1. Can 16-detector multislice CT exclude skeletal lesions during tumour staging? Implications for the cancer patient.
- Author
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Groves AM, Beadsmoore CJ, Cheow HK, Balan KK, Courtney HM, Kaptoge S, Win T, Harish S, Bearcroft PW, and Dixon AK
- Subjects
- Adult, Aged, Aged, 80 and over, Breast Neoplasms pathology, Esophageal Neoplasms pathology, Female, Humans, Kidney Neoplasms pathology, Male, Middle Aged, Neoplasm Staging, Patient Satisfaction, Prospective Studies, Prostatic Neoplasms pathology, Radiopharmaceuticals, Sensitivity and Specificity, Soft Tissue Neoplasms diagnostic imaging, Soft Tissue Neoplasms secondary, Technetium Tc 99m Medronate, Tomography, Emission-Computed, Whole Body Imaging, Bone Neoplasms diagnostic imaging, Bone Neoplasms secondary, Breast Neoplasms diagnostic imaging, Esophageal Neoplasms diagnostic imaging, Kidney Neoplasms diagnostic imaging, Prostatic Neoplasms diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Current imaging guidelines recommend that many cancer patients undergo soft-tissue staging by computed tomography (CT) whilst the bones are imaged by skeletal scintigraphy (bone scan). New CT technology has now made it feasible, for the first time, to perform a detailed whole-body skeletal CT. This advancement could save patients from having to undergo duplicate investigations. Forty-three patients with known malignancy were investigated for bone metastasis using skeletal scintigraphy and 16-detector multislice CT. Both studies were performed within six weeks of each other. Whole-body images were taken 4 h after injection of 500 Mbq (99m)Tc-MDP using a gamma camera. CT was performed on a 16-detector multislice CT machine from the vertex to the knee. The examinations were reported independently and discordant results were compared at follow-up. Statistical equivalence between the two techniques was tested using the Newcombe-Wilson method within the pre-specified equivalence limits of +/-20%. Scintigraphy detected bone metastases in 14/43 and CT in 13/43 patients. There were seven discordances; four cases were positive on scintigraphy, but negative on CT; three cases were positive on CT and negative on scintigraphy. There was equivalence between scintigraphy and CT in detecting bone metastases within +/-19% equivalence limits. Patients who have undergone full whole-body staging on 16-detector CT may not need additional skeletal scintigraphy. This should shorten the cancer patient's diagnostic pathway.
- Published
- 2006
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