Volume 114, Issue 6 p. 818-823
Urological Oncology

Spine metastases in prostate cancer: comparison of technetium-99m-MDP whole-body bone scintigraphy, [18F]choline positron emission tomography(PET)/computed tomography (CT) and [18F]NaF PET/CT

Mads H. Poulsen

Corresponding Author

Mads H. Poulsen

Research Unit of Urology, Department of Urology, Odense University Hospital, Odense, Denmark

Correspondence: Mads Hvid Poulsen, Department of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark.

e-mail: [email protected]

Search for more papers by this author
Henrik Petersen

Henrik Petersen

Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

Search for more papers by this author
Poul F. Høilund-Carlsen

Poul F. Høilund-Carlsen

Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

Search for more papers by this author
Jørn S. Jakobsen

Jørn S. Jakobsen

Research Unit of Urology, Department of Urology, Odense University Hospital, Odense, Denmark

Search for more papers by this author
Oke Gerke

Oke Gerke

Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

Search for more papers by this author
Jens Karstoft

Jens Karstoft

Department of Radiology, Odense University Hospital, Odense, Denmark

Search for more papers by this author
Signe I. Steffansen

Signe I. Steffansen

Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

Search for more papers by this author
Steen Walter

Steen Walter

Research Unit of Urology, Department of Urology, Odense University Hospital, Odense, Denmark

Search for more papers by this author
First published: 09 December 2013
Citations: 103

Abstract

Objective

To compare the diagnostic accuracy of the following imaging techniques in the detection of spine metastases, using magnetic resonance imaging (MRI) as a reference: whole-body bone scintigraphy (WBS) with technetium-99m-MDP, [18F]-sodium fluoride (NaF) positron emission tomography (PET)/computed tomography (CT) and [18F]-fluoromethylcholine (FCH) PET/CT.

Patients and Methods

The study entry criteria were biopsy-proven prostate cancer, a positive WBS consistent with bone metastases, and no history of androgen deprivation. Within 30 days of informed consent, trial scans were performed in random order. Scans were interpreted blindly for the purpose of a lesion-based analysis. The primary target variable was bone lesion (malignant/benign) and the ‘gold standard’ was MRI.

Results

A total of 50 men were recruited between May 2009 and March 2012. Their mean age was 73 years, their median PSA level was 84 ng/mL, and the mean Gleason score of the tumours was 7.7. A total of 46 patients underwent all four scans, while four missed one PET/CT scan. A total of 526 bone lesions were found in the 50 men: 363 malignant and 163 non-malignant according to MRI. Sensitivity, specificity, positive and negative predictive values and accuracy were: WBS: 51, 82, 86, 43 and 61%; NaF-PET/CT: 93, 54, 82, 78 and 81%; and FCH-PET/CT: 85, 91, 95, 75 and 87%, respectively.

Conclusions

We found that FCH-PET/CT and NaF-PET/CT were superior to WBS with regard to detection of prostate cancer bone metastases within the spine. The present results call into question the use of WBS as the method of choice in patients with hormone-naïve prostate cancer.