Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1.5T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial - Abstract

PURPOSE: Detection of bone metastases in breast and prostate cancer patients remains a major clinical challenge.

The aim of the current trial was to compare the diagnostic accuracy of 99mTc-hydroxymethane diphosphonate (99mTc-HDP) planar bone scintigraphy (BS), 99mTc-HDP SPECT, 99mTc-HDP SPECT/CT, 18F-NaF PET/CT and whole body 1.5 Tesla magnetic resonance imaging (MRI), including diffusion weighted imaging, (wbMRI+DWI) for the detection of bone metastases in high risk breast and prostate cancer patients.

MATERIAL AND METHODS: Twenty-six breast and 27 prostate cancer patients at high risk of bone metastases underwent 99mTc-HDP BS, 99mTc-HDP SPECT, 99mTc-HDP SPECT/CT, 18F-NaF PET/CT and wbMRI+DWI. Five independent reviewers interpreted each individual modality without the knowledge of other imaging findings. The final metastatic status was based on the consensus reading, clinical and imaging follow-up (minimal and maximal follow-up time was 6, and 32 months, respectively). The bone findings were compared on patient-, region-, and lesion-level.

RESULTS: 99mTc-HDP BS was false negative in four patients. In the region-based analysis, sensitivity values for 99mTc-HDP BS, 99mTc-HDP SPECT, 99mTc-HDP SPECT/CT, 18F-NaF PET/CT, and wbMRI+DWI were 62%, 74%, 85%, 93%, and 91%, respectively. The number of equivocal findings for 99mTc-HDP BS, 99mTc-HDP SPECT, 99mTc-HDP SPECT/CT, 18F-NaF PET/CT and wbMRI+DWI was 50, 44, 5, 6, and 4, respectively.

CONCLUSION: wbMRI+DWI showed similar diagnostic accuracy to 18F-NaF PET/CT and outperformed 99mTc-HDP SPECT/CT, and 99mTc-HDP BS.

Written by:
Jambor I, Kuisma A, Ramadan S, Huovinen R, Sandell M, Kajander S, Kemppainen J, Kauppila E, Auren J, Merisaari H, Saunavaara J, Noponen T, Minn H, Aronen HJ, Seppänen M.   Are you the author?
Department of Diagnostic Radiology, University of Turku, Turku, Finland.

Reference: Acta Oncol. 2015 Apr 2:1-9. Epub ahead of print.
doi: 10.3109/0284186X.2015.1027411


PubMed Abstract
PMID: 25833330

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