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Bone single-photon emission computed tomography/computed tomography in cancer care in the past decade: a systematic review and meta-analysis as well as recommendations for further work

Mohd Rohani MF, Zanial AZ, Suppiah S, Phay Phay K, Mohamed Aslum Khan F, Mohamad Najib FH, et al.

Nucl Med Commun, 2021 Jan;42(1):9-20.
PMID: 33165258 DOI: 10.1097/MNM.0000000000001306

Skeletal whole-body scintigraphy (WBS), although widely used as a sensitive tool for detecting metastatic bone disease in oncology cases, has relatively low specificity. Indeterminate bone lesions (IBLs) detected by WBS cause a diagnostic dilemma, which hampers further management plans. In the advent of hybrid imaging, single-photon emission computed tomography/computed tomography (SPECT/CT) has been gaining popularity as a tool to improve the characterisation of IBLs detected by WBS. As yet, there has not been a systematic review to objectively evaluate the diagnostic capabilities of SPECT/CT in this area. We conducted a systematic review of relevant electronic databases up to 30 August 2020. The outcomes of interest were the reporting of SPECT/CT to identify benign and malignant IBLs and the calculation of the sensitivity and specificity of the index test, based on histopathological examination or clinical and imaging follow-up as the reference standard. After the risk of bias and eligibility assessment, 12 articles were identified and synthesised in the meta-analysis. The pooled sensitivity and specificity of SPECT/CT for diagnosing IBLs are 93.0% [95% confidence interval (CI) 0.91-0.95] and 96.0% (95% CI 0.94-0.97), respectively. There was heterogeneity of the articles due to variable imaging protocols, duration of follow-up and scoring methods for interpreting the SPECT/CT results. The heterogeneity poses a challenge for accurate interpretation of the true diagnostic capability of SPECT/CT. In conclusion, targeted SPECT/CT improves the specificity of diagnosing bone metastases, but efforts need to be made to standardise the thresholds for SPECT/CT, methodology, as well as harmonising the reporting and interpretation criteria. We also make some recommendations for future works.

Matched MeSH terms: Single Photon Emission Computed Tomography Computed Tomography/methods*
Accuracy Assessment of SUV Measurements in SPECT/CT: A Phantom Study

Halim F, Yahya H, Jaafar KN, Mansor S

J Nucl Med Technol, 2021 Sep;49(3):250-255.
PMID: 33722927 DOI: 10.2967/jnmt.120.259168

Advances in iterative image reconstruction enable absolute quantification of SPECT/CT studies by incorporating compensations for collimator-detector response, attenuation, and scatter. This study aimed to assess the quantitative accuracy of SPECT/CT based on different levels of 99mTc activity (low/high) using different SUV metrics (SUVmean, SUVmax, SUV0.6 max, and SUV0.75 max [the average values that include pixels greater than 60% and 75% of the SUVmax in the volume of interest, respectively]). Methods: A Jaszczak phantom equipped with 6 fillable spheres was set up with low and high activity ratios of 1:4 and 1:10 (background-to-sphere) on background activities of 10 and 60 kBq/mL, respectively. The fixed-size volume of interest based on the diameter of each sphere was drawn on SPECT images using various metrics for SUV quantification purposes. Results: The convergence of activity concentration was dependent on the number of iterations and application of postfiltering. For the background-to-sphere ratio of 1:10 with a low background activity concentration, the SUVmean metric showed an underestimation of about 38% from the actual SUV, and SUVmax exhibited an overestimation of about 24% for the largest sphere diameter. Meanwhile, bias reductions of as much as -6% and -7% for SUV0.6 max and SUV0.75 max, respectively, were observed. SUVmax gave a more accurate reading than the others, although points that exceeded the actual value were detected. At 1:4 and 1:10 background activity of 10 kBq/mL, a low activity concentration attained a value close to the actual ratio. Use of 2 iterations and 10 subsets without postfiltering gave the most accurate values for reconstruction and the best image overall. Conclusion: SUVmax is the best metric in a high- or low-contrast-ratio phantom with at least 2 iterations, 10 subsets, and no postfiltering.

