Is bone scintigraphy necessary in initial staging of prostate cancer patients?

Our aim was to determine whether serum prostate specific antigen (PSA) and total Gleason score (GS) on biopsy in newly diagnosed prostate cancer (PCa) can predict osseous metastases and eliminate the need for a bone scan as a routine procedure in initial staging. We studied retrospectively 155 patients with previously untreated PCa who underwent bone scintigraphy. Relationship between PSA, GS and bone metastases was examined. Sensitivity, specificity, likelihood ratio (LR) and odds ratio (OR) were calculated with corresponding 95% conidence interval. Results showed that thirty of all bone scans (19.35%) were positive for metastases. This proportion was significantly higher in patients with PSA>20ng/mL (31.66% , P=0.002) vs. PSA<10ng/mL (10.52%). For PSA<10ng/mL as well as 10ng/mL≤ PSA≤ 20ng/mL the test was not a predictor for bone metastases (OR=0.36; OR=0.55). For PSA>20 ng/mL (OR=3.53) the likelihood of bone metastases was increased by 13% . The proportion of positive scintigraphy findings was significantly lower in patients with GS≤ 7 (11.47% ) vs. GS≥ 8 (48.48% , P<0.0001). The GS≥ 8 was highly predictive for bone metastases (OR=7.260). The analysis showed that GS≥ 8 increases the risk of bone metastases by 29%. In conclusion, bone scintigraphy is not necessary in asymptomatic patients with localized disease, GS≤ 6 and PSA<10ng/mL, because of the negligible risk of bone metastases in that stage. Higher levels of GS and PSA may predict bone metastases.     

The value of a baseline bone scan in patients with newly diagnosed prostate cancer.

PURPOSE: This study evaluated the role of bone scans in managing newly diagnosed, untreated prostate cancer. METHODS: Two hundred seventy consecutive staging bone scans in patients (mean age, 69 years) with newly diagnosed prostate cancer who had serum prostate-specific antigen (PSA) determinations and biopsies between January 1995 and October 1997 were evaluated retrospectively. RESULTS: The bone scans were positive for metastatic bone disease in 24 patients and negative in 246. Serum PSA levels, the number of positive biopsy cores, the extent of tumor in the prostate gland, and Gleason scores were all significantly correlated with scintigraphic bone metastases (P < 0.0001 for each). Of the 177 patients with PSA levels less than 10 ng/ml, three had bone metastases. Bone metastases were found in 2 of 34 patients with PSA levels of 10.1 to 20 ng/ml, in 3 of 29 patients with PSA values of 20.1 to 50 ng/ml, and in 16 of 30 patients with PSA levels greater than 50.1 ng/ml. Only one patient had a bone metastasis when the prostate cancer involved fewer than 2 biopsy cores (1 of 135) or when disease was confined to one lobe (1 of 131), but the incidence increased significantly when the malignancy involved three or more biopsy cores (20 of 114) or disease was present in both prostate lobes (20 of 118). Four of 160 patients with Gleason scores less than 6 had bone metastases, whereas 20 of 110 patients with Gleason scores greater than 7 had bone metastases. CONCLUSIONS: The likelihood of bone metastases is low in patients with newly diagnosed, untreated prostate cancer when the initial PSA level was less than 10 ng/ml, the number of positive biopsy cores was less than 2, tumor was confined to one lobe, or the Gleason score was less than 6. However, none of these criteria can be used to exclude metastatic bone disease. A baseline bone scan is an important staging procedure and should be obtained to provide maximum data for clinical management of the disease.     

The clinical utility of prostate-specific antigen and bone scintigraphy in prostate cancer follow-up.

To assess the value of serum prostate-specific antigen (PSA) in prostate cancer follow-up, we prospectively studied 107 consecutive patients with: (1) pathologically confirmed prostate cancer; (2) definitive prostatectomy and/or radiation therapy greater than or equal to 3 mo prior to bone scanning; and (3) one bone scan and serum PSA sampling within 3 mo of each other. The mean and range of patient follow-up since definitive therapy was 1.6 and 0.5-8 yr, respectively. Abnormal bone scans were correlated with pertinent radiographs. Of 107 bone scans, 16 demonstrated metastatic bone disease. A PSA value of less than or equal to 8 ng/ml excluded bone metastases with a predictive value of a negative test of 98.5%. Without radiographic correlation, abnormal bone scans rarely represented metastases if the PSA value was less than or equal to 8 ng/ml. In summary, serum PSA concentration determines the need for follow-up bone scanning and assists in scan interpretation in patients status post definitive therapy for prostate cancer.     

