Quantitative bone SPECT/CT: high specificity for identification of prostate cancer bone metastases

• Published in: BMC musculoskeletal disorders 2019-12, Vol.20 (1), p.619-619, Article 619
• Main Authors: Tabotta, Flavian, Jreige, Mario, Schaefer, Niklaus, Becce, Fabio, Prior, John O, Nicod Lalonde, Marie
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Benign; Biphenyl (Compound); Bone and Bones - diagnostic imaging; Bone and Bones - pathology; Bone cancer; Bone metastases; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; Bone scintigraphy; Cancer patients; CAT scans; Computed tomography; Corporate presidents; Diagnosis; Diagnostic imaging; Diphosphonates; Humans; Labels; Lesions; Male; Medical research; Mentoring programs; Metastases; Metastasis; Middle Aged; Musculoskeletal diseases; Organotechnetium Compounds; Osteoarthritis; Osteoblasts; Pelvis; Propane; Prostate cancer; Prostatic Neoplasms - pathology; Retrospective Studies; Scintigraphy; Sensitivity and Specificity; Single photon emission computed tomography; Single Photon Emission Computed Tomography Computed Tomography; SPECT/CT; Spinal osteoarthritis; Sport utility vehicles; SUV; Tomography
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-019-3001-6

Bone scintigraphy with Tc-labeled diphosphonates can identify prostate cancer bone metastases with high sensitivity, but relatively low specificity, because benign conditions such as osteoarthritis can also trigger osteoblastic reactions. We aimed to investigate the diagnostic performance of Tc-2,3-dicarboxy propane-1,1-diphosphonate ( Tc-DPD) uptake quantification by single-photon emission computed tomography coupled with computed tomography (SPECT/CT) for distinguishing prostate cancer bone metastases from spinal and pelvic osteoarthritic lesions. We retrospectively assessed 26 bone scans from 26 patients with known prostate cancer bone metastases and 13 control patients with benign spinal and pelvic osteoarthritic changes without known neoplastic disease. Quantitative SPECT/CT (xSPECT, Siemens Symbia Intevo, Erlangen, Germany) was performed and standardized uptake values (SUVs) were quantified with measurements of SUV and SUV (g/mL) in all bone metastases for the prostate cancer group and in spinal and pelvic osteoarthritic changes for the control group. We used receiver operating characteristics (ROC) curves to determine the optimum SUV cutoff value to distinguish between bone metastases and benign spinal and pelvic lesions. In total, 264 prostate cancer bone metastases were analyzed, showing a mean SUV and SUV of 34.6 ± 24.6 and 20.8 ± 14.7 g/mL, respectively. In 24 spinal and pelvic osteoarthritic lesions, mean SUV and SUV were 14.2 ± 3.8 and 8.9 ± 2.2 g/mL, respectively. SUV and SUV were both significantly different between the bone metastases and osteoarthritic groups (p ≤ 0.0001). Using a SUV cutoff of 19.5 g/mL for prostate cancer bone metastases in the spine and pelvis, sensitivity, specificity, positive and negative predictive values were 87, 92, 99 and 49%, respectively. This study showed significant differences in quantitative Tc-DPD uptake on bone SPECT/CT between prostate cancer bone metastases and spinal and pelvic osteoarthritic changes, with higher SUV and SUV in metastases. Using a SUV cutoff of 19.5 g/mL, high specificity and positive predictive value for metastases identification in the spine and pelvis were found, thus increasing accuracy of bone scintigraphy.