Matched MeSH terms: Single Photon Emission Computed Tomography Computed Tomography*
Pulmonary Embolism in an Asymptomatic COVID-19 Patient Detected on Ventilation/Perfusion SPECT/CT

Mahaletchumy T, Muhamad M, Mohammad Kazmin NE, Kori N, Periyasamy P

Clin Nucl Med, 2021 Jul 01;46(7):e360-e362.
PMID: 33443945 DOI: 10.1097/RLU.0000000000003513

Severe COVID-19 infection is associated with significant coagulopathy. We would like share a case of an asymptomatic 26-year-old man who tested positive for COVID-19 and had elevated d-dimer levels. Because of inconclusive CTPA findings, V/Q (ventilation/perfusion) SPECT/CT was performed, which confirmed the presence of pulmonary embolism. This case highlights the fact that pulmonary embolism should not be overlooked in a COVID-19 patient who has raised d-dimer levels, even in the absence of symptoms. It also highlights the importance of performing a V/Q study when CTPA results are inconclusive or when there are contraindications for iodinated contrast media.

Matched MeSH terms: Single Photon Emission Computed Tomography Computed Tomography*
Fulltext Wiener filter improves diagnostic accuracy of CAD SPECT images-comparison to angiography and CT angiography

Masoomi MA, Al-Shammeri I, Kalafallah K, Elrahman HMA, Ragab O, Ahmed E, et al.

Medicine (Baltimore), 2019 Jan;98(4):e14207.
PMID: 30681596 DOI: 10.1097/MD.0000000000014207

Many discrepancy in selection of proper filter and its parameters for individual cases exists. The authors investigate the impact of the most common filters on patient NM images with coronary artery disease (CAD), and compare the results with the computerized tomography (CT)-Angio and angiography for accuracy.The investigation initiated by performing various single photon emission computerized tomography (SPECT)/CT scan of the national electrical manufacturers association chest phantoms having hot and cold inserts. Data acquired on GE 670 PRO SPECT/CT; 360Ø, 64 frames, 60 seconds, low energy high resolution (LEHR) 128, low energy general purpose (LEGP) with CT attenuation (120 kV and 170 mA). The images reconstructed with filtered back projection and ITERATIVE ordered-subset expectation maximization utilizing filters; Hann, Butterworth, Metz, Hamming, and Wiener. The Image contrast was calculated to assess absolute nearness of the inserts. Based on the preliminary results, then scans of 92 patients with CAD; 64 males and 28 females, age 41 to 77 years old, who had been reported earlier reprocessed with the nominated filter and were reported by 2 NM expert. The results compared to the earlier reports and to the CT-Angio and angiography.The optimization suggested 3 filters; Wiener (Wi), Metz and Butterworth (But) provide the highest contrast (99- 66.4%) and (81- 32%) for the cold and hot inserts respectively, with the (Wi) filter to be the better option. The reprocessed patients scan with the (Wi) presented an elevated diagnostic accuracy, correlated well with the CT-Angio and angiography results (P

Matched MeSH terms: Single Photon Emission Computed Tomography Computed Tomography/methods; Single Photon Emission Computed Tomography Computed Tomography/statistics & numerical data
Fulltext Incremental Value of Single-photon Emission Computed Tomography-computed Tomography for Characterization of Skeletal Lesions in Breast Cancer Patients

Mahaletchumy T, AbAziz A

World J Nucl Med, 2017 Oct-Dec;16(4):303-310.
PMID: 29033679 DOI: 10.4103/1450-1147.215496