Correlation of procollagen (I) with prostate specific antigen and bone scan for the diagnosis of bone metastases in patients with prostate carcinoma

Procollagen (I) carboxyterminal propeptide (PICP) is a metabolite of procollagen, a precursor molecule of collagen type I, which accounts for more than 90% of the organic matrix of the bones. Serum PICP levels indicate the rate of bone collagen synthesis and therefore the osteoblastic activity. In this study we evaluate the clinical usefulness of serum PICP as an indicator of bone metastases in patients with prostate cancer in relation to bone scan and to prostate specific antigen (PSA) measurements. We found no similar study in the literature relating these three tests. Seventy-eight patients (median age 63+/-4,3 years) with prostate adenocarcinoma were examined. The diagnosis was confirmed histologically. Bone metastases were diagnosed in 42 (54%) of them assessed by bone scans (Group A), while the remaining 36 patients (46%) had no bone metastases (negative bone scans and X-rays) (Group B). We also examined 21 patients with benign prostate hyperplasia as a control group (Group C). All patients had serum PICP measurements, bone scans with (99m)Tc-MDP and PSA measurements. None of them had a history of disease or of using drugs known to affect bone metabolism. Serum levels of PICP were assayed by a radioimmunoassay (RIA) kit (Orion Cooperation, Farmos Diagnostics, Finland). Serum PSA was also tested by a RIA kit (Tandem-R, Hybritech Inc, USA). PICP levels in Group A were 265+/-89 microg/l, in Group B 128+/-39 microg/l and in Group C patients 110+/-48 microg/l. High levels of PICP above 170 microg/l, were diagnostic of bone metastases with sensitivity 54%, specificity 93% and accuracy 84%. In comparison, PSA levels above 4 ng/ml were also diagnostic with a sensitivity of 68%, specificity of 91% and accuracy 88%. Patients with low levels of PICP, lower than 90 microg/l, n=31, had no bone metastases. The positive prognostic value of bone scan was 74% with a sensitivity of 76%, specificity of 58% and accuracy 71%. Positive bone scans combined with very high levels of PICP and PSA, had positive prognostic value 97%, with sensitivity of 78%, specificity of 96% and accuracy 97%, while bone scans with levels of PICP lower than 170 microg/l, had positive prognostic value of 32%. Levels of PICP and PSA were significantly higher in patients with prostate cancer and bone metastases in comparison to patients with benign prostate hyperplasia (P<0.0001) respectively. Also, levels of PICP and PSA were higher in patients with prostate cancer without metastases as compared to prostate hyperplasia (P<0.0005 and P<0.0001 respectively) (Wilcoxon-Mann-Whitney test). When metastases were more extensive, PICP levels were higher than PSA. It is concluded that PICP as a marker of osteoblastic activity is useful for diagnosing bone metastases of prostate adenocarcinoma but when co-evaluated with PSA and the bone scan, the diagnostic accuracy of these three diagnostic procedures is much higher.     

Evaluation of metastatic bone disease with pentavalent 99Tc(m)-dimercaptosuccinic acid: a comparison with whole-body scanning and 4/24 hour quantitation of vertebral lesions

