Multislice SPECT/CT in Benign and Malignant Bone Disease: When the Ordinary Turns Into the Extraordinary

https://doi.org/10.1053/j.semnuclmed.2009.07.005Get rights and content

Nuclear medicine has entered a new era of multimodality imaging. Dedicated multislice single-photon emission computed tomography/computed tomography (SPECT/CT) cameras are relatively new additions to the diagnostic armamentarium in nuclear medicine. The integration of SPECT and CT provides precise anatomical localization and may enable characterization of abnormalities identified on planar or SPECT imaging by providing structural information by CT. The evidence in support of SPECT/CT is rapidly amounting but still relatively limited. To date, studies have suggested improved diagnostic confidence and specificity in the diagnosis of bone pathology. The combination of functional information and anatomical localization has the potential to influence medical practice with newer imaging algorithms. This review presents the current evidence and potential indications of SPECT/CT bone imaging in the assessment of benign and malignant conditions.

Section snippets

Potential Applications in Patients With Cancer

The accurate detection or exclusion of bone metastases is of high clinical importance in the staging, management, and prognosis of cancer patients. The vertebral column and pelvis are the most common sites of metastatic bone disease due to the presence of a high proportion of red marrow.12 Furthermore, in the spine coexisting pathology, such as severe degenerative disease and compression fractures can make diagnosis of malignant infiltration or disease difficult.13

It is well recognized that

Potential Applications: Non-Oncology Scenario (Benign Bone Pathology)

Currently, there is limited evidence for the use of SPECT/CT in benign bone pathologies. Even-Sapir et al29 prospectively assessed the role of low-dose SPECT/CT (Infinia/Hawkeye 4) in 76 non-oncological patients with nonspecific findings on planar imaging. SPECT/CT reached a final diagnosis in 58% (49/85) of lesions in 59% (45/76) of patients, obviating the need to perform additional imaging.29 In addition, in another 30% (23/76) of patients, SPECT/CT guided additional imaging.

Conclusion

Hybrid imaging with SPECT/CT is not only a fascinating and exciting development but also challenging to optimize the combination of functional information and anatomical localization, which has the potential to influence medical practice with newer imaging algorithms. Most of the studies support the usefulness of SPECT/CT for improving diagnostic accuracy and increasing the confidence in interpreting the scans. However, published reports on the applications of SPECT/CT are still extremely

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