The added value of SPECT/spiral CT in patients with equivocal bony metastasis from hepatocellular carcinoma.
UNLABELLED
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.
['Zhang|Y|Y|', 'Shi|H|H|', 'Li|B|B|', 'Cai|L|L|', 'Gu|Y|Y|', 'Xiu|Y|Y|']
D000328:Adult D000368:Aged D001859:Bone Neoplasms D006528:Carcinoma, Hepatocellular D005260:Female D006801:Humans D007089:Image Enhancement D008113:Liver Neoplasms D008297:Male D008875:Middle Aged D064847:Multimodal Imaging D015203:Reproducibility of Results D012680:Sensitivity and Specificity D015899:Tomography, Emission-Computed, Single-Photon D036542:Tomography, Spiral Computed D051598:Whole Body Imaging
hepatocellular carcinoma bone Single photon emission computed tomography / computed tomography neoplasm metastasis