The aim of this study was to establish the value of 99Tcm(V)-DMSA scintigraphy in the detection of metastatic bone lesions and compare the results to 99Tcm-MDP bone scintigraphy. Thirty-four patients presenting with metastatic bone disease (Group 1) and 12 controls with degenerative skeletal lesions (Group 2) were studied. Conventional bone scanning and 99Tcm(V)-DMSA whole-body scanning were performed on all patients. All scans were interpreted visually. Furthermore, lesion-to-normal bone ratios (L/N) in vertebral metastases on the 4 and 24 h bone scans were obtained in 58 lesions of cancer patients and in 23 benign (degenerative) vertebral lesions of the control group. 99Tcm-MDP L/N ratios at 24 h (3.08 +/- 0.32) were significantly higher than those at 4 h (2.48 +/- 0.24) in the malignant foci (P < 0.001). No significant difference was observed in benign lesions (P > 0.05). In 167 (164 metastatic, 3 traumatic) of 186 99Tcm-MDP positive lesions (90%) of Group 1, 99Tcm(V)-DMSA uptake was observed. The remaining 19 lesions (10%) were 99Tcm(V)-DMSA negative. Fourteen of these 19 sites were diagnosed as benign. The remaining five foci were malignant. In four lung cancer metastases showing no 99Tcm-MDP uptake, 99Tcm(V)-DMSA uptake was observed. There was no 99Tcm(V)-DMSA accumulation in any of the 99Tcm-MDP positive degenerative lesions of Group 2. All quantitatively evaluated (n = 42) vertebral metastatic foci and two compression fractures in Group 1 showed 99Tcm(V)-DMSA accumulation and an increased 99Tcm-MDP L/N ratio at 24 h. A total of 36 degenerative lesions (Groups 1 and 2) and one compression fracture (Group 1) showed neither 99Tcm(V)-DMSA uptake nor an increased 99Tcm-MDP L/N ratio at 24 h. Our results indicate that quantitative 4/24 h analysis of vertebral lesions on 99Tcm-MDP scans has a similar diagnostic value to 99Tcm(V)-DMSA imaging in the detection of bone metastases. However, the accumulation of 99Tcm(V)-DMSA in four lung cancer metastases showing no 99Tcm-MDP uptake is encouraging and justifies further research in patients with proven bone metastases and negative bone scans.     

Correlation of prostate-specific antigen and technetium-99m HMDP bone imaging

For an evaluation of the clinical utility of prostate-specific antigen (PSA), 32 prostatic carcinoma patients (ages 54-76) and 13 nonprostatic carcinoma patients (ages 60-70) underwent PSA measurements and bone imaging. At the time of bone imaging, each patient's PSA value was measured by a monoclonal immunoradiometric assay. All 13 nonprostatic carcinoma patients (11 bronchogenic, 1 colon, and 1 urinary bladder) gave normal PSA values, although 6 had metastatic bone disease. The 32 prostatic cancer patients were divided into 2 groups of 16 each; PSA levels in Group 1 were abnormal (greater than or equal to ng/ml): PSA levels in Group 2 were normal (less than 4 ng/ml). In Group 1, bone images of 14 patients showed bone metastases; 6 of the 14 showed progression of metastases in a 6- to 12-month period. Two patients in Group 1 were negative for skeletal metastases. Twelve patients in Group 2 were negative for skeletal metastases; bone imaging in 1 showed regression of skeletal metastases; and 3 patients had unchanged bone lesion(s). The data indicate that PSA measurements may enhance bone imaging interpretation and provide valuable clinical monitoring of prostatic carcinoma. In the case of a patient with positive bone imaging and an unknown primary, PSA measurements may definitively determine if metastases originated from prostatic carcinoma.     

Bone scans with one or two new abnormalities in cancer patients with no known metastases: frequency and serial scintigraphic behavior of benign and malignant lesions

Scintigraphic, radiologic, and clinical follow-up findings were reviewed in cases in which bone scans (n = 301) showed one or two new abnormalities in patients with malignancy but no known metastases. Metastatic disease was confirmed for 25 of 231 scans (11%) with one new abnormality and for 17 of 70 scans (24%) with two new abnormalities. The prevalence of metastases was 0.06 to 0.13 for lesions in all regions of the skeleton, except the sternum (three of six) and the pelvis (10 of 32). On follow-up scans, in the absence of an interval change in therapy, 19 of 21 metastases became more intense, whereas most benign abnormalities either remained unchanged (47%) or resolved (41%). Benign lesions in the ribs, extremities, and pelvis generally resolved within 12-24 months, while most benign skull and spine abnormalities were still apparent after 35-58 months of follow-up.     

The benefit of SPECT when added to planar scintigraphy in patients with bone metastases in the spine.

