Diagnostic Value of Bone SPECT/CT Using ^99mTc-Methylene Diphosphonate in Patients with Unspecified Chest Wall Pain

Abstract

Purpose We investigated the diagnostic performance of single photon emission computed tomography (SPECT)/computed tomography (CT) as a combination of functional and anatomic imaging, in patients with unspecified chest wall pain.

Methods Fifty-two patients with unspecified chest wall pain and no history of recent major traumatic events or cardiac disease were included. The number and location of radioactive chest wall lesions were evaluated on both planar images and SPECT/CT. The clinical diagnosis was made based on all of the clinical and imaging data and follow-up information.

Results Chest wall diseases were diagnosed in 42 patients (80.8 %). SPECT/CT showed abnormal findings in 35 (67.3 %) patients with positive predictive value (PPV) of 97.1 %. SPECT/CT revealed 56 % more lesions than planar bone scan (P = 0.002) and most of the abnormal radioactive lesions (94.6 %) showed combined morphological changes on the matched CT component. When comparing between age subgroups (< 60 y vs. ≥ 60 y), the prevalence of chest wall disease and diagnosis rate of fracture was significantly higher in the older age group. On SPECT/CT, the older age group showed higher frequency of having abnormal finding (95.8 % vs. 42.9 %, P < 0.001) and significantly more lesions were detected (a total of 189 vs. 32, P = 0.003).

Conclusion SPECT/CT showed good diagnostic performance and proved to have higher sensitivity, detecting 56 % more lesions than planar bone scan. A negative result could be helpful for excluding pathologic chest wall disease. SPECT/CT might be recommended for integration in to the diagnostic workup in patients with unspecified chest wall pain, especially in patients ≥ 60 y of age, considering the high disease prevalence and the high frequency of positive results.

Zusammenfassung

Ziel Wir untersuchten die diagnostische Leistung der Einzelphotonen-Emissions-Computertomografie (SPECT)/Computertomografie (CT) als Kombination aus funktioneller und anatomischer Bildgebung bei Patienten mit unspezifischen Brustwandschmerzen.
Methoden. Zweiundfünfzig Patienten mit unspezifischen Brustwandschmerzen und ohne kürzliche schwere traumatische Ereignisse oder Herzerkrankungen in der Anamnese wurden eingeschlossen. Anzahl und Lage der radioaktiven Brustwandläsionen wurden sowohl auf den planaren Aufnahmen als auch in der SPECT/CT bewertet. Die klinische Diagnose wurde auf Grundlage aller klinischen und bildgebenden Daten sowie der Informationen aus der Nachuntersuchung gestellt.

Ergebnisse Erkrankungen der Brustwand wurden bei 42 Patienten (80,8%) diagnostiziert. SPECT/CT zeigte bei 35 Patienten (67,3%) auffällige Befunde mit einem positiven Vorhersagewert von 97,1%. In der SPECT/CT wurden 56% mehr Läsionen entdeckt als in der planaren Skelettszintigrafie (p=0,002), und die meisten abnormen radioaktiven Läsionen (94,6%) wiesen kombinierte morphologische Veränderungen in der entsprechenden CT-Komponente auf. Beim Vergleich der Altersuntergruppen (<60 Jahre vs. ≥ 60 Jahre) war die Prävalenz von Brustwanderkrankungen und die Diagnoserate von Frakturen in der älteren Gruppe signifikant höher. Bei der SPECT/CT-Untersuchung wurden in dieser Gruppe häufiger auffällige Befunde festgestellt (95,8% vs. 42,9%, p<0,001) und es wurden signifikant mehr Läsionen entdeckt (insgesamt 189 vs. 32, p=0,003).

Schlussfolgerung Die SPECT/CT zeigte eine gute diagnostische Leistung und höhere Sensitivität, da sie 56 % mehr Läsionen entdeckte als die planare Skelettszintigrafie. Ein negatives Ergebnis könnte hilfreich sein, um eine pathologische Brustwanderkrankung auszuschließen. In Anbetracht der hohen Erkrankungsprävalenz und der großen Häufigkeit positiver Befunde kann empfohlen werden, SPECT/CT in die diagnostische Abklärung von unspezifischen Brustwandschmerzen zu integrieren, insbesondere bei Patienten im Alter von ≥ 60 Jahren.

Schlüsselwörter

SPECT - SPECT/CT - Brustwandschmerzen - Tc-99m-Methylendiphosphonat

Keywords

SPECT - SPECT/CT - Chest wall pain - Tc-99m methylene diphosphonate

Publication History

Received: 02 March 2021

Accepted after revision: 13 July 2021

Article published online:
12 November 2021

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