Thesis (MSc (Medical Imaging and Clinical Oncology. Nuclear Medicine))--University of Stellenbosch, 2010. / ENGLISH SUMMARY: Introduction: Bone scintigraphy is used extensively in evaluating metastatic disease.
There are currently no clear recommendations for the use of SPECT/CT in metastatic
bone disease. Existing procedural guidelines from the Society of Nuclear Medicine
(SNM) for SPECT/CT do not provide specific indications for use of SPECT/CT in bone
scintigraphy, and there are currently no other guidelines for the use of SPECT/CT in
bone scintigraphy that the author is aware of. The aim of this study was to investigate
the additional value of SPECT/CT, and to identify the clinical indications for which
SPECT/CT is most useful in patients with suspected bone metastases.
Subjects and Methods: Forty-two patients with equivocal lesions on planar
scintigraphy were prospectively recruited and planar imaging, SPECT, and SPECT/CT
done on all patients. On reading of SPECT and then SPECT/CT, patients and individual
lesions were classified as malignant, benign or equivocal. Radiological studies and
available clinical information were also used during reading of scans. Review of clinical
information, radiological studies and/or follow-up bone scans were used as gold
standard. The results of the SPECT and SPECT/CT were compared in terms of
proportion of equivocal findings and accuracy. Results: Forty-two patients with 189 skeletal lesions were examined. There was a
diverse variety of primary tumours, although the majority had breast (n=22) or prostate
cancer (n=8). Overall, SPECT/CT resulted in a significant reduction in the proportion of
equivocal findings on both a patient-wise (p=0.0015) and lesion-wise basis (p<0.0001).
The overall accuracy of SPECT/CT was significantly higher than that of SPECT on both
a patient-wise (p=0.0026) and lesion-wise basis (p<0.0001). Generally SPECT/CT
decreased the proportion of equivocal findings and increased the accuracy independent
of the presence of bone pain, type of primary tumour, or skeletal region involved.
SPECT/CT did not significantly improve the diagnostic confidence of readers in
equivocal lumbar lesions although accuracy was significantly improved in this region.
Conclusion: SPECT/CT performs significantly better than SPECT alone for the
interpretation of equivocal planar lesions. There is no evidence that the benefit of
SPECT/CT is dependent on the type of primary tumour or the presence of bone pain.
Where resources are limited, SPECT/CT is indicated only in those patients in whom
correct classification of the lesions in question is expected to alter the patient’s
management. SPECT/CT images should be interpreted with the aid of a diagnostic
radiologist or nuclear medicine physicians should acquire sufficient experience in
Computed Tomographic image interpretation in order to optimise diagnostic benefit from
SPECT/CT. / AFRIKAANSE OPSOMMING: Inleiding: Beenflikkergrafie word wyd vir die evaluering van metastatiese siekte
gebruik. Daar bestaan tans geen duidelike aanbevelings vir die gebruik van
Enkelfotonemissie rekenaartomografie gekombineer met rekenaartomografie
(EFERT/RT, Engels SPECT/CT) in metastatiese beensiekte nie. Bestaande riglyne van
die Amerikaanse Society of Nuclear Medicine (SNM) vir EFERT/RT gee nie spesifieke
indikasies vir die gebruik van EFERT/RT in beenflikkergrafie nie, en daar is tans geen
ander riglyne waarvan die outeur bewus is nie. Die doel van hierdie studie was om die
bykomende waarde van EFERT/RT te ondersoek, en om dié kliniese indikasies waar
EFERT/RT in pasiënte met vermoedelike beenmetastases mees nuttig sal wees, te
identifiseer.
Pasiënte en Metodes: Twee en veertig pasiënte met twyfelagtige letsels op planare
skeletflikkergrafie is prospektief geselekteer en planare beelding, EFERT en EFERT/RT
is op alle pasiënte gedoen. Tydens beoordeling van EFERT en daarna EFERT/RT
beelde is pasiënte en individuele letsels as maligne, benigne of twyfelagtig
geklassifiseer. Radiologiese studies en beskikbare kliniese inligting is ook tydens
interpretasie van flikkergramme gebruik. Kliniese inligting, radiologiese studies en/of
opvolg beenflikkergramme is as goue standaard gebruik. Die resultate van EFERT en
EFERT/RT is ten opsigte van die aantal twyfelagtige bevindings en akkuraatheid
vergelyk.
Resultate: Twee en veertig pasiënte met 189 skeletale letsels is ondersoek. Daar was
‘n verskeidenheid van primêre tumore, maar die meerderheid van pasiënte het borsvi
(n=22) of prostaatkanker (n=8) gehad. Die gebruik van EFERT/RT het gelei tot ‘n
betekenisvolle afname in die aantal twyfelagtige bevindings, beide op ‘n pasiënt- en ‘n
letselbasis (p=0.0015 en p<0.0001 onderskeidelik). Die algehele akkuraatheid van
EFERT/RT was betekenisvol hoër as die van EFERT alleen, beide op pasiënt- en op
letselbasis (p=0.0026 en p<0.0001 onderskeidelik). Oor die algemeen het EFERT/RT
die aantal twyfelagtige letsels verminder en die akkuraatheid verhoog, ongeag die
teenwoordigheid van beenpyn, die tipe primêre tumor of die area van die skelet wat
betrokke was. In twyfelagtige lumbale letsels het EFERT/RT nie die diagnostiese
vertroue van beoordelaars van flikkergramme verhoog nie, alhoewel die akkuraatheid
vir hierdie gebied wel betekenisvol toegeneem het.
Gevolgtrekking: EFERT/RT vaar betekenisvol beter as EFERT in die beoordeling van
twyfelagtige letsels op planare beenflikkergramme. Daar is geen bewys dat die voordeel
van EFERT/RT afhanklik is van die tipe primêre tumor of die teenwoordigheid van
beenpyn nie. Waar hulpbronne beperk is, is EFERT/RT slegs aangedui in dié pasiënte
waar verwag word dat korrekte klassifikasie van die betrokke letsel behandeling sal
beïnvloed. EFERT/RT beelde behoort met die hulp van ‘n diagnostiese radioloog
beoordeel te word, of kerngeneeskundiges moet genoegsame ondervinding in die
interpretasie van rekenaartomografiebeelde hê om die diagnostiese voordeel van
EFERT/RT optimaal te kan benut.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/4039 |
| Date | 03 1900 |
| Creators | Ndlovu, Xolani |
| Contributors | Warwick, James M., University of Stellenbosch. Faculty of Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine. |
| Publisher | Stellenbosch : University of Stellenbosch |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 66 p. |
| Rights | University of Stellenbosch |
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