The added value of multislice SPECT/CT in patients with equivocal bony metastasis from carcinoma of the prostate

  • Vincent Helyar
  • Hosahalli K. Mohan
  • Tara Barwick
  • Lefteris Livieratos
  • Gopinath Gnanasegaran
  • Susan E. M. Clarke
  • Ignac Fogelman
Original Article



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 99mTc-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.


SPECT/CT Bony metastasis Prostate cancer 


Financial support



  1. 1.
    Heidenreich A, Aus G, Abbou C, Bolla M, Joniau S, Matveev V, et al. Guidelines on prostate cancer. European Association of Urology 2007.Google Scholar
  2. 2.
    Love C, Din AS, Tomas MB, Kalapparambath TP, Palestro CJ. Radionuclide bone imaging: an illustrative review. Radiographics 2003;23:341–58.CrossRefPubMedGoogle Scholar
  3. 3.
    National Institute of Clinical Excellence. Improving outcomes in urological cancer 2002.Google Scholar
  4. 4.
    Huncharek M, Muscat J. Serum prostate-specific antigen as a predictor of radiographic staging studies in newly diagnosed prostate cancer. Cancer Invest 1995;13:31–5.CrossRefPubMedGoogle Scholar
  5. 5.
    Minoves M. Bone and joint sports injuries: the role of bone scintigraphy. Nucl Med Commun 2003;24:3–10.CrossRefPubMedGoogle Scholar
  6. 6.
    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;187:193–8.PubMedGoogle Scholar
  7. 7.
    Reinartz P, Schaffeldt J, Sabri O, Zimny M, Nowak B, Ostwald E, et al. Benign versus malignant osseous lesions in the lumbar vertebrae: differentiation by means of bone SPET. Eur J Nucl Med 2000;27:721–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Römer W, Nömayr A, Uder M, Bautz W, Kuwert T. SPECT-guided CT for evaluating foci of increased bone metabolism classified as indeterminate on SPECT in cancer patients. J Nucl Med 2006;47:1102–6.PubMedGoogle Scholar
  9. 9.
    Horger M, Eschmann SM, Pfannenberg C, Vonthein R, Besenfelder H, Claussen CD, et al. Evaluation of combined transmission and emission tomography for classification of skeletal lesions. AJR Am J Roentgenol 2004;183:655–61.PubMedGoogle Scholar
  10. 10.
    Utsunomiya D, Shiraishi S, Imuta M, Tomiguchi S, Kawanaka K, Morishita S, et al. Added value of SPECT/CT fusion in assessing suspected bone metastasis: comparison with scintigraphy alone and nonfused scintigraphy and CT. Radiology 2006;238:264–71.CrossRefPubMedGoogle Scholar
  11. 11.
    Svanholm H, Starklint H, Gundersen HJ, Fabricius J, Barlebo H, Olsen S. Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic. APMIS 1989;97:689–98.CrossRefPubMedGoogle Scholar
  12. 12.
    Horger M, Bares R. The role of single-photon emission computed tomography/computed tomography in benign and malignant bone disease. Semin Nucl Med 2006;36:286–94.CrossRefPubMedGoogle Scholar
  13. 13.
    Strobel K, Burger C, Seifert B, Husarik DB, Soyka JD, Hany TF. Characterization of focal bone lesions in the axial skeleton: performance of planar bone scintigraphy compared with SPECT and SPECT fused with CT. AJR Am J Roentgenol 2007;188:W467–74.CrossRefPubMedGoogle Scholar
  14. 14.
    Raghavan D, Scher HI, Leibel SA, Lange PH. Principles and practice of genitourinary oncology. Philadelphia: Lippincott-Raven; 1997.Google Scholar
  15. 15.
    Tangen CM, Faulkner JR, Crawford ED, Thompson IM, Hirano D, Eisenberger M, et al. Ten-year survival in patients with metastatic prostate cancer. Clin Prostate Cancer 2003;2:41–5.PubMedGoogle Scholar
  16. 16.
    Administration of Radioactive Substances Advisory Committee. Notes for guidance on the clinical administration of radiopharmaceuticals and use of sealed radioactive sources. 2006. 2008.
  17. 17.
    Department of Health. The NHS Cancer Plan: a plan for investment, a plan for reform. 2000. Accessed 12 Dec 2007.Google Scholar
  18. 18.
    National Institute of Health and Clinical Excellence. Prostate cancer: diagnosis and treatment. NICE Clinical Guideline 58. 2008. 2008.

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Vincent Helyar
    • 1
  • Hosahalli K. Mohan
    • 2
  • Tara Barwick
    • 2
  • Lefteris Livieratos
    • 2
  • Gopinath Gnanasegaran
    • 2
  • Susan E. M. Clarke
    • 2
  • Ignac Fogelman
    • 2
  1. 1.School of MedicineKing’s College LondonTaunton, SomersetUK
  2. 2.Department of Nuclear MedicineGuy’s and St Thomas’ NHS Foundation TrustLondonUK

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