Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
EJNMMI Research
Published in: EJNMMI Research 1/2016

Open Access 01-12-2016 | Original research

Longitudinal analysis of bone metabolism using SPECT/CT and 99mTc-diphosphono-propanedicarboxylic acid: comparison of visual and quantitative analysis

Authors: Michael Beck, James C. Sanders, Philipp Ritt, Julia Reinfelder, Torsten Kuwert

Published in: EJNMMI Research | Issue 1/2016

Login to get access

Abstract

Background

The therapy response of osseous metastases (OM) is commonly monitored by bone scintigraphies (BS). The aim of this study was to compare visual evaluation of changes in tracer uptake with quantitation in absolute units in OMs; 52 OMs from 19 patients who underwent BS with SPECT/CT at time points one and two (TP1/2) were analyzed retrospectively, with an average of 10.3 months between TP1 and 2. Tracer uptake in lesions was visually compared by two independent readers in both planar scintigraphies and SPECT/CT across both TPs and classified as regressive, stable, or progressive. Quantitative analysis was performed by measuring peak standardized uptake values (SUV). Based on quantitation, lesions were similarly classified as regressive (>30 % decrease), progressive (>30 % increase), or stable (rest). If available, uptake in reference regions in the lower thoracic or lumbar spine was used for normalization.

Results

In OMs at TP1 and TP2, mean SUVpeak (±SD) was found to be 20.4 (±20.8) and 16.4 (±11.5), respectively. For the reference region, mean SUVmean was 5.6 (±1.9) and 4.9 (±2.2). Agreement between quantitative and visual assessment was only moderate, with an average Cohen’s kappa of 0.42 for planar scintigraphy and 0.62 for SPECT/CT. Discrepancies occurred in between 11 and 22 of the 52 lesions, depending on the reader and whether planar or SPECT imaging was considered.