PURPOSE: This study compared the efficiency of SPECT with planar bone scans in differentiating malignant from benign lesions and in detecting metastases to the spine. METHODS: Planar scintigraphy and SPECT were performed in 37 patients with low back pain without known malignancy and in 38 patients with confirmed malignancy. The type, location, and intensity of tracer accumulation were compared on the planar and SPECT scans. The malignant or benign nature of lesions was proved by radiologic methods, histologic findings, 6 month follow-up, or all of these. RESULTS: More metastases were detected by SPECT (SPECT, 58 of 64; planar, 42 of 64; P < 0.01). In three of seven patients with known malignancy who had a normal result of planar scan, only SPECT detected metastases. Fifty-nine metastases were radiologically mainly osteolytic, one was osteoblastic and four were mixed. Most lesions showed increased radioactivity (40 of 42 on planar scans vs. 45 of 58 on SPECT) and 2 of 42 (5%) vs. 12 of 58 (21%) were cold with marginally increased uptake. One of 58 metastases was a cold lesion seen on SPECT only. Lesions were more often malignant than benign when seen on SPECT in a pedicle (n = 5; malignant = 3, benign = 2), in the body and pedicle (n = 22; malignant = 14, benign = 8), within the vertebral body (n = 5; malignant = 4, benign = 1) and in the whole vertebra (n = 6; malignant = 4, benign = 2). The lesion to background ratio was higher on SPECT than on planar scans (SPECT, 2.26; planar scans, 1.86; P < 0.05 in malignant lesions). CONCLUSIONS: SPECT of the spine improved the diagnostic accuracy of bone scans when added to a planar scan in patients with known malignancy and clinical suspicion of spinal metastases when the planar scan was borderline abnormal. It helps in differentiating between benign and malignant lesions of the spine.     

Role of skeletal scintigraphy in advanced retinoblastomas

PURPOSE: To document the incidence of skeletal metastases exclusively in advanced cases of retinoblastoma and to rationalize the use of preoperative skeletal scintigraphy in such patients. MATERIAL AND METHODS: Preoperative bone scans of 36 consecutive patients with advanced retinoblastoma who underwent skeletal scintigraphy during 1998 to 2003 were analyzed retrospectively. Bone scans were classified as: Grade 1 (high probability scan for skeletal metastases), Grade 2 (equivocal malignant or benign abnormalities), or Grade 3 (normal or certainly benign lesions). RESULTS: Grade 1 scan was found in 3 (8.33%) patients; bone metastases were confirmed by additional investigations. Grade 2 scan was found in 5 (13.88%) patients; bone metastases were excluded in all by additional investigations. Grade 3 scan was found in the remaining 28 (77.77%) patients. Extraorbital extension of disease was demonstrated by fine needle aspiration of lymph nodes in five patients, which included all three patients with Grade 1 scan. In addition to lymph node metastases, two patients had intracranial extension of the disease; demonstrated by contrast-enhanced magnetic resonance imaging of the head. One patient had liver metastases detected on abdominal ultrasound. None of the patients had skeletal metastases only. CONCLUSION: Routine preoperative bone scan is not justified in patients with locally advanced retinoblastoma. Bone scan should only be performed in patients with documented extraocular metastatic disease.     

Transperineal sonography guided biopsy of the prostate: critical review of 1107 cases

PURPOSE: To assess the predictive value for a positive biopsy of different indicators (rectal examination, transrectal ultrasonography, total PSA, PSA density). MATERIAL AND METHODS: Positive predictive value was assessed on 1107 consecutive US-guided transperineal biopsies performed from 1991 to 2001 (cancer=344, dysplasia (PIN)=64, atypical hyperplasia=4, benign hyperplasia=686, inadequate=9) with univariate and multivariate analysis. RESULTS: Increasing age (chi square for trend 52.2, p <0.001), positive rectal examination (chi square 233, df=1, p<0.001) or ultrasonography (chi square 191, df=1, p<0.001), total PSA (chi square for trend 68.9, p<0.001) and PSA density (cutoff 0.15, chi square 104, df=1, p<0.001; cutoff 0.20, chi square 104, df=1, p<0,001) were all significantly associated to the likelihood of a positive biopsy outcome. Multivariate analysis stresses the independent role of Psa density over total PSA. If the parameters studied had determined the biopsy, spared benign biopsies [positive rectal examination=505 (66%), positive ultrasonography=467 (61%), PSA>4=124 (16%), PSA>10=159 (74%), PSA density >0,15=426 (62%), PSA density >0.20=517 (75%)] would not have justified the amount of delayed cancer biopsies [positive rectal examination=103 (29%), positive ultrasonography=55 (15%), PSA>4=42 (12%), PSA>10=569 (46%), PSA density >0,15=73 (25%), PSA density >0,20=107 (37%)]. CONCLUSIONS: The parameters currently available prior to biopsy, if used alone, allow no reliable prediction of biopsy outcome. Positive predictive value, particularly for PSA density, allows a better evaluation of biopsy indication, particularly for random sextant biopsies in the 4-10 ng/ml PSA range, which are frequently negative.     

