Abstract
Objective
Qualitative interpretation in bone scan is often complicated by the presence of degenerative joint disease (DJD), especially in the elderly patient. The aim of this study is to compare objectively 99mTc-MDP tracer uptake between DJD and osseous metastases of the spine using semi-quantitative assessment with SPECT SUV.
Methods
Bone scan with SPECT/CT using 99mTc-MDP was performed in 34 patients diagnosed with prostate carcinoma. SPECT/CT was performed based on our institutional standard guidelines. SUVmax based on body weight in 238 normal vertebrae visualized on SPECT/CT was quantified as baseline. A total of 211 lesions in the spine were identified on bone scan. Lesions were characterized into DJD or bone metastases based on its morphology on low-dose CT. Semi-quantitative evaluation using SUVmax was then performed on 89 DJD and 122 metastatic bone lesions. As most of the bone lesions were small in volume, the effect of partial volume effect (PVE) on SUVmax was also assessed. The corrected SUVmax values were obtained based on the recovery coefficient (RC) method.
Results
The mean SUVmax for normal vertebrae was 7.08 ± 1.97, 12.59 ± 9.01 for DJD and 36.64 ± 24.84 for bone metastases. The SUVmax of bone metastases was significantly greater than DJD (p value < 0.05). To assess for diagnostic accuracy, receiver operating characteristic (ROC) curve was performed. The area under the curve (AUC) was found to be fairly high at 0.874 (95% CI 0.826–0.921). The cutoff SUVmax value ≥ 20 gave a sensitivity of 73.8% and specificity of 85.4% in differentiating bone metastases from DJD. The corrected SUVmax for both DJD and bone metastases was smaller with a mean of 6.82 ± 6.02 and 24.77 ± 20.61, respectively. The cutoff SUVmax value was also lower with a value of 10, which gave a sensitivity of 73.8% and specificity of 86.5%.
Conclusion
SPECT SUVmax was significantly higher in bone metastases than DJD. Semi-quantitative assessment with SUVmax can complement qualitative analysis. A cutoff SUVmax of ≥ 20 can be used to differentiate bone metastases from DJD. Partial volume effect should be taken into consideration in the quantification of small lesion size.
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References
McLoughlin LC, O’Kelly F, O’Brien C, Sheikh M, Feeney J, Torreggiani W, et al. The improved accuracy of planar bone scintigraphy by adding single photon emission computed tomography (SPECT-CT) to detect skeletal metastases from prostate cancer. Ir J Med Sci. 2016;185(1):101–5.
Macedo F, Ladeira K, Pinho F, Saraiva N, Bonito N, Pinto L, et al. Bone metastases: an overview. Oncol Rev. 2017;11(1):321.
Langsteger W, Rezaee A, Pirich C, Beheshti M. 18F-NaF-PET/CT and 99mTc-MDP bone scintigraphy in the detection of bone metastases in prostate cancer. Semin Nucl Med. 2016;46(6):491–501.
O’Sullivan GJ, Carty FL, Cronin CG. Imaging of bone metastasis: an update. World J Radiol. 2015;7(8):202–11.
Tombal B, Lecouvet F. Modern detection of prostate cancer’s bone metastasis: is the bone scan era over? Adv Urol. 2012;1:1. https://doi.org/10.1155/2012/893193.
Donohoe KJ, Cohen EJ, Giammarile F, Grady E, Greenspan BS, Henkin RE, et al. Appropriate use criteria for bone scintigraphy in prostate and breast cancer: summary and excerpts. J Nucl Med. 2017;58(4):14N–7N.
Muzahir S, Jeraj R, Liu G, Hall LT, Munoz A, Rio D, et al. Differentiation of metastatic vs degenerative joint disease using semi-quantitative analysis with 18 F-NaF PET/CT in castrate resistant prostate cancer patients. Am J Nucl Med Mol Imaging. 2015;5(2):162–8.
Helyar V, Mohan HK, Barwick T, Livieratos L, Gnanasegaran G, Clarke SEM, et al. The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma of the prostate. Eur J Nucl Med Mol Imaging. 2010;37(4):706–13.
Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ. Radionuclide bone imaging: an illustrative review. Radio Graph. 2003;23(2):341–58.
