Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2015; 54(06): 255-261
DOI: 10.3413/Nukmed-0730-15-03

Original article

Schattauer GmbH

The added value of SPECT/spiral CT in patients with equivocal bony metastasis from hepatocellular carcinoma

Zusatznutzen der SPECT/Spiral-CT bei Patienten mit unklaren Knochenmetastasen eines hepatozellulären Karzinoms

Y. Zhang

¹Department of Nuclear Medicine, Zhongshan Hospital, Fudan University; Nuclear Medicine Institute of Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China

,

H. Shi

¹Department of Nuclear Medicine, Zhongshan Hospital, Fudan University; Nuclear Medicine Institute of Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China

,

B. Li

¹Department of Nuclear Medicine, Zhongshan Hospital, Fudan University; Nuclear Medicine Institute of Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China

,

L. Cai

¹Department of Nuclear Medicine, Zhongshan Hospital, Fudan University; Nuclear Medicine Institute of Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China

,

Y. Gu

¹Department of Nuclear Medicine, Zhongshan Hospital, Fudan University; Nuclear Medicine Institute of Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China

,

Y. Xiu

¹Department of Nuclear Medicine, Zhongshan Hospital, Fudan University; Nuclear Medicine Institute of Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China

› Institutsangaben

Summary

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). Patients, 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.

Zusammenfassung

In dieser Studie sollte der zusätzliche Nutzen bewertet werden, den die Single-Photon-Emissions- Computertomografie (SPECT) / Spiral- Computertomografie (CT) für die Beurteilung unklarer Knochenläsionen bei Patienten mit hepatozellulärem Karzinom (HCC) gegenüber der SPECT alleine bietet. Patienten, Methoden: Retrospektive Studie mit 65 Patienten (61 Männer, 4 Frauen; mittleres Alter 53,1 ± 10,1 Jahre; Altersbereich 31–78 Jahre) mit pathologisch gesichertem HCC, bei denen eine planare Ganzkörper-Szintigraphie sowie eine SPECT/CT durchgeführt wurden. Jede Läsion wurde anhand einer 5-Punkte-Skala (0, negativ; 1, benigne; 2, wahrscheinlich benigne; 3, wahrscheinlich Knochenmetastase; 4, Knochenmetastase) visuell eingestuft. Läsionen mit einem diagnostisch sicheren Punktwert von 3 oder 4 wurden als Metastasen klassifiziert. Die endgültige Diagnose basierte bei allen Läsionen auf der pathologischen Bestätigung oder der Kontrolle durch Ganzkörper-Szintigraphie und SPECT/Spiral- CT, die zweimal oder öfter durchgeführt wurden. Für SPECT alleine und SPECT/CT wurden Diagnosegenauigkeit, Sensitivität, Spezifität, positiver (PPV) und negativer (NPV) Vorhersagewert berechnet. Ergebnisse: Diagnosegenauigkeit, Sensitivität, Spezifität, PPV und NPV der SPECT alleine lagen bei 78,4, 70,9%, 94,9%, 96,8% bzw. 59,7%. Für die übereinstimmung zwischen SPECT alleine und den Endergebnissen ergab sich zudem ein Kappa- Wert von 0,567 (p < 0,001), der als mäßige übereinstimmung betrachtet wurde. Diagnosegenauigkeit, Sensitivität, Spezifität, PPV und NPV der SPECT/CT betrugen 99,2%, 100%, 97,4%, 98,9% bzw. 100%. Ferner ergab sich ein Kappa-Wert von 0,981 (p < 0.001) für die übereinstimmung zwischen SPECT/CT und den Endergebnissen, was als nahezu perfekte übereinstimmung galt. Schlussfolgerung: SPECT/Spiral-CT ist bei der Differenzialdiagnose unklarer Knochenläsionen bei Patienten mit HCC präziser und vorteilhafter als SPECT alleine.

Keywords

Keywords

Single photon emission computed tomography / computed tomography - hepatocellular carcinoma - bone - neoplasm metastasis

Schlüsselwörter

Schlüsselwörter

Single-Photon-Emissions-Computer tomographie / Computertomographie - hepato-zelluläres Karzinom - Knochen - Neoplasie - Metastase