The incremental value of single-photon emission computed tomography-computed tomography (SPECT-CT) over planar bone scintigraphy and SPECT in detecting skeletal lesions in breast cancer patients and its effect on patient management is assessed in this study. This is a prospective study which was conducted over 1-year duration. Whole-body planar scintigraphy, SPECT, and SPECT-CT were performed in 85 breast cancer patients with total of 128 lesions. Correlative imaging and clinical follow-up was used as the reference standard. McNemar's multistep analysis was performed for each patient and each lesion. On patient-wise analysis, 47 patients had equivocal diagnosis on planar bone scintigraphy, 28 on SPECT, and eight on SPECT-CT. On lesion-wise analysis, there were 72 equivocal lesions on planar bone scintigraphy, 48 on SPECT, and 15 on SPECT-CT. Overall, SPECT-CT resulted in a significant reduction in the proportion of equivocal diagnosis on both patient-wise (P < 0.004) and lesion-wise basis (P < 0.004), irrespective of the skeletal region involved. The sensitivity on a per-patient basis was 43%, 58%, and 78% for planar bone scintigraphy, SPECT, and SPECT-CT, respectively. Similarly, the specificity was 85%, 92%, and 94% for planar bone scintigraphy, SPECT, and SPECT-CT, respectively. Patient management was correctly altered in 32% of the patients based on SPECT-CT interpretation. Our data suggest that adding SPECT-CT to whole-body imaging significantly improves sensitivity and specificity in diagnosing bone metastases and significantly reduces the proportion of equivocal diagnosis in all regions of the skeleton. The most important outcome is derived from the accurate alteration in patient management clinically by down- and up-staging of patients and a more precise identification of metastatic extent.

Matched MeSH terms: Single Photon Emission Computed Tomography Computed Tomography
Fulltext SPECT-CT in differentiating metastatic and degenerative lesions of the spine

Khadijah Abdul Hamid, Sazilah Ahmad Sarji, Mohammad Nazri Md Shah, Ibrahim Lutfi Shuaib

Malaysian Journal of Medicine and Health Sciences, 2020;16(102):31-37.
MyJurnal

Introduction: The purpose of this study was to determine the usefulness of SPECT-CT in differentiating metastatic and degenerative disease of the spine. Methods: Twenty-eight patients aged 50 years and above diagnosed with various cancers were referred for whole body (WB) planar bone scintigraphy. Those with a maximum three foci of tracer up- take in the spine were selected for the study. SPECT-CT of these areas of uptake was performed and the lesions were classified as degenerative, indeterminate or metastasis. A repeat study (WB planar bone scintigraphy and SPECT-CT) was performed between 3 to 12 months later. These areas of uptake were reassessed and compared with the first WB planar bone scintigraphy and SPECT-CT. The second SPECT-CT was used as the standard for the diagnosis. Results: Thirty-seven lesions in 28 patients were assessed. The sensitivity of the first WB planar bone scintigraphy, second WB planar bone scintigraphy and first SPECT-CT is 75%, 62.5% and 75% respectively. The specificity of the first WB planar bone scintigraphy, second WB planar bone scintigraphy and first SPECT-CT is 86%, 93%, 90% respectively. There was 2.7% of ‘indeterminate lesion’ in the first WB planar bone scintigraphy, 5.4% in the second WB planar bone scintigraphy, and 5.4% in the first SPECT-CT. The indeterminate lesions were resolved in the second SPECT-CT. Conclusion: SPECT- CT is useful in differentiating degenerative disease from metastatic lesions in the spine.

Matched MeSH terms: Single Photon Emission Computed Tomography Computed Tomography
Fulltext Tc99m-besilesomab with the added benefit of Single Photon Emission Computed Tomography/Computed Tomography (spect/ct): current role in infection detection and localisation

Farahnaz Mohamed Aslum Khan, Siti Zarina Amir Hassan, Noor Khairiah A. Karim, Khadijah Abdul Hamid, Leong, Chee Loon

Malaysian Journal of Medicine and Health Sciences, 2018;14(201):1-8.
MyJurnal

Imaging modality has become increasingly important in hospital setting especially in cases of unknown site of infection/pyrexia of unknown origin (PUO) and osteomyelitis (OM). In recent years, nuclear imaging has been used and is known to deliver prompt and precise diagnoses of numerous infectious diseases. The purpose of the study is to detect and localise the site of infection using Tc99m-besilesomab and to assess the added contributions of single photon emission computed tomography/computed tomography (SPECT/CT) over planar scan in patients with PUO and OM. Methods: Tc99m-besilesomab with SPECT/CT were prospectively performed in 23 patients (eight males, 15 females) with suspected infection. True findings were diagnosed by both cold and hot spot in the scan with reference to positive blood or tissue cultures, or other additional imaging. Results: Tc99m-besilesomab managed to detect presence of infection with high sensitivity of 87.5% and specificity of 71.4%. Interobserver variability agreement that was obtained between the presence of infection and the ability of Tc99m-besilesomab imaging to detect it was significant (p