Even-Sapir E. Malignant bone involvement. Cancer Imaging. 2005;46(8):1356–67.
Kuwert T. Skeletal SPECT/CT: a review. Clin Transl Imaging. 2014;2(6):505–17.
Rahman MH, Ali MY, Ahmed SAM. The role of SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients. Faridpur Med Coll J. 2013;8(1):31–3.
Beck M, Sanders JC, Ritt P, Reinfelder J, Kuwert T. Longitudinal analysis of bone metabolism using SPECT/CT and 99mTc-diphosphono-propanedicarboxylic acid: comparison of visual and quantitative analysis. EJNMMI Res. 2016;6(1):60.
Even-Sapir E, Martin RH, Barnes DC, Pringle CR, Iles SE, Mitchell MJ. Role of SPECT in differentiating malignant from benign lesions in the lower thoracic and lumbar vertebrae. Radiology. 1993;187(1):193–8.
Cachovan M, Vija AH, Hornegger J, Kuwert T. Quantification of 99mTc-DPD concentration in the lumbar spine with SPECT/CT. EJNMMI Res. 2013;3(1):1–8.
Kaneta T, Ogawa M, Daisaki H, Nawata S, Yoshida K, Inoue T. SUV measurement of normal vertebrae using SPECT/CT with Tc-99m methylene diphosphonate. Am J Nucl Med Mol Imaging. 2016;6(5):262–8.
Adams MC, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. Am J Roentgenol. 2010;195(2):310–20.
Hayes AJ, Reynolds S, Nowell MA, Meakin LB, Habicher J, Ledin J, et al. Spinal deformity in aged zebrafish is accompanied by degenerative changes to their vertebrae that resemble osteoarthritis. PLoS ONE. 2013;8(9):1–12.
Maccauro G, Spinelli MS, Mauro S, Perisano C, Graci C, Rosa MA. Physiopathology of spine metastasis. Int J Surg Oncol. 2011;2011:1–8.
Florimonte L, Dellavedova L, Maffioli LS. Radium-223 dichloride in clinical practice: a review. Eur J Nucl Med Mol Imaging. 2016;43(10):1896–909.
Kuji I, Yamane T, Seto A, Yasumizu Y, Shirotake S, Oyama M. Skeletal standardized uptake values obtained by quantitative SPECT/CT as an osteoblastic biomarker for the discrimination of active bone metastasis in prostate cancer. Eur J Hybrid Imaging. 2017;1(2):1–16.
Win AZ, Aparici CM. Normal SUV values measured from NaF18-PET/CT bone scan studies. PLoS ONE. 2014;9(9):1–6.
Zaw Win Aung, Aparici CM. Factors affecting uptake of NaF-18 by the normal skeleton. J Clin Med Res. 2014;6(6):435–42.
Bailey D, Willowson KP. An evidence-based review of quantitative SPECT imaging and potential clinical applications personalised monte carlo dosimetry platfrom view project radiation biology in radionuclide therapy view project. Artic J Nucl Med. 2013;54:83–9.
Börm W, Gleixner M, Klasen J. Spinal tumors in coexisting degenerative spine disease—a differential diagnostic problem. Eur Spine J. 2004;13(7):633–8.
Bettinardi V, Castiglioni I, De Bernardi E, Gilardi MC. PET quantification: strategies for partial volume correction. Clin Transl Imaging. 2014;2:199–21818.
Nyathi M, Sithole ME. Quantification of partial volume effects in single photon emission computed tomography. Int J Electr Comput Sci IJECS-IJENS. 2016;16(05):1–9.
Acknowledgements
This study was supported by the short-term research grant of the Universiti Sains Malaysia (304/PPSP/6315121). The study was approved by Human Research Ethics Committee USM (HREC), Universiti Sains Malaysia (Reference: USM/JEPeM/17050266).
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Mohd Rohani, M.F., Mat Nawi, N., Shamim, S.E. et al. Maximum standardized uptake value from quantitative bone single-photon emission computed tomography/computed tomography in differentiating metastatic and degenerative joint disease of the spine in prostate cancer patients. Ann Nucl Med 34, 39–48 (2020). https://doi.org/10.1007/s12149-019-01410-4
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DOI: https://doi.org/10.1007/s12149-019-01410-4