Association between number and sites of new bone scan abnormalities and presence of skeletal metastases in patients with breast cancer

Review of 1,441 bone scans performed on 242 breast cancer patients without known skeletal metastases identified 239 scans with new abnormalities. Findings on 54 of these 239 scans (23%) represented bone metastases. The proportion of scans reflecting metastases, grouped by the number of new abnormalities, was: (1) 20/182 (11%); (2) 9/26 (35%); (3) 4/9 (45%); (4) 1/2 (50%); greater than or equal to 5-20/20 (100%). When metastatic disease presented as a bone scan with 1-4 new abnormalities, the spine was the most common site of involvement (18 of 34 (53%)), followed by the skull (5/34; 15%), extremities and sternum (each 4/34; 12%). Rib lesions were the most common new findings on scans with less than 5 new abnormalities (seen on 76 of 219 scans (35%)) but only infrequently represented metastases (n = 2). Considering as indicative of malignancy only, those bone scans which demonstrated either (a) greater than or equal to 5 new abnormalities, (b) initial radiographic correlation suggestive of metastases, or (c) thoracic spine lesions with normal correlative radiographs, the presence of skeletal metastatic disease could be predicted with a sensitivity of 0.80 and a specificity of 0.94.     

Prevalence and patterns of bone metastases detected with positron emission tomography using F-18 FDG

PURPOSE: The aim of this retrospective study was to report the prevalence and imaging characteristics of bone metastases detected with F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and, when possible, compare these findings with the performance of bone scans in the same patients. METHODS: The reports of 403 patients with histologically proved malignant disease who underwent a PET scan for initial or post-therapeutic staging were reviewed for the presence of possible bone metastases. Based on the final diagnosis confirmed by histopathologic analysis or clinical follow-up, the PET findings of patients with positive bone metastases were evaluated in terms of location, intensity, and patterns. When the PET scan was positive, the PET results were compared with the findings of available bone scans. RESULTS: PET studies suggested the presence of bone metastases in 38 patients (9%). No follow-up data were available for 9 patients, and the remaining 29 were evaluated further. Of these patients, 6 had false-positive findings, whereas bone metastatic involvement was clinically confirmed in 23 patients. The primary malignant findings included lung cancer (n = 9), esophageal cancer (n = 3), lymphoma (n = 2), melanoma (n = 2), thyroid cancer (n = 2), breast cancer (n = 1), colon cancer (n = 1), prostate cancer (n = 1), testicular cancer (n = 1), and nasopharyngeal cancer (n = 1). On PET, 5 patients had a solitary metastatic focus (22%), and the remaining 18 patients had multiple lesions (78%). The vertebrae were the most frequently involved bones (74%), followed by pelvic bones (70%), ribs (65%), upper extremities including the scapula (48%), sternum (43%), and lower extremities (43%). The patterns of abnormal uptake were classified into three groups: focal (15 patients, 65%), diffuse (2 patients, 9%), and a mixed pattern (6 patients, 26%). Most of the lesions showed intense abnormal uptake (18 patients, 78%); 5 patients had both intense and moderate FDG uptake. Thirteen of the 23 patients with confirmed bone metastases also had a bone scan, which revealed positive bone disease in all of these patients. However, PET consistently revealed more metastatic foci than did the bone scan on a lesion basis. CONCLUSIONS: The most frequent pattern of detectable bone metastases with FDG-PET imaging was multiple foci of intense uptake. PET revealed more lesions than did bone scanning, independent of the type of cancer or location of bone involvement, in patients who were accurately diagnosed by FDG-PET imaging.     

