Ignac Fogelman

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

PurposeThe 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.MethodsThis was a retrospective review of 40 consecutive prostate cancer patients (mean age 71xa0years) 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.ResultsFifty 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 pu2009<u20090.0001. Follow-up imaging confirmed the SPECT/CT diagnoses in 14 patients.ConclusionThe 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.

Osteopetrosis: radiological & radionuclide imaging.

Osteopetrosis is a rare inherited bone disease where bones harden and become abnormally dense. While the diagnosis is clinical, it also greatly relies on appearance of the skeleton radiographically. X-ray, radionuclide bone scintigraphy and magnetic resonance imaging have been reported to identify characteristics of osteopetrosis. We present an interesting case of a 59-year-old man with a history of bilateral hip fractures. He underwent 99mTc-methylene diphosphonate whole body scan supplemented with single-photon emission computed tomography/computed tomography of spine, which showed increased uptake in the humeri, tibiae and femora, which were in keeping with osteopetrosis.

Bone Scintigraphy: Patterns, Variants, Limitations and Artefacts

Radionuclide bone scintigraphy is a highly sensitive investigative tool, routinely used in the evaluation of patients with cancer for suspected bone metastases and in various benign musculoskeletal conditions. Technological innovations such as single photon emission computed tomography (SPECT), positron emission tomography (PET), PET/CT and SPECT/CT have been incorporated into the assessment of various musculoskeletal diseases. One of the limitations of bone scintigraphy is its relatively reduced specificity. Some of the limited specificity can be addressed with a thorough knowledge and experience of normal variants, as well as common patterns of disease, in order to avoid misinterpretation. In this chapter, we discuss the common patterns, variants, artefacts and pitfalls in conventional radionuclide planar, SPECT and hybrid bone SPECT/CT Imaging.

Interesting Signs in Nuclear Medicine.

Classic radiological and nuclear medicine signs have been reported extensively because of a myriad of pathophysiological processes. When encountered, they aid in diagnosis of conditions and add confidence for the reader, at times even hinting at a specific diagnosis. The naming of signs is commonly associated with objects from everyday life to establish familiarity with visual findings. Association of signs and disease comes with regular practice and improves understanding of the image and its underlying cause. In this article, we have collated nuclear medicine signs reported in the literature since 1970.

Conventional Nuclear Medicine and Hybrid Imaging in Monitoring the Treatment of Skeletal Malignancy

Skeletal malignancy encompasses both primary malignant bone tumours and bone metastases, the latter being more common. In fact, the skeleton represents one of the most common sites of metastases together with the liver and lungs. The common malignancies that metastasise to the bones are breast, prostate and lung cancers. Primary bone malignancies in contrast are rare, and the relatively common ones include osteosarcoma and Ewing sarcoma.

Soft Tissue Uptake in Radionuclide Bone Scintigraphy

Patients with suspected malignancy, infection, inflammation, trauma, or metabolic bone disease are referred for bone scintigraphy to establish the extent, if any, of skeletal involvement. Often, extra-osseous uptake of radiotracer is identified, which may either be an incidental finding or relevant to the underlying bone pathology.

Hybrid Imaging in the Management of Complex Foot and Ankle Problems

Management of chronic ankle and foot pain remains a challenge given the complex anatomy and function of the foot. Imaging plays a crucial role in the management of these, and the American College of Radiology has published the appropriateness criteria for the use of the available investigating modalities in the management of foot and ankle pathologies. These are broadly classified into anatomical and functional imaging modalities. Recent introduction of SPECT/CT scanners which are capable of combining functional and anatomical images promises an exciting and important development, and this chapter describes our clinical experience with SPECT/CT and discusses its potential applications in the imaging of complex foot and ankle pathologies.