Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Nuclear Medicine

To evaluate the diagnostic performance of 99mTc MDP bone scintigraphy using SPECT / CT in comparison to diffusion weighted (DW) MRI in the characterization of solitary osseous lesions detected on planar bone scintigraphy. This ongoing prospective study recruited 29 cancer patients referred for bone scintigraphy (staging / restaging / follow-up) with their planar whole body scan showing solitary equivocal osseous lesion. Every patient further underwent SPECT / CT and DW MRI within two weeks. Studies were read independently by one experienced nuclear medicine physician and one experienced radiologist on a 5- point score: (score 1 = benign, score 2 = likely benign, score 3 = equivocal, score 4 = likely malignant and score 5 = malignant). The final diagnosis of disease status was made on the basis of subsequent clinical/imaging follow up for at least 6 months. Of the 29 patients evaluated, only 9 (31%) proved to have osseous metastases and 20 (69%) were disease free. SPECT/CT and DW-MRI had sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of 67% vs 67%, 90% vs 75%, 86% vs 83%, 75% vs 55% and 83% vs 72%; respectively. Both modalities were true positive in 4, true negative in 14, false positive in 1 and false negative in 1 patient (s). No statistically significant difference noted in sensitivity, specificity or accuracy. Bone scintigraphy using SPECT / CT is not superior to DW MRI in characterization of solitary osseous lesions detected on planar scans. Further work is ongoing to identify the exact role of each modality in this setting

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