18F-氟化钠PET和PET-CT诊断肺癌骨转移的对比研究

目的 对比研究18F-氟化钠(18F-NaF)PET和PET-CT对肺癌骨转移诊断的准确性.方法 34例初始诊断为肺癌的患者接受18F-NaF PET-CT检查,对PET和PET-CT图像分别进行解释,发现的病变分为恶性、良性和不确定三种.骨转移的综合评价方法包括MRI(34例)、18F-氟脱氧葡糖糖PET-CT(4例)、组织学活检(2例)和临床随访(6例).结果 按患者水平分析时,34例患者中的11例(32%)发生骨转移,其中,18F-NaF PET-CT准确诊断所有患者的骨转移,无假阳性和假阴性,而18F-NaF PET诊断真阳性8例、3例不能确定,18F-NaF PET确诊的8例骨转移患者中的4例PET没有显示全部转移病变(假阴性和不确定病变);按病变水平分析时,118个病变获得最终诊断,其中转移病变47个、良性病变71个,其中,18F-NaF PET诊断真阳性27个、真阴性64个、不确定病变24个、假阴性1个、假阳性2个,而18F-NaF PET-CT诊断真阳性46个、假阴性1个、真阴性71个.按患者水平分析,将不确定病变归为恶性时,18F-NaF PET-CT的特异性高于18F-NaF PET(100% vs 78%,χ2=10.78,P<0.05),二者的灵敏度均为100%;将不确定病变归为良性时,18F-NaF PET-CT诊断骨转移的灵敏度显著高于18F-NaF PET(100% vs 73%,χ2=6.41,P<0.01),二者特异度差异无显著性(100% vs 96%,χ2=2.03,P>0.05);按病变水平分析时,得到与患者水平分析相似结果.结论 18F-NaF PET-CT诊断肺癌骨转移的准确性优于18F-NaF PET,PET-CT中的低剂量CT可进一步提高良、恶性病变的鉴别能力.     

Serum bone alkaline phosphatase levels enhance the clinical utility of prostate specific antigen in the staging of newly diagnosed prostate cancer patients.

The aim of this study was to analyse the clinical utility of serum bone alkaline phosphatase (BAP) in addition to prostate-specific antigen (PSA) in the staging of newly diagnosed untreated prostate cancer patients. A prospective study was conducted, analysing serum BAP and PSA concentrations in 295 consecutive newly diagnosed untreated prostate cancer patients (T1-4, N0-1, M0-1b), 93 of whom had bone metastases on bone scan. The relationship of each marker with extent of bone disease, the influence of several clinical variables on both serum marker levels, the efficiency in predicting bone metastasis through receiver operating characteristic curves and, finally, the clinical utility in avoiding unnecessary bone scans were determined. Significant differences were found in the serum levels of both BAP and PSA between patients with and patients without bone metastases. Multiple regression analysis showed the extent of bone disease to be the only variable that influenced both serum levels. However, while serum BAP levels showed a statistical relationship with extent of bone disease, serum PSA levels did not. The best prediction of bone scan findings was obtained with the combination of both markers using a cut-off of 20 ng/ml, with positive and negative predictive values of 46.5% and 100%, respectively. This greater efficiency could permit 32.2% of initial bone scans to be avoided. False-positive and false-negative rates of BAP were 7.5% and 14%, respectively. This study suggests that serum BAP levels could play a complementary role in the diagnosis of bone metastasis in prostate cancer patients. This marker could provide useful clinical information on the degree of skeletal metastasis and constitute an easy way of enhancing the clinical utility of PSA. The addition of this marker to PSA in the initial evaluation could permit staging bone scan to be avoided at a PSA range of 10-20 ng/ml, with significant implications for cost saving.     