Matched MeSH terms: Single Photon Emission Computed Tomography Computed Tomography
Fulltext Combined Techniques of Non-invasive 99mTc-Besilesomab/99mTc-Sulfur Colloid with Hybrid SPECT/CT Imaging in Characterising Cellulitis from Symptomatic Perimegaprosthetic Infection: A Case Report

Tagiling N, Mohd-Rohani MF, Wan-Sohaimi WF, Faisham WI, Nawi NM

Malays Orthop J, 2020 Nov;14(3):188-193.
PMID: 33403085 DOI: 10.5704/MOJ.2011.032

Megaprosthesis is used to restore the form and function of massive skeletal defects, but it is accompanied by risks of failure, mainly due to perimegaprosthetic infection (PMI). In practice, the diagnosis of infected megaprosthesis among patients with a high index of clinical suspicion, elevated serological markers, and multiple negative or inconclusive imaging can be very challenging and poses a diagnostic conundrum to many orthopaedic surgeons. We present the case of a symptomatic 26-year-old female with large B-cell lymphoma who developed cellulitis with suspected complication of PMI 15 months post-implantation. The combination of advanced nuclear medicine imaging strategies, i.e., 99mTc-besilesomab/99mTc-sulfur colloid scintigraphy with hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) scanning helps to characterise and delineate both infections. Invasive procedures such as joint aspiration and biopsy were avoided, and the patient was successfully treated with antibiotics. Hence, we report a case where advanced imaging modalities were decisive in the investigation of PMI.

Matched MeSH terms: Single Photon Emission Computed Tomography Computed Tomography
Fulltext Standardized Uptake Value from Semiquantitative Bone Single-Photon Emission Computed Tomography/Computed Tomography in Normal Thoracic and Lumbar Vertebrae of Breast Cancer Patients

Rohani MFM, Yonan SNM, Tagiling N, Zainon WMNW, Udin Y, Nawi NM

Asian Spine J, 2020 Oct;14(5):629-638.
PMID: 32213791 DOI: 10.31616/asj.2019.0308

STUDY DESIGN: Retrospective study.
PURPOSE: This study aims to semiquantitatively evaluate the standardized uptake value (SUV) of 99mTc-methylene diphosphonate (MDP) radionuclide tracer in the normal vertebrae of breast cancer patients using an integrated single-photon emission computed tomography (SPECT)/computed tomography (CT) scanner.
OVERVIEW OF LITERATURE: Molecular imaging techniques using gamma cameras and stand-alone SPECT have traditionally been utilized to evaluate metastatic bone diseases. However, these methods lack quantitative analysis capabilities, impeding accurate uptake characterization.
METHODS: A total of 30 randomly selected female breast cancer patients were enrolled in this study. The SUV mean (SUVmean) and SUV maximum (SUVmax) values for 286 normal vertebrae at the thoracic and lumbar levels were calculated based on the patients' body weight (BW), body surface area (BSA), and lean body mass (LBM). Additionally, 106 degenerative joint disease (DJD) lesions of the spine were also characterized, and both their BW SUVmean and SUVmax values were obtained. A receiver operating characteristic (ROC) curve analysis was then performed to determine the cutoff value of SUV for differentiating DJD from normal vertebrae.
RESULTS: The mean±standard deviations for the SUVmean and SUVmax in the normal vertebrae displayed a relatively wide variability: 3.92±0.27 and 6.51±0.72 for BW, 1.05±0.07 and 1.75±0.17 for BSA, and 2.70±0.19 and 4.50±0.44 for LBM, respectively. Generally, the SUVmean had a lower coefficient of variation than the SUVmax. For DJD, the mean±standard deviation for the BW SUVmean and SUVmax was 5.26±3.24 and 7.50±4.34, respectively. Based on the ROC curve, no optimal cutoff value was found to differentiate DJD from normal vertebrae.
CONCLUSIONS: In this study, the SUV of 99mTc-MDP was successfully determined using SPECT/CT. This research provides an approach that could potentially aid in the clinical quantification of radionuclide uptake in normal vertebrae for the management of breast cancer patients.

Matched MeSH terms: Single Photon Emission Computed Tomography Computed Tomography