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Characterization of Focal Bone Lesions in the Axial Skeleton: Performance of Planar Bone Scintigraphy Compared with SPECT and SPECT Fused with CT

¹ Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland, 8091.
² Institute of Biostatistics, University Hospital Zurich, Zurich, Switzerland.

View larger version (35K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —56-year-old woman who underwent staging 1 week after resection of multicentric breast cancer and axillary lymph node metastasis. Anterior (A) and posterior (B) planar bone scintigraphic images with increased focal uptake (arrow, A) in right side of sternum. Differentiation between degenerative uptake in right sternoclavicular joint and solitary metastatic lesion in sternum is difficult.

View larger version (42K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —56-year-old woman who underwent staging 1 week after resection of multicentric breast cancer and axillary lymph node metastasis. Anterior (A) and posterior (B) planar bone scintigraphic images with increased focal uptake (arrow, A) in right side of sternum. Differentiation between degenerative uptake in right sternoclavicular joint and solitary metastatic lesion in sternum is difficult.

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —56-year-old woman who underwent staging 1 week after resection of multicentric breast cancer and axillary lymph node metastasis. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and software-fused SPECT/CT (E, H) images at level of focal uptake. Fused image shows focal uptake is in sternum (arrow, E and H) and not in sternoclavicular joint. MRI findings (not shown) confirmed SPECT fused with CT diagnosis of solitary metastatic lesion of breast cancer.

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —56-year-old woman who underwent staging 1 week after resection of multicentric breast cancer and axillary lymph node metastasis. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and software-fused SPECT/CT (E, H) images at level of focal uptake. Fused image shows focal uptake is in sternum (arrow, E and H) and not in sternoclavicular joint. MRI findings (not shown) confirmed SPECT fused with CT diagnosis of solitary metastatic lesion of breast cancer.

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —56-year-old woman who underwent staging 1 week after resection of multicentric breast cancer and axillary lymph node metastasis. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and software-fused SPECT/CT (E, H) images at level of focal uptake. Fused image shows focal uptake is in sternum (arrow, E and H) and not in sternoclavicular joint. MRI findings (not shown) confirmed SPECT fused with CT diagnosis of solitary metastatic lesion of breast cancer.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —56-year-old woman who underwent staging 1 week after resection of multicentric breast cancer and axillary lymph node metastasis. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and software-fused SPECT/CT (E, H) images at level of focal uptake. Fused image shows focal uptake is in sternum (arrow, E and H) and not in sternoclavicular joint. MRI findings (not shown) confirmed SPECT fused with CT diagnosis of solitary metastatic lesion of breast cancer.

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1G —56-year-old woman who underwent staging 1 week after resection of multicentric breast cancer and axillary lymph node metastasis. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and software-fused SPECT/CT (E, H) images at level of focal uptake. Fused image shows focal uptake is in sternum (arrow, E and H) and not in sternoclavicular joint. MRI findings (not shown) confirmed SPECT fused with CT diagnosis of solitary metastatic lesion of breast cancer.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1H —56-year-old woman who underwent staging 1 week after resection of multicentric breast cancer and axillary lymph node metastasis. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and software-fused SPECT/CT (E, H) images at level of focal uptake. Fused image shows focal uptake is in sternum (arrow, E and H) and not in sternoclavicular joint. MRI findings (not shown) confirmed SPECT fused with CT diagnosis of solitary metastatic lesion of breast cancer.

View larger version (46K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —34-year-old man with skeletal pain. Anterior (A) and posterior (B) planar bone scintigraphic images show increased focal uptake (arrow) in left part of third lumbar vertebral body.

View larger version (43K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —34-year-old man with skeletal pain. Anterior (A) and posterior (B) planar bone scintigraphic images show increased focal uptake (arrow) in left part of third lumbar vertebral body.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —34-year-old man with skeletal pain. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and fused SPECT/CT (E, H) images at level of focal uptake show increased uptake belongs to polylobulated sclerotic lesion (arrowheads, C and F) in left part of vertebral body. Fused images show lesion (arrows, E and H) with good match between CT lesion and focal uptake on SPECT image. Diagnosis of melorheostosis was established. MRI and follow-up CT findings 6 months after CT and SPECT confirmed diagnosis.

View larger version (85K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —34-year-old man with skeletal pain. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and fused SPECT/CT (E, H) images at level of focal uptake show increased uptake belongs to polylobulated sclerotic lesion (arrowheads, C and F) in left part of vertebral body. Fused images show lesion (arrows, E and H) with good match between CT lesion and focal uptake on SPECT image. Diagnosis of melorheostosis was established. MRI and follow-up CT findings 6 months after CT and SPECT confirmed diagnosis.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —34-year-old man with skeletal pain. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and fused SPECT/CT (E, H) images at level of focal uptake show increased uptake belongs to polylobulated sclerotic lesion (arrowheads, C and F) in left part of vertebral body. Fused images show lesion (arrows, E and H) with good match between CT lesion and focal uptake on SPECT image. Diagnosis of melorheostosis was established. MRI and follow-up CT findings 6 months after CT and SPECT confirmed diagnosis.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —34-year-old man with skeletal pain. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and fused SPECT/CT (E, H) images at level of focal uptake show increased uptake belongs to polylobulated sclerotic lesion (arrowheads, C and F) in left part of vertebral body. Fused images show lesion (arrows, E and H) with good match between CT lesion and focal uptake on SPECT image. Diagnosis of melorheostosis was established. MRI and follow-up CT findings 6 months after CT and SPECT confirmed diagnosis.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2G —34-year-old man with skeletal pain. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and fused SPECT/CT (E, H) images at level of focal uptake show increased uptake belongs to polylobulated sclerotic lesion (arrowheads, C and F) in left part of vertebral body. Fused images show lesion (arrows, E and H) with good match between CT lesion and focal uptake on SPECT image. Diagnosis of melorheostosis was established. MRI and follow-up CT findings 6 months after CT and SPECT confirmed diagnosis.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2H —34-year-old man with skeletal pain. Axial (C-E) and coronal (F-H) CT (C, F), SPECT (D, G), and fused SPECT/CT (E, H) images at level of focal uptake show increased uptake belongs to polylobulated sclerotic lesion (arrowheads, C and F) in left part of vertebral body. Fused images show lesion (arrows, E and H) with good match between CT lesion and focal uptake on SPECT image. Diagnosis of melorheostosis was established. MRI and follow-up CT findings 6 months after CT and SPECT confirmed diagnosis.

View larger version (37K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —55-year-old man with skeletal pain. Posterior planar scintigraphic images show paravertebral focal uptake (arrow, B).

View larger version (36K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —55-year-old man with skeletal pain. Posterior planar scintigraphic images show paravertebral focal uptake (arrow, B).

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —55-year-old man with skeletal pain. Axial CT (C), SPECT (D), and fused SPECT/CT (E) images show focal uptake corresponds to periosteal reaction (arrow, C and E) caused by old rib fracture.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —55-year-old man with skeletal pain. Axial CT (C), SPECT (D), and fused SPECT/CT (E) images show focal uptake corresponds to periosteal reaction (arrow, C and E) caused by old rib fracture.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —55-year-old man with skeletal pain. Axial CT (C), SPECT (D), and fused SPECT/CT (E) images show focal uptake corresponds to periosteal reaction (arrow, C and E) caused by old rib fracture.

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