[18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients

Purpose We evaluated the potential of PET/CT and [¹⁸F]fluoromethylcholine (FCH) in the assessment of suspected recurrence of prostate cancer after treatment. Methods One hundred consecutive prostate cancer patients with a persistent increase in serum PSA (>0.1 ng/ml) after radical prostatectomy (58 cases), radiotherapy (21 cases) or hormonal therapy alone (21 cases) were investigated. After injection of 3.7–4.07 MBq/kg of FCH, both early (at <15 min) and delayed (at >60 min) PET/CT scans were performed in 43 patients, delayed PET/CT scans in 53 patients and early PET/CT scans in four patients. Results Of the 100 patients, 54 (PSA 0.22–511.79 ng/ml) showed positive FCH PET/CT scans. Thirty-seven patients had bone and/or abdominal lymph node uptake, while 17 showed pelvic activity. Malignant disease was confirmed in all but one. Delayed SUV_max of bone metastases was significantly higher (p<0.0001 by paired t test) than that measured at <15 min, whereas no differences were observed between early and delayed SUVs of malignant lymph nodes or pelvic disease. Forty-six patients (PSA 0.12–14.3 ng/ml) showed negative FCH PET/CT scans. Of the negative PET/CT scans, 89% were obtained in patients with serum PSA <4 ng/ml and 87% in patients with a Gleason score <8. In none of these cases could recurrent tumour be proven clinically during a follow-up of 6 months. Conclusion FCH PET/CT is not likely to have a significant impact on the care of prostate cancer patients with biochemical recurrence until PSA increases to above 4 ng/ml. However, in selected patients, FCH PET/CT helps to exclude distant metastases when salvage local treatment is intended.     

^99mTc（V）—DMSA骨显像诊断骨转移瘤的临床价值

目的：评价99mTc（V）－DMSA显像在骨转移瘤诊断中的意义。材料和方法：对91例疑骨转移瘤患者行99mTc（V）DMSA全身显像，并与99mTc-MDP全身骨显像及其它检查对比。结果：74例证实存在骨转移瘤者，99mTc．MDP骨显像均显示异常放射性浓聚，99mTc（V）-DMSA显像72例显示了与99mTc-MDP显像某些相同部位的放射性浓聚，2例99mTc（V）DMSA显像阴性。17例骨良性病变，99mTc－MDP骨显像显示轻度异常放射性浓聚，而99mTc（V）-DMSA显像却未见异常的放射性浓聚。结论：99mTc（V）－DMSA诊断骨转移瘤的特异性比99mTc-MDP骨显像高，在骨良恶性肿瘤鉴别诊断中具有重要的临床价值。     

Radioimmune imaging of bone marrow in patients with suspected bone metastases from primary breast cancer

Radioimmune imaging of bone marrow was performed by technetium-99m- (99mTc) labeled antigranulocyte monoclonal antibody BW 250/183 (AGMoAb) scans in 32 patients with suspected bone metastases from primary breast cancer. AGMoAb scans showed bone marrow defects in 25/32 (78%) patients; bone invasion was subsequently confirmed in 23 (72%) patients. Conventional bone scans performed within the same week detected bone metastases in 17/32 (53%) patients (p less than 0.001). AGMoAb scans detected more sites indicating metastatic disease than bone scans in 12 of these 17 patients (71%). All patients with bone metastases in the axial skeleton had bone marrow defects at least at the sites of bone metastases. Of 15 patients with normal, or indicative of, benign disease bone scans, 8 patients (53%) presented with bone marrow defects in the AGMoAb scans. Bone invasion was confirmed in six of them. AGMoAb bone marrow scans provide a method for the early detection of bone metastatic invasion in patients with breast cancer and suspected bone metastases.     

^18F-氟化钠PET和PET-CT诊断肺癌骨转移的对比研究

目的对比研究^18F-氟化钠（^18F-NaF）PET和PET-CT对肺癌骨转移诊断的准确性。方法34例初始诊断为肺癌的患者接受^18F-NaFPET-CT检查,对PET和PET-CT图像分别进行解释,发现的病变分为恶性、良性和不确定三种。骨转移的综合评价方法包括MRI（34例）、^18F-氟脱氧葡糖糖PET-CT（4例）、组织学活检（2例）和临床随访（6例）。结果按患者水平分析时,34例患者中的11例（32％）发生骨转移,其中,^18F-NaFPET—CT准确诊断所有患者的骨转移,无假阳性和假阴性,而^18F-NaFPET诊断真阳性8例、3例不能确定,^18F-NaFPET确诊的8例骨转移患者中的4例PET没有显示全部转移病变（假阴性和不确定病变）;按病变水平分析时,118个病变获得最终诊断,其中转移病变47个、良性病变71个,其中,^18F-NaFPET诊断真阳性27个、真阴性64个、不确定病变24个、假阴性1个、假阳性2个,而^18F-NaFPET-CT诊断真阳性46个、假阴性1个、真阴性71个。按患者水平分析,将不确定病变归为恶性时,^18F-NaFPET-CT的特异性高于^18F-NaFPET（100％vs78％,χ2=10．78,P〈0．05）,二者的灵敏度均为100％;将不确定病变归为良性时,^18F-NaFPET-CT诊断骨转移的灵敏度显著高于^18F-NaFPET（100％vs73％,r=6．41,P〈0．01）,二者特异度差异无显著性（100％vs96％,χ^2=2．03,P〉0．05）;按病变水平分析时,得到与患者水平分析相似结果。结论 ^18F-NaFPET-CT诊断肺癌骨转移的准确性优于^18F-NaFPET,PET—CT中的低剂量CT可进一步提高良、恶性病变的鉴别能力。     

