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. 2017 Nov 1;7(5):218-227.
eCollection 2017.

Diagnostic test accuracy study of 18F-sodium fluoride PET/CT, 99mTc-labelled diphosphonate SPECT/CT, and planar bone scintigraphy for diagnosis of bone metastases in newly diagnosed, high-risk prostate cancer

Randi F Fonager  1   2 , Helle D Zacho  1   2 , Niels C Langkilde  3 , Joan Fledelius  4 , June A Ejlersen  4 , Christian Haarmark  5 , Helle W Hendel  5 , Mine Benedicte Lange  2   6 , Mads R Jochumsen  7 , Jesper C Mortensen  4 , Lars J Petersen  1   2
Affiliations

Diagnostic test accuracy study of 18F-sodium fluoride PET/CT, 99mTc-labelled diphosphonate SPECT/CT, and planar bone scintigraphy for diagnosis of bone metastases in newly diagnosed, high-risk prostate cancer

Randi F Fonager et al. Am J Nucl Med Mol Imaging. .

Abstract

The aim of this study was to prospectively compare planar, bone scan (BS) versus SPECT/CT and NaF PET/CT in detecting bone metastases in prostate cancer. Thirty-seven consecutive, newly diagnosed, prostate cancer patients with prostate specific antigen (PSA) levels ≥ 50 ng/mL and who were considered eligible for androgen-deprivation therapy (ADT) were included in this study. BS, SPECT/CT, and NaF PET/CT, were performed prior to treatment and were repeated after six months of ADT. Baseline images from each index test were independently read by two experienced readers. The reference standard was based on a consensus decision made by a multidisciplinary team on the basis of baseline and follow-up images of the index tests, the findings of the baseline index tests by the experienced readers, and any available imaging, biochemical, and clinical data, including the response to ADT. Twenty-seven (73%) of the 37 patients had bone metastases according to the reference standard. The sensitivities for BS, SPECT/CT and NaF PET/CT were 78%, 89%, and 89%, respectively, and the specificities were 90%, 100%, and 90%, respectively. The positive predictive values of BS, SPECT/CT and NaF PET/CT were 96%, 100%, and 96%, respectively, and the negative predictive values were 60%, 77% and 75%, respectively. No statistically significant difference among the three imaging modalities was observed. All three imaging modalities showed high sensitivity and specificity. NaF PET/CT and SPECT/CT showed numerically improved, but not statistically superior, sensitivity compared with BS in this limited and selected patient cohort.

Keywords: Diagnostic test accuracy; NaF PET/CT; SPECT/CT; bone metastases; bone scan; prostate cancer.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flowchart for the recruitment of patients.
Figure 2
Figure 2
Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values of bone scan (BS), SPECT/CT and NaF PET/CT. Error bars indicate the upper 95% confidence interval.
Figure 3
Figure 3
An illustrative example of baseline imaging of a 74-year-old patient classified as true positive for bone metastases by both SPECT/CT and NaF PET/CT, but false negative by planar whole-body bone scan. Anterior and posterior projections of the bone scan (A) were interpreted as non-metastatic on the dichotomous scale (with equivocal uptake in the pelvic region noted on the three-point scale). Both SPECT (B) and NaF PET (C) showed metastatic lesions on the maximum intensity projection images (long and short black arrows). These lesions were confirmed by fused SPECT/CT and PET/CT: Axial images corresponding to the lesion indicated by a long black arrow on (B and C) are shown on the fused SPECT/CT (D), on the corresponding CT from the NaF PET/CT scan showing sclerosis at the site of the lesion (E), and finally on (F), which shows the fused NaF PET/CT image (white arrows).
See this image and copyright information in PMC

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