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Prospective Evaluation of the Clinical Value of Planar Bone Scans, SPECT, and ¹⁸F-Labeled NaF PET in Newly Diagnosed Lung Cancer

Departments of Nuclear Medicine, Internal Medicine, and Diagnostic Radiology, University of Ulm, Ulm, Germany

Previous studies have shown that vertebral bone metastases (BM) not seen on planar bone scintigraphy (BS) might be present on ¹⁸F-fluoride PET scans or at MRI. Therefore, we evaluated the effect of SPECT or ¹⁸F-labeled NaF PET (¹⁸F 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 ¹⁸F PET. MRI and all available imaging methods, as well as the clinical course, were used as reference methods. BS with and without SPECT and ¹⁸F 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 ¹⁸F PET produced no false-negatives. The area under the ROC curve was 0.779 for BS, 0.944 for SPECT, and 0.993 for ¹⁸F PET. The areas under the ROC curve of ¹⁸F 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 ¹⁸F 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, ¹⁸F 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.

Key Words: lung cancer • bone metastases • PET • SPECT

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