A Comparison between FDG PET/CT, CT and MRI in Detection of Spinal Metastases and its Impact on Clinical Management | ||
| Egyptian Journal Nuclear Medicine | ||
| Article 4, Volume 8, Issue 8, December 2013, Pages 30-44 PDF (627.84 K) | ||
| Document Type: Original Paper, Oncology | ||
| DOI: 10.21608/egyjnm.2013.5458 | ||
| Author | ||
| Magdy Kotb* | ||
| National Cancer Institute , Cairo University | ||
| Abstract | ||
| The aim of this study was to compare the diagnostic value of combined F-18-FDG PET/CT, CT and MRI indetection of spinal metastatic lesionsand their impact on management of these patients. Patients and methods: A total of 22 patients with biopsy-proven malignancy were enrolled. All patients underwent spinal MRI and whole body F-18-FDG PET/CT examinations using standard techniques. The diagnostic capabilities of the imaging modalities were compared in the same spinal field of view. F-18-FDG PET/CT and MRI findings were compared with the results of biopsy or clinical / radiological follow up for at least 12 months as the reference standards. Results: A total of 214 vertebral lesions were detected in 22 cancer patients based on combined clinical and radiological follow up (FU), these lesions were divided into: 129 metastatic & 85 benign lesions. Moreover these 22 patients were divided into: 12 with spinal metastases and 10 free from spinal metastases. Both lesions & patients based data analysis showed a significant higher diagnostic accuracy for the combined F-18- FDG PET/CT (98.5% and 94.5%) compared to MRI (86% and 68%) and CT (79.5% & 54.5%) respectively (P<0.05).The significant difference between F-18 FDG PET/CT and morphological techniques were more obvious on specificity indices rather than sensitivity indices in both lesion and patient based analysis. On the other hand, MRI results were superior to those of CT on both lesions and patients data analysis. On lesion-based analysis, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for F- 18 FDG PET/CT were 99%, 98%, 98% & 99%, For MRI were 88.4%, 82.4%,88.4% and 82.3%, and for CT were 83.7%, 73%, 82.4 and 74.5% respectively. On patientbased analysis the sensitivity and specificity for F-18 FDG PET/CT were 100% & 90% compared to 75% &60% in MRI and 66.6% &40% in CT (P<0.05). The relative superiority of the F-18 FDG based technique compared to the morphological techniques in respect to sensitivity and specificity provide significant changes in patient management in 27.2 % & 41% of cases compared to MRI & CT respectively. Conclusion: Combined F-18 FDG PET/CT scan showed the highest utmost sensitivity, specificity and accuracy followed by MRI and lastly CT in the detection of spinal metastatic lesions. Consequently18F-FDG PET/CT has a better impact on clinical management compared to MRI&CT | ||
| Keywords | ||
| FDGPET/CT – MRI – Spine – Cancer | ||
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