Korean J Radiol.  2013 Jun;14(3):510-519. 10.3348/kjr.2013.14.3.510.

Bone Positron Emission Tomography with or without CT Is More Accurate than Bone Scan for Detection of Bone Metastasis

• Lee SJ
• Lee WW
• Kim SE

• KMID: 1705468
• DOI: http://doi.org/10.3348/kjr.2013.14.3.510

Abstract

OBJECTIVE
Na18F bone positron emission tomography (bone PET) is a new imaging modality which is useful for the evaluation of bone diseases. Here, we compared the diagnostic accuracies between bone PET and bone scan for the detection of bone metastasis (BM).
MATERIALS AND METHODS
Sixteen cancer patients (M:F = 10:6, mean age = 60 +/- 12 years) who underwent both bone PET and bone scan were analyzed. Bone PET was conducted 30 minutes after the injection of 370 MBq Na18F, and a bone scan was performed 3 hours after the injection of 1295 MBq 99mTc-hydroxymethylene diphosphonate.
RESULTS
In the patient-based analysis (8 patients with BM and 8 without BM), the sensitivities of bone PET (100% = 8/8) and bone scan (87.5% = 7/8) were not significantly different (p > 0.05), whereas the specificity of bone PET (87.5% = 7/8) was significantly greater than that of the bone scan (25% = 2/8) (p < 0.05). In the lesion-based analysis (43 lesions in 14 patients; 31 malignant and 12 benign), the sensitivity of bone PET (100% = 31/31) was significantly greater than that of bone scan (38.7% = 12/31) (p < 0.01), and the specificity of bone PET (75.0% = 9/12) was also significantly higher than that of bone scan (8.3% = 1/12) (p < 0.05). The receiver operating characteristic curve analysis showed that bone PET was significantly more accurate than the bone scan in the patient (p = 0.0306) and lesion (p = 0.0001) based analyses.
CONCLUSION
Na18F bone PET is more accurate than bone scan for BM evaluation.

Keyword

Na18F; Positron emission tomography; Positron emission tomography/computed tomography; 99mTc-HDP; Bone scan; Bone metastasis

MeSH Terms

Adult
Aged
Aged, 80 and over
Area Under Curve
Bone Neoplasms/*radionuclide imaging/*secondary
Diphosphonates/diagnostic use
Female
Fluorine Radioisotopes/diagnostic use
Fluorodeoxyglucose F18/diagnostic use
Humans
Male
Middle Aged
Multimodal Imaging/methods
Organotechnetium Compounds/diagnostic use
Positron-Emission Tomography/*methods
Retrospective Studies
Sensitivity and Specificity
Sodium/diagnostic use
Tomography, X-Ray Computed/methods
Diphosphonates
Fluorine Radioisotopes
Fluorodeoxyglucose F18
Organotechnetium Compounds
Sodium

Figure

• 

  Fig. 1 Findings of bone positron emission tomography (PET) and bone scan in 84-year-old male prostate cancer patient (no.2 in Table 1) with numerous bone metastatic lesions. A. Anterior and posterior planar images of bone scan show multiple bone metastases. B. Bone PET anterior and posterior maximum-intensity projection images reveal numerous metasatic bone leisons. Please note that metastatic lesions on bone PET are more prominent than those on bone scan.

• 

  Fig. 2 Case demonstration showing higher specificity of bone positron emission tomography (PET) than bone scan in 77-year-old male patient with colon cancer (no.14 in Table 1). He has been complaining of intractable back pain. A. Bone scan shows focally increased uptake at L4 vertebral body (black arrows), which was suspected of bone metastasis. B. Bone PET maximum-intensity projection images also revealed hot uptake at same location (black arrows). C. Trans-axial images of CT, bone PET, and fusion image (from left to right) clearly demonstrate that osteophyte at L4 has intense uptake of Na18F (white arrow). It is noteworthy that tomographic images (C) play decisive role in determining nature of osteophyte.

• 

  Fig. 3 Case demonstration showing higher sensitivity of bone positron emission tomography (PET) than bone scan in 44-year-old female patient with breast cancer (no.3 in Table 1). A. Anterior and posterior bone scan images show only 3 abnormal foci in skull (arrowheads). B. Skull lesions observed in bone scan are found to be more prominent in bone PET (arrowheads) (top, posterior maximum-intensity projection [MIP]; middle, right lateral MIP; and bottom, left lateral MIP images). In addition, many other bone metastatic lesions are found in skull, lumbar spines, sacrum, pelvic bones, and left femur.

• 

  Fig. 4 Case demonstration showing false positivity of bone positron emission tomography (PET) and bone scan in 39-year-old male patient with thyroid cancer (no.9 in Table 1). A. (left, bone scan posterior planar; middle, bone PET posterior maximum-intensity projection [MIP]; and right, 18F-FDG PET posterior image) Bone scan and bone PET revealed abnormal uptake in left 7th rib posterior arc (black arrows); however, 18F-FDG PET was negative in left 7th rib area. B. (left, CT; middle, fusion of bone PET/CT; and right, fusion of 18F-FDG PET/CT) CT revealed osteosclerotic lesion in left 7th rib posterior arc, which was compatible with hot uptake in bone PET/CT; however, lesion was negative in 18F-FDG PET/CT (white arrows). C. Posterior image of 131I whole body scan obtained 2 days after administration of 131I (30 mCi). No lesion was found in left 7th rib area.

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  Fig. 5 Receiver operating characteristic curve analyses. Bone positron emission tomography (PET) was significantly more accurate than bone scan in patient (p = 0.0306) and lesion (p = 0.0001) based analyses.

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