J Nucl Med 2001 Dec;42(12):1800-4
Prospective evaluation of the clinical value of planar bone scans, SPECT, and
(18)F-labeled NaF PET in newly diagnosed lung cancer.
Schirrmeister H, Glatting G, Hetzel J, Nussle K, Arslandemir C, Buck AK, Dziuk
K, Gabelmann A, Reske SN, Hetzel M.
Previous studies have shown that vertebral bone metastases (BM) not seen on
planar bone scintigraphy (BS) might be present on (18)F-fluoride PET scans or at
MRI. Therefore, we evaluated the effect of SPECT or (18)F-labeled NaF PET ((18)F
PET) imaging on the management of patients with newly diagnosed lung cancer.
METHODS: Fifty-three patients with small cell lung cancer or locally advanced
non-small cell lung cancer were prospectively examined with planar BS, SPECT of
the vertebral column, and (18)F PET. MRI and all available imaging methods, as
well as the clinical course, were used as reference methods. BS with and without
SPECT and (18)F PET were compared using a 5-point scale for receiver operating
characteristic (ROC) curve analysis. RESULTS: Twelve patients had BM. BS
produced 6 false-negatives, SPECT produced 1 false-negative, and (18)F PET
produced no false-negatives. The area under the ROC curve was 0.779 for BS,
0.944 for SPECT, and 0.993 for (18)F PET. The areas under the ROC curve of (18)F
PET and BS complemented by SPECT were not significantly different, and both
tomographic methods were significantly more accurate than planar BS. As a result
of SPECT or (18)F PET imaging, clinical management was changed in 5 patients
(9%) or 6 patients (11%), respectively. CONCLUSION: As indicated by the area
under the ROC curve analysis, (18)F PET is the most accurate whole-body imaging
modality for screening for BM. Routinely performed SPECT imaging is practicable,
is cost-effective, and improves the accuracy of BS.
