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Can 16-detector multislice CT exclude skeletal lesions during tumour staging? Implications for the cancer patient

  • Oncology
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Abstract

Current imaging guidelines recommend that many cancer patients undergo soft-tissue staging by computed tomography (CT) whilst the bones are imaged by skeletal scintigraphy (bone scan). New CT technology has now made it feasible, for the first time, to perform a detailed whole-body skeletal CT. This advancement could save patients from having to undergo duplicate investigations. Forty-three patients with known malignancy were investigated for bone metastasis using skeletal scintigraphy and 16-detector multislice CT. Both studies were performed within six weeks of each other. Whole-body images were taken 4 h after injection of 500 Mbq 99mTc-MDP using a gamma camera. CT was performed on a 16-detector multislice CT machine from the vertex to the knee. The examinations were reported independently and discordant results were compared at follow-up. Statistical equivalence between the two techniques was tested using the Newcombe-Wilson method within the pre-specified equivalence limits of ±20%. Scintigraphy detected bone metastases in 14/43 and CT in 13/43 patients. There were seven discordances; four cases were positive on scintigraphy, but negative on CT; three cases were positive on CT and negative on scintigraphy. There was equivalence between scintigraphy and CT in detecting bone metastases within ±19% equivalence limits. Patients who have undergone full whole-body staging on 16-detector CT may not need additional skeletal scintigraphy. This should shorten the cancer patient's diagnostic pathway.

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Acknowledgements

The authors are indebted to all the technical/radiographic and clerical staff of both the nuclear medicine and radiology departments of our hospital. The authors appreciate our Institution’s Urology and Oncology doctors for cooperating with our study. The study received a small financial award from the Royal Society of Medicine, UK.

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Authors and Affiliations

  1. Department of Radiology, Addenbrooke's Hospital NHS Trust and the University of Cambridge, Hills Rd, Box 218, Cambridge, CB2 2QQ, UK

    Ashley M. Groves, Clare J. Beadsmoore, Helen M. Courtney, Srinivasan Harish, Philip W. P. Bearcroft & Adrian K. Dixon

  2. Department of Nuclear Medicine, Addenbrooke's Hospital NHS Trust and the University of Cambridge, Hills Rd, Cambridge, CB2 2QQ, UK

    Heok K. Cheow & Kottekkattu K. Balan

  3. Centre for Applied Medical Statistics (CAMS), Department of Public Health and Primary Care, University of Cambridge Forvie Site, Institute of Public Health, Robinson Way, Cambridge, CB2 2SR, UK

    Stephen Kaptoge

  4. Department of Medicine, Lister Hospital, Stevenage, Hertfordshire, SG1 4AB, UK

    Thida Win

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  1. Ashley M. Groves
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  2. Clare J. Beadsmoore
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  3. Heok K. Cheow
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  4. Kottekkattu K. Balan
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  5. Helen M. Courtney
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  6. Stephen Kaptoge
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  7. Thida Win
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  8. Srinivasan Harish
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  9. Philip W. P. Bearcroft
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  10. Adrian K. Dixon
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Correspondence to Ashley M. Groves.

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Groves, A.M., Beadsmoore, C.J., Cheow, H.K. et al. Can 16-detector multislice CT exclude skeletal lesions during tumour staging? Implications for the cancer patient. Eur Radiol 16, 1066–1073 (2006). https://doi.org/10.1007/s00330-005-0042-z

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  • DOI: https://doi.org/10.1007/s00330-005-0042-z

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