COMPARISON OF BONE SINGLE-PHOTON EMISSION TOMOGRAPHY AND PLANAR IMAGING IN THE DETECTION OF VERTEBRAL METASTASES IN PATIENTS WITH BACK PAIN

Bone scan has long been considered to be an important diagnostic test in searching for bone metastases. However, considerable difficulty is encountered in the vertebral region due to the complexity of structure s and the fact that other benign lesions, especially degenerative chan ges, are very common there. Single-photon emission tomography (SPET) h as been reported to be useful in the differentiation of benign from ma lignant conditions. Here we report our experience with bone SPET in th e diagnosis of vertebral metastases. This is a retrospective study of technetium-99m methylene diphosphonate (MDP) bone scans in 174 consecu tive patients who were referred for the investigation of back pain in our department. MDP planar and SPET images were obtained. Of teh 174 p atients, 98 had a known history of malignant tumours. The diagnosis of vertebral metastasis was made on the basis of the patients' clinical histories and the findings with other imaging techniques such as magne tic resonance imaging, computed tomography or follow-up bone scan. We found that the presence of pedicle involvement as seen on SPET was an accurate diagnostic criterion of vertebral metastasis. SPET had a sens itivity of 87%, a specificity of 91%, a positive predictive value of 8 2%, a negative predictive value of 94% and an accuracy of 90%. On the other hand, planar study had a sensitivity of 74%, a specificity of 81 %, a positive predictive value of 64%, a negative predictive value of 88% and an accuracy of 79% in diagnosing vertebral metastasis. Except with regard to the negative predictive value, SPET performed statistic ally better than planar imaging. Only 9/147 (6.4%) lesions involving t he vertebral body alone and 3/49 (6.1%) lesions involving facet joints alone were subsequently found to be metastases. We conclude that bone SPET is an accurate diagnostic test for the detection of vertebral me tastases and is superior to planar imaging in this respect.