JOURNAL DESCRIPTION
The Medical Radiology and Radiation Safety journal ISSN 1024-6177 was founded in January 1956 (before December 30, 1993 it was entitled Medical Radiology, ISSN 0025-8334). In 2018, the journal received Online ISSN: 2618-9615 and was registered as an electronic online publication in Roskomnadzor on March 29, 2018. It publishes original research articles which cover questions of radiobiology, radiation medicine, radiation safety, radiation therapy, nuclear medicine and scientific reviews. In general the journal has more than 30 headings and it is of interest for specialists working in thefields of medicine¸ radiation biology, epidemiology, medical physics and technology. Since July 01, 2008 the journal has been published by State Research Center - Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency. The founder from 1956 to the present time is the Ministry of Health of the Russian Federation, and from 2008 to the present time is the Federal Medical Biological Agency.
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Medical Radiology and Radiation Safety. 2018. Vol. 63. No. 2. P. 41-46
NUCLEAR MEDICINE
DOI: 10.12737/article_5ac61fd62feba6.78437892
Osteoscintigraphy and SPECT/CT in the Diagnosis of Various Variants of Bone Metastases
A.D. Ryzhkov, A.S. Krylov, A.B. Bludov, S.V. Shiryaev
N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
A.D. Ryzhkov - Senior Researcher, Dr. Sc. Med.; A.S. Krylov - Radiologist, PhD Med, Member of the European Association of Nuclear Medicine and Molecular Imaging (EANMMI); A.B. Bludov - Research Worker, PhD Med.; S.V. Shiryaev - Head of Lab., Dr. Sc. Med., President of the OSMI, Member of EANMMI, Member of ACNMMI, Member of SNMMI
Abstract
Purpose: To determine the diagnostic capabilities of body scan (BS) and SPECT/CT in the diagnosis of various variants of bone metastases (BM).
Material and methods: The data of 37 patients with BM of breast cancer (20 patients), prostate cancer (7 patients) and other tumors various localization (10 patients) were analyzed. The study was carried out in two stages: first, BS was performed, 3 hours after intravenous introduction of an osteotropic radiopharmaceutical labeled with 99mTc (technephor or phosphotech), followed by SPECT/CT of the selected zone of interest. All studies were performed on a combined system Symbia T2 (Siemens) with a 2-slice low dose CT.
Results: With BS the foci of the tumor lesion were identified in 33 cases, and in SPECT/CT in 37 cases. There were detected 159 BM (21 sites: 0.4-0.9, 59 sites: 1.0-1.9, 79 sited: 2.0-4.5 сm). The total detectable incidence of metastases with BS was 66.0 % (105 BM) of all metastases detected in comparison with SPECT/CT (159 BM). Detectability with BS increased with increasing size of detectable foci. Foci less than 1 cm are detected in isolated case (1 from 21 cases). Metastases measuring from 1 cm to 1.9 cm are detected only in 52.5 % of cases (31 from 59 cases). The detectability of large metastases (2 cm or more) with BS (92.4 %) approaches the SPECT/CT (100 %) - 73 from 79 cases.
There were detected with BS 27 osteoblastic BM in comparison 56 BM with SPECT/CT (48.2 %). The detectability with BS of mixed BM (76.3 %) and octeolitic BM (75.4 %) showed no differences. Firstly it can be explained by a predominance of smaller osteoblastic foci, and secondly reparative processes in metastases, accompanied by reduction of the radiopharmaceutical. The correction of the conclusion of the BS was required just in 24 cases: in 8 cases, when the BS was marked overdiagnosis, 16 - underdiagnosis. However, BS does not lose its value as a screening. In one case, even if BS has been revealed metastasis, it is not yet accompanied by destruction of bone tissue.
Despite such significant differences in diagnostic accuracy of BS and SPECT/CT, BS proved to be uninformative only in 2 cases: when undetected metastases without primary tumor identified, and in the case of the screening of metastasis the accumulation of the radiopharmaceutical in the bladder. In 2 other cases, the lack of accumulation of the radiopharmaceutical was determined by the reparation that can only be considered conditionally uninformative.
However, SPECT/CT shows clear advantages in the visualization of bone metastases due to computed tomography, allowing to estimate the structure of bone tissue. In 9 cases even to SPECT-slices metastases were not accompanied by pathological accumulation of the radiopharmaceutical.
Conclusion: SPECT/CT is a highly informative method for detecting bone metastases, the use of which allows reducing the time of examination and dose irradiation of patients due to the rejection of additional radiological procedures. In addition, SPECT/CT at the same time allows differential diagnosis of structural and metabolic bone changes, which increases both the accuracy of primary diagnosis and control of treatment.
Key words SP: ECT/CT, bone scintigraphy, bone metastases
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For citation: Ryzhkov AD, Krylov AS, Bludov AB, Shiryaev SV. Osteoscintigraphy and SPECT/CT in the Diagnosis of Various Variants of Bone Metastases. Medical Radiology and Radiation Safety. 2018;63(2):41-6. Russian. DOI: 10.12737/article_5ac61fd62feba6.78437892.
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