Can 16-detector multislice CT exclude skeletal lesions during tumour staging? Implications for the cancer patient

Eur Radiol. 2006 May;16(5):1066-73. doi: 10.1007/s00330-005-0042-z. Epub 2006 Jan 10.

Abstract

Current imaging guidelines recommend that many cancer patients undergo soft-tissue staging by computed tomography (CT) whilst the bones are imaged by skeletal scintigraphy (bone scan). New CT technology has now made it feasible, for the first time, to perform a detailed whole-body skeletal CT. This advancement could save patients from having to undergo duplicate investigations. Forty-three patients with known malignancy were investigated for bone metastasis using skeletal scintigraphy and 16-detector multislice CT. Both studies were performed within six weeks of each other. Whole-body images were taken 4 h after injection of 500 Mbq (99m)Tc-MDP using a gamma camera. CT was performed on a 16-detector multislice CT machine from the vertex to the knee. The examinations were reported independently and discordant results were compared at follow-up. Statistical equivalence between the two techniques was tested using the Newcombe-Wilson method within the pre-specified equivalence limits of +/-20%. Scintigraphy detected bone metastases in 14/43 and CT in 13/43 patients. There were seven discordances; four cases were positive on scintigraphy, but negative on CT; three cases were positive on CT and negative on scintigraphy. There was equivalence between scintigraphy and CT in detecting bone metastases within +/-19% equivalence limits. Patients who have undergone full whole-body staging on 16-detector CT may not need additional skeletal scintigraphy. This should shorten the cancer patient's diagnostic pathway.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / diagnostic imaging*
  • Bone Neoplasms / secondary*
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology
  • Esophageal Neoplasms / diagnostic imaging*
  • Esophageal Neoplasms / pathology
  • Female
  • Humans
  • Kidney Neoplasms / diagnostic imaging*
  • Kidney Neoplasms / pathology
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Patient Satisfaction
  • Prospective Studies
  • Prostatic Neoplasms / diagnostic imaging*
  • Prostatic Neoplasms / pathology
  • Radiopharmaceuticals
  • Sensitivity and Specificity
  • Soft Tissue Neoplasms / diagnostic imaging
  • Soft Tissue Neoplasms / secondary
  • Technetium Tc 99m Medronate
  • Tomography, Emission-Computed
  • Tomography, X-Ray Computed*
  • Whole Body Imaging

Substances

  • Radiopharmaceuticals
  • Technetium Tc 99m Medronate