The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma of the prostate
The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma of the prostate
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DOI：
10.1007/s00259-009-1334-3
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发表时间：
2010-04-01
影响因子：
9.1
通讯作者：
Fogelman, Ignac
中科院分区：
文献类型：
--
作者：
Helyar, Vincent;Mohan, Hosahalli K.;Fogelman, Ignac
本研究旨在探讨单光子发射计算机断层扫描(SPECT/CT)对前列腺癌患者诊断的可信度、评价者间的一致性以及对临床治疗的影响，以探讨SPECT/CT对前列腺癌患者全身平面骨扫描和SPECT的附加价值。由两名独立的评价者对图像进行评估；评价者之间的一致性使用加权kappa评分进行评估。使用4分诊断置信度表记录每个异常增加的示踪剂摄取灶。获得机构审查委员会的批准。对40名患者的50个平面骨显像病变进行了评估。在报告平面研究和SPECT扫描时，评价者将61%的病变评价为不明确。在报告SPECT/CT扫描时，只有8%的病变被评为可疑，24%被评为恶性，68%被评为良性。评价者间一致性的加权kappa评分为：核素骨显像0.43，SPECT 0.56，SPECT/CT 0.87。在P<；0.0001，所有这些都具有重要意义。有14名患者的随诊影像证实了SPECT/CT的诊断。SPECT/CT的加入显著减少了不明确的报告；大多数患者得到了明确的诊断，这是因为与单纯的平面或SPECT成像相比，对于有可疑骨转移的前列腺癌患者，诊断的置信度有所提高。
The purpose of this study was to investigate the additional value of single photon emission computed tomography/computed tomography (SPECT/CT) over whole-body planar bone scintigraphy and SPECT in prostate cancer patients in terms of diagnostic confidence, inter-reviewer agreement and the possible impact on the clinical management.This was a retrospective review of 40 consecutive prostate cancer patients (mean age 71 years) who underwent Tc-99m-methylene diphosphonate (MDP) whole-body planar bone scintigraphy, SPECT and SPECT/CT between April 2006 and April 2008. The images were evaluated by two independent reviewers; inter-reviewer agreement was evaluated using a weighted kappa score. Each focus of abnormal increased tracer uptake was recorded using a 4-point diagnostic confidence scale. Institutional Review Board approval was obtained.Fifty lesions on planar bone scintigraphy in the 40 patients were evaluated. On reporting the planar study and SPECT scans, reviewers rated 61% of lesions as equivocal. On reporting the SPECT/CT scans only 8% of lesions were rated as equivocal, 24% were rated as malignant and 68% as benign. Weighted kappa scores for inter-reviewer agreement were 0.43 for bone scintigraphy, 0.56 for SPECT and 0.87 for SPECT/CT. All were significant at p < 0.0001. Follow-up imaging confirmed the SPECT/CT diagnoses in 14 patients.The addition of SPECT/CT resulted in a significant reduction of equivocal reports; a definitive diagnosis was given in the majority of the patients due to the improved diagnostic confidence compared to planar or SPECT imaging alone in prostate cancer patients with suspected bone metastases.