References
1 Bellah RD, Summerville DA, Treves ST, Micheli LJ. Low back pain in adolescent athletes: Detection of stress injury to the pars interarticularis with SPECT. Radiology 1991; 180: 509-512.
2 Bodner RJ, Heyman S, Drummond DS, Gregg JR. The use of single photon emission computed tomography (SPECT) in the diagnosis of low-back pain in young patients. Spine 1988; 13: 1155-1160.
3 Chen CY, Wu K, Lin WH. et al. High false negative rate of Tc-99m MDP whole body bone scintigraphy in detecting skeletal metastases for patients with hepatoma. J Formos Med Assoc 2012; 111: 140-146.
4 Chen JG, Zhang SW. Liver cancer epidemic in China: past, present and future. Semin Cancer Biol 2011; 21: 59-69.
5 Dutton JA, Hughes SP, Peters AM. SPECT in the management of patients with back pain and spondylolysis. Clin Nucl Med 2000; 25: 93-96.
6 Eustace S, Tello R, DeCarvalho V. et al. A comparison of whole body turboSTIR MR imaging and planar ^99mTc-methylene diphosphonate scintigraphy in the examination of patients with suspected skeletal metastases. AJR Am J Roentgenol 1997; 169: 1655-1661.
7 Even-Sapir E, Martin RH, Barnes DC. et al. Role of SPECT in differentiating malignant from benign lesions in the lower thoracic and lumbar vertebrae. Radiology 1993; 187: 193-198.
8 Fukutomi M, Yokota M, Chuman H. et al. Increased incidence of bone metastases in hepatocellular carcinoma. Eur J Gastroenterol Hepatol 2001; 13: 1083-1088.
9 He J, Zeng ZC, Tang ZY. et al. Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma receiving external beam radiotherapy. Cancer 2009; 115: 2710-2720.
10 Helyar V, Mohan HK, Barwick T. et al. The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma of the prostate. Eur J Nucl Med Mol Imaging 2010; 37: 706-713.
11 Horger M, Bares R. The role of single-photon emission computed tomography/computed tomography in benign and malignant bone disease. Semin Nucl Med 2006; 36: 286-294.
12 Horger M, Eschmann SM, Pfannenberg C. et al. Evaluation of combined transmission and emission tomography for classification of skeletal lesions. AJR 2004; 183: 655-661.
13 Jiang L, Han L, Tan H. et al. Diagnostic value of ^99mTc-MDP SPECT/spiral CT in assessing indeterminate spinal solitary lesion of patients without malignant history. Ann Nucl Med 2013; 27: 460-467.
14 Kashima M, Yamakado K, Takaki H. et al. Radiofrequency ablation for the treatment of bone metastases from hepatocellular carcinoma. AJR Am J Roentgenol 2010; 194: 536-541.
15 Kobayashi K, Okuyama C, Kubota T. et al. Do short-time SPECT images of bone scintigraphy improve the diagnostic value in the evaluation of solitary lesions in the thoracic spine in patients with extraskeletal malignancies?. Ann Nucl Med 2005; 19: 557-566.
16 Linke R, Kuwert T, Uder M. et al. Skeletal SPECT/CT of the peripheral extremities. AJR Am J Roentgenol 2010; 194: W329-W335.
17 Love C, Din AS, Tomas MB. et al. Radionuclide bone imaging: an illustrative review. Radiographics 2003; 23: 341-358.
18 Romer W, Nomayr A, Uder M. et al. SPECT-Guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients. J Nucl Med 2006; 47: 1102-1106.
19 Rybak LD, Rosenthal DI. Radiological imaging for the diagnosis of bone metastases. Q J Nucl Med 2001; 45: 53-64.
20 Savelli G, Chiti A, Grasselli G. et al. The role of bone SPET study in diagnosis of single vertebral metastases. Anticancer Res 2000; 20: 1115-1120.
21 Schillaci O, Danieli R, Manni C. et al. Is SPECT/CT with a hybrid camera useful to improve scintigraphic imaging interpretation?. Nucl Med Commun 2004; 25: 705-710.
22 Sharma P, Singh H, Kumar R. et al. Bone scintigraphy in breast cancer: added value of hybrid SPECT-CT and its impact on patient management. Nucl Med Commun 2012; 33: 139-147.
23 Strobel K, Burger C, Seifert B. et al. Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. AJR Am J Roentgenol 2007; 188: W467-74.
24 Utsunomiya D, Shiraishi S, Imuta M. 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: 264-271.
25 Witjes CD, Verhoef C, Kwekkeboom DJ. et al. Is bone scintigraphy indicated in surgical work-up for hepatocellular carcinoma patients?. J Surg Res 2013; 181: 256-261.
26 Zhang Y, Shi H, Cheng D. et al. Added value of SPECT/spiral CT versus SPECT in diagnosing solitary spinal lesions in patients with extraskeletal malignancies. Nucl Med Commun 2013; 34: 451-458.
27 Zhang Y, Shi H, Gu Y. et al. Differential diagnostic value of single-photon emission computed tomography/spiral computed tomography with Tc-99m-methylene diphosphonate in patients with spinal lesions. Nucl Med Commun 2011; 32: 1194-1200.
28 Zhao Z, Li L, Li F, Zhao L. Single photon emission computed tomography/spiral computed tomography fusion imaging for the diagnosis of bone metastasis in patients with known cancer. Skeletal Radiol 2010; 39: 147-153.