The added value of SPECT/spiral CT in patients with equivocal bony metastasis from hepatocellular carcinoma

 

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Summary

The aim of this study was to evaluate the incremental value provided by single-photon emission computed tomography (SPECT)/spiral computed tomography (CT) over SPECT alone for the evaluation of equivocal bone lesions in patients with hepatocellular carcinoma (HCC). Patients, methods: This was a retrospective study of 65 patients (61 men and 4 women; mean age, 53.1 ± 10.1 years; age range, 31–78 years) with HCC confirmed by pathology who underwent planar whole body scintigraphy and SPECT/CT. Each lesion was scored visually using a 5-point scale (0, negative; 1, benign; 2, likely benign; 3, likely bone metastasis; 4, bone metastasis). Lesions in which diagnostic confidence was scored as 3 or 4 were categorized into metastases.The final diagnosis of each lesion was based on pathological confirmation or follow-up by whole body scintigraphy and SPECT/spiral CT conducted two or more times. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SPECT alone and SPECT/CT were computed. Results: The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of SPECT alone were 78.4, 70.9%, 94.9%, 96.8% and 59.7%, respectively. Moreover, for agreement of SPECT alone and the final results, the kappa value was 0.567 (p < 0.001), which was considered to be moderate agreement. The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of SPECT/CT were 99.2%, 100%, 97.4%, 98.9% and 100 %, respectively. Furthermore, for agreement of SPECT/CT and the final results, the kappa value was 0.981 (p < 0.001), which was considered to be nearly perfect agreement. Conclusions: SPECT/spiral CT is more accurate and valuable than SPECT alone in the differential diagnosis of equivocal bone lesions in patients with HCC.

Zusammenfassung

In dieser Studie sollte der zusätzliche Nutzen bewertet werden, den die Single-Photon-Emissions- Computertomografie (SPECT) / Spiral- Computertomografie (CT) für die Beurteilung unklarer Knochenläsionen bei Patienten mit hepatozellulärem Karzinom (HCC) gegenüber der SPECT alleine bietet. Patienten, Methoden: Retrospektive Studie mit 65 Patienten (61 Männer, 4 Frauen; mittleres Alter 53,1 ± 10,1 Jahre; Altersbereich 31–78 Jahre) mit pathologisch gesichertem HCC, bei denen eine planare Ganzkörper-Szintigraphie sowie eine SPECT/CT durchgeführt wurden. Jede Läsion wurde anhand einer 5-Punkte-Skala (0, negativ; 1, benigne; 2, wahrscheinlich benigne; 3, wahrscheinlich Knochenmetastase; 4, Knochenmetastase) visuell eingestuft. Läsionen mit einem diagnostisch sicheren Punktwert von 3 oder 4 wurden als Metastasen klassifiziert. Die endgültige Diagnose basierte bei allen Läsionen auf der pathologischen Bestätigung oder der Kontrolle durch Ganzkörper-Szintigraphie und SPECT/Spiral- CT, die zweimal oder öfter durchgeführt wurden. Für SPECT alleine und SPECT/CT wurden Diagnosegenauigkeit, Sensitivität, Spezifität, positiver (PPV) und negativer (NPV) Vorhersagewert berechnet. Ergebnisse: Diagnosegenauigkeit, Sensitivität, Spezifität, PPV und NPV der SPECT alleine lagen bei 78,4, 70,9%, 94,9%, 96,8% bzw. 59,7%. Für die übereinstimmung zwischen SPECT alleine und den Endergebnissen ergab sich zudem ein Kappa- Wert von 0,567 (p < 0,001), der als mäßige übereinstimmung betrachtet wurde. Diagnosegenauigkeit, Sensitivität, Spezifität, PPV und NPV der SPECT/CT betrugen 99,2%, 100%, 97,4%, 98,9% bzw. 100%. Ferner ergab sich ein Kappa-Wert von 0,981 (p < 0.001) für die übereinstimmung zwischen SPECT/CT und den Endergebnissen, was als nahezu perfekte übereinstimmung galt. Schlussfolgerung: SPECT/Spiral-CT ist bei der Differenzialdiagnose unklarer Knochenläsionen bei Patienten mit HCC präziser und vorteilhafter als SPECT alleine.

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