Screening for bone metastases: whole-body MRI using a 32-channel system versus dual-modality PET-CT

The diagnostic accuracy of screening for bone metastases was evaluated using whole-body magnetic resonance imaging (WB-MRI) compared with combined fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) (FDG-PET-CT). In a prospective, blinded study, 30 consecutive patients (18 female, 12 male; 24–76 years) with different oncological diseases and suspected skeletal metastases underwent FDG-PET-CT as well as WB-MRI with the use of parallel imaging (PAT). With a 32-channel scanner, coronal imaging of the entire body and sagittal imaging of the complete spine was performed using T1-weighted and short tau inversion recovery (STIR) sequences in combination. PET-CT was conducted using a low-dose CT for attenuation correction, a PET-emission scan and diagnostic contrast-enhanced CT scan covering the thorax, abdomen and pelvis. Two radiologists read the MRI scans, another radiologist in combination with a nuclear medicine physician read the PET-CT scans, each in consensus. The standard of reference was constituted by radiological follow-up within at least 6 months. In 28 patients, 102 malignant and 25 benign bone lesions were detected and confirmed. WB-MRI showed a sensitivity of 94% (96/102), PET-CT exams achieved 78% (79/102; P<0.001). Specificities were 76% (19/25) for WB-MRI and 80% (20/25) for PET-CT (P>0.05). Diagnostic accuracy was 91% (115/127) and 78% (99/127; P<0.001), respectively. Cut-off size for the detection of malignant bone lesions was 2 mm for WB-MRI and 5 mm for PET-CT. WB-MRI revealed ten additional bone metastases due to the larger field of view. In conclusion, WB-MRI and FDG-PET-CT are robust imaging modalities for a systemic screening for metastatic bone disease. PAT allows WB-MRI bone marrow screening at high spatial resolution and with a diagnostic accuracy superior to PET-CT.     

Serum bone alkaline phosphatase levels enhance the clinical utility of prostate specific antigen in the staging of newly diagnosed prostate cancer patients

The aim of this study was to analyse the clinical utility of serum bone alkaline phosphatase (BAP) in addition to prostate-specific antigen (PSA) in the staging of newly diagnosed untreated prostate cancer patients. A prospective study was conducted, analysing serum BAP and PSA concentrations in 295 consecutive newly diagnosed untreated prostate cancer patients (T1–4, N0–1, M0–1b), 93 of whom had bone metastases on bone scan. The relationship of each marker with extent of bone disease, the influence of several clinical variables on both serum marker levels, the efficiency in predicting bone metastasis through receiver operating characteristic curves and, finally, the clinical utility in avoiding unnecessary bone scans were determined. Significant differences were found in the serum levels of both BAP and PSA between patients with and patients without bone metastases. Multiple regression analysis showed the extent of bone disease to be the only variable that influenced both serum levels. However, while serum BAP levels showed a statistical relationship with extent of bone disease, serum PSA levels did not. The best prediction of bone scan findings was obtained with the combination of both markers using a cut-off of 20 ng/ml, with positive and negative predictive values of 46.5% and 100%, respectively. This greater efficiency could permit 32.2% of initial bone scans to be avoided. False-positive and false-negative rates of BAP were 7.5% and 14%, respectively. This study suggests that serum BAP levels could play a complementary role in the diagnosis of bone metastasis in prostate cancer patients. This marker could provide useful clinical information on the degree of skeletal metastasis and constitute an easy way of enhancing the clinical utility of PSA. The addition of this marker to PSA in the initial evaluation could permit staging bone scan to be avoided at a PSA range of 10–20 ng/ml, with significant implications for cost saving. Received 4 December 1998 and in revised form 15 February 1999