Comparison of 18F fluoride PET/CT and 99mTc-MDP bone scan in the detection of skeletal metastases in urinary bladder carcinoma

Clin Nucl Med. 2013 Aug;38(8):616-21. doi: 10.1097/RLU.0b013e31828da5cc.

Abstract

Aim: The aim of this study was to compare (18)F-fluoride PET/CT and (99m)Tc-MDP bone scintigraphy in the detection of skeletal metastases in urinary bladder carcinoma.

Patients and methods: In this prospective study, 48 patients with urinary bladder carcinoma (44 male and 4 female patients, aged 35-80 years) underwent (99m)Tc-MDP planar and SPECT/CT bone scan (BS) followed by (18)F-fluoride PET/CT within 48 hours. Skeletal metastasis diagnosed on each of these techniques was compared against a final diagnosis based on contrast-enhanced CT, MRI, skeletal survey, clinical follow-up, and histological correlation.

Results: (18)F-fluoride PET/CT identified bony metastases and changed the management in 17 of 48 patients (35%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of (99m)Tc-MDP planar BS were 82.35%, 64.51%, 56%, 86.95%, and 70.83%; of (99m)Tc-MDP SPECT/CT were 88.23%, 74.19%, 65.21%, 92%, and 79.16%; and of (18)F-fluoride PET/CT were 100%, 87.09%, 80.95%, 100%, and 91.66%, respectively. Fair agreement between (99m)Tc-MDP planar BS and F-fluoride PET/CT (κ = 0.42) and excellent agreement between SPECT/CT and (18)F-fluoride PET/CT (κ = 0.74) were found.

Conclusions: ( 18)F-fluoride PET/CT has higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in detecting bone metastases in urinary bladder carcinoma than conventional (99m)Tc-MDP planar BS. SPECT/CT improves all these parameters compared with planar BS and may serve as a cost-effective screening procedure for the detection of skeletal metastases in high-risk patients.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / diagnosis*
  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / secondary
  • Bone and Bones / diagnostic imaging
  • Female
  • Fluorides*
  • Fluorine Radioisotopes*
  • Humans
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Positron-Emission Tomography*
  • Technetium Tc 99m Medronate*
  • Tomography, X-Ray Computed*
  • Urinary Bladder Neoplasms / pathology*

Substances

  • Fluorine Radioisotopes
  • Fluorides
  • Technetium Tc 99m Medronate