 for SPECT, SPECT + CT, and SPECT/CT fusion imaging, respectively, and 29.7% (11/37), 27.8% (5/18), and 20.0% (1/5) of lesions were confirmed to be malignant by radiologic follow-up over at least 1 year.

SPECT/spiral CT is particularly valuable for the diagnosis of bone metastasis in patients with known cancer by providing precise anatomic localization and detailed morphologic characteristics.