Benign versus malignant osseous lesions in spine: differentiation by means of bone SPECT/CT fused image

This study compared the efficiency of SPECT-CT fused image with planar bone scan, bone SPECT and CT in differentiating malignant from benign lesions and detecting metastases to the spine. Methods. Total 144 patients with spinal lesions underwent planar bone scan (WB), single photon tomography (SPECT), CT and SPECT-CT fused image by a SPECT/CT system. The malignant or benign nature of lesions was proved by radiological Methods, histological findings, 6-24 month follow-up, or all of these. The diagnostic results was divided into 4 types, i.e., normal, benign, doubtful malignant and malignant. Results. There were 137 malignant and 252 benign lesions in 144 patients, respectively. The percentages of doubtful malignant diagnosed by WB, SPECT, CT and fused image are 22.6%, 5.1%, 9.5% and 0%, respectively, p < 0.01-0.001, except for the comparison between the percentages of SPECT and CT. Sensitivities in detection of malignant lesions by WB, SPECT, CT and fused image are 75.2%, 94.2%, 96.6% and 99.3%, respectively, P < 0.001, excepting for the comparisons between those of SPECT and CT, and between those of CT and fused image. The sensitivities m detection of benign lesions by WB, SPECT, CT and fused image are, 56.7%, 86.5%, 90.1% and 96.8%, respectively, P < 0.005 - 0.001, excepting for the comparison between those of SPECT and CT. The specificities in detection of maliganant lesions by WB, SPECT, CT and fused image are 70.6%, 88.9%, 97.2% and 97.6%, respectively, P < 0.001, excepting for the comparison between those of CT and fused image. Conclusion. Bone SPECT-CT fused image has highest diagnostic and differentiating diagnostic values in detection of spinal abnormalities over the planar bone scanning and SPECT. The CT by present SPECT/CT system can complement planar bone scanning and SPECT and is clinically valuable in detection of spinal abnormalities. (authors)