Comparison of 18F Fluoride PET/CT and 99mTc-MDP Bone Scan in the Detection of Skeletal Metastases in Urinary Bladder Carcinoma

• Published in: Clinical nuclear medicine 2013-08, Vol.38 (8), p.616-621
• Main Authors: Chakraborty, Dhritiman, Bhattacharya, Anish, Mete, Uttam Kumar, Mittal, Bhagwant Rai
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Bone and Bones - diagnostic imaging; Bone Neoplasms - diagnosis; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; Female; Fluorides; Fluorine Radioisotopes; Humans; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Technetium Tc 99m Medronate; Tomography, X-Ray Computed; Urinary Bladder Neoplasms - pathology
• ISSN: 0363-9762; 1536-0229
• DOI: 10.1097/RLU.0b013e31828da5cc

AIMThe aim of this study was to compare F-fluoride PET/CT and Tc-MDP bone scintigraphy in the detection of skeletal metastases in urinary bladder carcinoma. PATIENTS AND METHODSIn this prospective study, 48 patients with urinary bladder carcinoma (44 male and 4 female patients, aged 35–80 years) underwent Tc-MDP planar and SPECT/CT bone scan (BS) followed by F-fluoride PET/CT within 48 hours. Skeletal metastasis diagnosed on each of these techniques was compared against a final diagnosis based on contrast-enhanced CT, MRI, skeletal survey, clinical follow-up, and histological correlation. RESULTSF-fluoride PET/CT identified bony metastases and changed the management in 17 of 48 patients (35%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Tc-MDP planar BS were 82.35%, 64.51%, 56%, 86.95%, and 70.83%; of Tc-MDP SPECT/CT were 88.23%, 74.19%, 65.21%, 92%, and 79.16%; and of F-fluoride PET/CT were 100%, 87.09%, 80.95%, 100%, and 91.66%, respectively. Fair agreement between Tc-MDP planar BS and F-fluoride PET/CT (κ = 0.42) and excellent agreement between SPECT/CT and F-fluoride PET/CT (κ = 0.74) were found. CONCLUSIONSF-fluoride PET/CT has higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in detecting bone metastases in urinary bladder carcinoma than conventional Tc-MDP planar BS. SPECT/CT improves all these parameters compared with planar BS and may serve as a cost-effective screening procedure for the detection of skeletal metastases in high-risk patients.