Conclusions

Compared to measuring uptake in absolute units, visual evaluation of skeletal scintigraphies for change in tumor metabolism yields inconsistent results in roughly one third of the cases.
Literature
1.
2.
Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT, 18 F-fluoride PET, and 18 F-fluoride PET/CT. J Nucl Med. 2006;47:287–97.PubMed
3.
Mohler JL, Kantoff PW, Armstrong AJ, Bahnson RR, Cohen M, D'Amico AV, et al. Prostate cancer, version 2.2014. J Natl Compr Canc Netw. 2014;12:686–718.PubMed
4.
Schirrmeister H, Guhlmann A, Elsner K, Kotzerke J, Glatting G, Rentschler M, et al. Sensitivity in detecting osseous lesions depends on anatomic localization: planar bone scintigraphy versus 18 F PET. J Nucl Med. 1999;40:1623–9.PubMed
5.
Messiou C, Collins DJ, Giles S, de Bono JS, Bianchini D, de Souza NM. Assessing response in bone metastases in prostate cancer with diffusion weighted MRI. Eur Radiol. 2011;21:2169–77.CrossRefPubMed
6.
Du Y, Cullum I, Illidge TM, Ell PJ. Fusion of metabolic function and morphology: sequential [18 F] fluorodeoxyglucose positron-emission tomography/computed tomography studies yield new insights into the natural history of bone metastases in breast cancer. J Clin Oncol. 2007;25:3440–7.CrossRefPubMed
7.
Hillner BE, Siegel BA, Hanna L, Duan F, Quinn B, Shields AF. 18 F-fluoride PET used for treatment monitoring of systemic cancer therapy: results from the National Oncologic PET Registry. J Nucl Med. 2015;56:222–8.CrossRefPubMed
8.
Tateishi U, Gamez C, Dawood S, Yeung HW, Cristofanilli M, Macapinlac HA. Bone metastases in patients with metastatic breast cancer: morphologic and metabolic monitoring of response to systemic therapy with integrated PET/CT 1. Radiology. 2008;247:189–96.CrossRefPubMed
9.
Wetter A, Lipponer C, Nensa F, Heusch P, Rubben H, Schlosser TW, et al. Quantitative evaluation of bone metastases from prostate cancer with simultaneous [18 F] choline PET/MRI: combined SUV and ADC analysis. Ann Nucl Med. 2014;28:405–10.CrossRefPubMed
10.
Romer W, Nomayr A, Uder M, Bautz W, Kuwert T. SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients. J Nucl Med. 2006;47:1102–6.PubMed
11.
Savelli G, Maffioli L, Maccauro M, De Deckere E, Bombardieri E. Bone scintigraphy and the added value of SPECT (single photon emission tomography) in detecting skeletal lesions. Q J Nucl Med. 2001;45:27–37.PubMed
12.
Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology. 2006;238:264–71.CrossRefPubMed
13.
Vija AH, Hawman EG, Engdahl JC. Analysis of a SPECT OSEM reconstruction method with 3D beam modeling and optional attenuation correction: phantom studies. Nuclear Science Symposium Conference Record 2003 IEEE. 2003;4:2662–6.
14.
15.
Romer W, Reichel N, Vija HA, Nickel I, Hornegger J, Bautz W, et al. Isotropic reconstruction of SPECT data using OSEM3D: correlation with CT. Acad Radiol. 2006;13:496–502.CrossRefPubMed
16.
Zeintl J, Vija AH, Yahil A, Hornegger J, Kuwert T. Quantitative accuracy of clinical 99mTc SPECT/CT using ordered-subset expectation maximization with 3-dimensional resolution recovery, attenuation, and scatter correction. J Nucl Med. 2010;51:921–8.CrossRefPubMed
17.
18.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.CrossRefPubMed
19.
Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, et al. New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States. JNCI Canada J Natl Cancer Inst. 2000;92:205–16.CrossRefPubMed
20.
Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50 Suppl 1:122S–50.CrossRefPubMedPubMedCentral
21.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.CrossRef
22.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefPubMed
23.
Bailey DL, Willowson KP. An evidence-based review of quantitative SPECT imaging and potential clinical applications. J Nucl Med. 2013;54:83–9.CrossRefPubMed
24.
Imbriaco M, Larson SM, Yeung HW, Mawlawi OR, Erdi Y, Venkatraman ES, et al. A new parameter for measuring metastatic bone involvement by prostate cancer: the Bone Scan Index. Clin Cancer Res. 1998;4:1765–72.PubMed
25.
Bauerle T, Semmler W. Imaging response to systemic therapy for bone metastases. Eur Radiol. 2009;19:2495–507.CrossRefPubMed
26.
Ellmann S, Beck M, Kuwert T, Uder M, Bäuerle T. Multimodal imaging of bone metastases: from preclinical to clinical applications. J Orthop Translat. 2015;3:166–77.CrossRef
27.
Hayward JL, Rubens RD, Carbone PP, Heuson JC, Kumaoka S, Segaloff A. Assessment of response to therapy in advanced breast cancer. A project of the programme on clinical oncology of the International Union against Cancer, Geneva, Switzerland. Eur J Cancer. 1978;14:1291–2.CrossRefPubMed
28.
Uchida K, Nakajima H, Miyazaki T, Yayama T, Kawahara H, Kobayashi S, et al. Effects of alendronate on bone metabolism in glucocorticoid-induced osteoporosis measured by 18 F-fluoride PET: a prospective study. J Nucl Med. 2009;50:1808–14.CrossRefPubMed
29.
Cook Jr G, Parker C, Chua S, Johnson B, Aksnes AK, Lewington VJ. 18 F-fluoride PET: changes in uptake as a method to assess response in bone metastases from castrate-resistant prostate cancer patients treated with 223Ra-chloride (Alpharadin). EJNMMI Res. 2011;1:4.CrossRefPubMedPubMedCentral
30.
Hsu B, Chen FC, Wu TC, Huang WS, Hou PN, Chen CC, et al. Quantitation of myocardial blood flow and myocardial flow reserve with 99mTc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease. Eur J Nucl Med Mol Imaging. 2014;41:2294–306.CrossRefPubMed
31.
Condon B, Buchanan R, Garvie N, Ackery D, Fleming J, Taylor D, et al. Assessment of progression of secondary bone lesions following cancer of the breast or prostate using serial radionuclide imaging. Br J Radiol. 1981;54:18–23.CrossRefPubMed
32.
Sturgeon CM, Duffy MJ, Stenman U-H, Lilja H, Brünner N, Chan DW, et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem. 2008;54:e11–79.CrossRefPubMed
33.
Levenson RM, Sauerbrunn B, Bates H, Newman R, Eddy J, Ihde D. Comparative value of bone scintigraphy and radiography in monitoring tumor response in systemically treated prostatic carcinoma. Radiology. 1983;146:513–8.CrossRefPubMed
34.
Janicek MJ, Hayes DF, Kaplan WD. Healing flare in skeletal metastases from breast cancer. Radiology. 1994;192:201–4.CrossRefPubMed
Metadata
Title
Longitudinal analysis of bone metabolism using SPECT/CT and 99mTc-diphosphono-propanedicarboxylic acid: comparison of visual and quantitative analysis
Authors
Michael Beck
James C. Sanders
Philipp Ritt
Julia Reinfelder
Torsten Kuwert
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
EJNMMI Research / Issue 1/2016
Electronic ISSN: 2191-219X
DOI
https://doi.org/10.1186/s13550-016-0217-4

Other articles of this Issue 1/2016

EJNMMI Research 1/2016 Go to the issue

Original research

The clinical safety, biodistribution and internal radiation dosimetry of [18F]AH113804 in healthy adult volunteers

Original research

Optimal 2-[18F]fluoro-2-deoxy-d-galactose PET/CT protocol for detection of hepatocellular carcinoma

Original research

Quantitative accuracy of 177Lu SPECT reconstruction using different compensation methods: phantom and patient studies

Original research

A new method to quantify tau pathologies with 11C-PBB3 PET using reference tissue voxels extracted from brain cortical gray matter

Short communication

Impact of fasting on 18F-fluorocholine gastrointestinal uptake and detection of lymph node metastases in patients with prostate cancer

Original research

Pilot study: use of gallium-68 PSMA PET for detection of metastatic lesions in patients with renal tumour