Breast Cancer: Role of SPECT and PET in Imaging Bone Metastases
Section snippets
Bone Scintigraphy
Bone scintigraphy (BS), commonly performed with 99mtechnetium-methylene diphosphonate (99mTc-MDP) is a widely used procedure, provides a whole-body skeletal survey at a relatively low cost and is the standard initial imaging modality for assessment of bone metastases.5, 7, 8, 9 The uptake of 99mTc-MDP on the bone surface reflects increased vascularity and increased osteoblastic activity. Osteolytic lesions also demonstrated secondary bone formation, and therefore even osteolytic metastases can
Bone SPECT and SPECT/CT
The addition of single-photon emission computed tomography (SPECT) improves the diagnostic accuracy of BS.6 SPECT enables accurate localization of tracer activity, especially in complex skeletal structures, such as spine, skull, and pelvis, and therefore can improve diagnostic specificity.20 For example, early metastatic spread to the vertebral column is usually confined to the posterior part of the vertebral body and the pedicle, adjacent to the venous network. Therefore, accurate localization
Detection of Bone Metastases With 18F-Fluoride and FDG and Comparison With BS
Positron emission tomography (PET) images have higher resolution as well as higher sensitivity and specificity compared with BS with or without SPECT.31 In addition, PET/CT enables fusion of metabolic function and morphology in a single acquisition, also assisting in a clear differentiation between malignant and benign lesions.32
18F-labeled sodium fluoride is a nonspecific PET tracer used for assessment of bone metastases.12, 16 18F-fluoride diffuses through capillaries into the extracellular
Conclusion
FDG-PET/CT may be less sensitive than BS and 18F-fluoride PET/CT for the detection of bone metastases in patients with breast cancer, mainly in predominantly sclerotic lesions, with better performance indexes in osteolytic sites. However, compared with studies performed with 99mTc-MDP and 18F-fluoride, FDG-PET/CT is associated with a higher specificity for the assessment of bone lesions and, in addition, enables also accurate evaluation of the primary tumor, as well as soft-tissue metastases in
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