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Evaluation of Combined Transmission and Emission Tomography for Classification of Skeletal Lesions

¹ Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, Tuebingen 72076, Germany.
² Department of Nuclear Medicine, Eberhard-Karls-University, Ottfried-Müller-Strasse 14, Tuebingen 72076, Germany.
³ Department of Medical Biometry, Eberhard-Karls-University, Westbahnhofstrasse 55, Tuebingen 72070, Germany.

View larger version (26K): [in a new window]   Fig. 1A. —65-year-old man with bronchial carcinoma. Coronal (A) and sagittal (B) bone scintigrams (SPECT) obtained to rule out metastases show solitary strong radiotracer uptake along anterior border of ninth thoracic vertebral body (arrows). Images were interpreted as showing benign findings.

View larger version (25K): [in a new window]   Fig. 1B. —65-year-old man with bronchial carcinoma. Coronal (A) and sagittal (B) bone scintigrams (SPECT) obtained to rule out metastases show solitary strong radiotracer uptake along anterior border of ninth thoracic vertebral body (arrows). Images were interpreted as showing benign findings.

View larger version (60K): [in a new window]   Fig. 1C. —65-year-old man with bronchial carcinoma. Left lateral radiograph reveals only slight abnormality corresponding presumably to osteophyte (arrow).

View larger version (70K): [in a new window]   Fig. 1D. —65-year-old man with bronchial carcinoma. Transmission emission tomography images clearly show spondylosis (arrows) responsible for localized bone hypermetabolism, excluding malignancy.

View larger version (46K): [in a new window]   Fig. 2A. —72-year-old man with prostate cancer. Scintigrams show moderate bandlike radiotracer uptake along posterior part of right eighth rib (arrow), interpreted initially on scintigraphy as suspicious for bone metastases.

View larger version (136K): [in a new window]   Fig. 2B. —72-year-old man with prostate cancer. Radiograph of same region (arrow) as in A found no correlation.

View larger version (30K): [in a new window]   Fig. 2C. —72-year-old man with prostate cancer. Transmission emission tomography images clearly show ankylosis of corresponding costovertebral joint leading to stress-induced hypersclerosis (arrows). Increased bone mass was responsible for pathologic radiotracer uptake. CT follow-up over 3 years showed no further change in this lesion.

View larger version (133K): [in a new window]   Fig. 3A. —33-year-old woman with breast cancer (stage T1) and pain in her right shoulder. On bone scintigraphy (not shown), focal radiotracer uptake at posterior portion of sixth rib (arrow) was initially interpreted as bone metastasis. Fine punctual calcifications in projection on right scapula were overlooked on conventional radiographs of shoulder.

View larger version (23K): [in a new window]   Fig. 3B. —33-year-old woman with breast cancer (stage T1) and pain in her right shoulder. Transmission emission tomography images disclose cartilaginous exostosis (arrows) showing bone hypermetabolism because of impingement of corresponding rib.

View larger version (30K): [in a new window]   Fig. 4A. —65-year-old woman with known breast carcinoma and back pain. Coronal (A) and sagittal (B) bone scintigrams (SPECT) show focal radiotracer uptake in 12th vertebral body (arrows) that was suspected of indicating metastases.

View larger version (28K): [in a new window]   Fig. 4B. —65-year-old woman with known breast carcinoma and back pain. Coronal (A) and sagittal (B) bone scintigrams (SPECT) show focal radiotracer uptake in 12th vertebral body (arrows) that was suspected of indicating metastases.

View larger version (24K): [in a new window]   Fig. 4C. —65-year-old woman with known breast carcinoma and back pain. Transmission emission tomography images reveal fracture (arrows) of vertebral body. High-end CT (not shown) confirmed metastases by showing accompanying soft-tissue tumor.

View larger version (70K): [in a new window]   Fig. 5A. —56-year-old woman with breast carcinoma. Coronal (A) and sagittal (B) bone scintigrams (SPECT) show strong focal radiotracer uptake in left posterolateral part of eighth thoracic vertebral body (arrow, B).

View larger version (85K): [in a new window]   Fig. 5B. —56-year-old woman with breast carcinoma. Coronal (A) and sagittal (B) bone scintigrams (SPECT) show strong focal radiotracer uptake in left posterolateral part of eighth thoracic vertebral body (arrow, B).

View larger version (98K): [in a new window]   Fig. 5C. —56-year-old woman with breast carcinoma. Correlation with high-end CT image proved difficult because no abnormality was seen. Arrow indicates region in trabecular bone that corresponds to hot spot on bone scintigraphy.

View larger version (81K): [in a new window]   Fig. 5D. —56-year-old woman with breast carcinoma. Transmission emission tomography images show exact location of focal uptake (arrow) and helped guide biopsy.

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