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

• References

• 1 Ayloo A, Cvengros T, Marella S. Evaluation and treatment of musculoskeletal chest pain. Prim Care 2013; 40: 863-887
• 2 Winzenberg T, Jones G, Callisaya M. Musculoskeletal chest wall pain. Aust Fam Physician 2015; 44: 540-544
• 3 Verdon F, Burnand B, Herzig L. et al. Chest wall syndrome among primary care patients: a cohort study. BMC Fam Pract 2007; 8: 51
• 4 Klinkman MS, Stevens D, Gorenflo DW. Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Netwaor. J Fam Pract 1994; 38: 345-352
• 5 Talbot BS, Gange Jr CP, Chaturvedi A. et al. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment. RadioGraphics 2017; 37: 628-651
• 6 Cho SH, Sung YM, Kim MS. Missed rib fractures on evaluation of initial chest CT for trauma patients: pattern analysis and diagnostic value of coronal multiplanar reconstruction images with multidetector row CT. Br J Radiol 2012; 85: e845-e850
• 7 Zhang L, McMahon CJ, Shah S. et al. Clinical and Radiologic Predictive Factors of Rib Fractures in Outpatients With Chest Pain. Curr Probl Diagn Radiol 2018; 47: 94-97
• 8 Tomas X, Facenda C, Vaz N. et al. Thoracic wall trauma-misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging. Quant Imaging Med Surg 2017; 7: 384-397
• 9 Lee JW, Lee SW, Chang SH. et al. Clinical role of bone scintigraphy in low-to-intermediate Framingham risk patients with atypical chest pain. Nucl Med Commun 2018; 39: 411-416
• 10 Maeseneer MD, Mey JD, Lenchik L. et al. Helical CT of Rib Lesions: A Pattern-Based Approach. AJR Am J Roentgenol 2004; 182: 173-179
• 11 Niitsu M, Takeda T. Solitary hot spots in the ribs on bone scan: value of thin-section reformatted computed tomography to exclude radiography-negative fractures. J Comput Assist Tomogr 2003; 27: 469-474
• 12 Zhao Z, Li L, Li F. et al. Single photon emission computed tomography/spiral computed tomography fusion imaging for the diagnosis of bone metastasis in patients with known cancer. Skeletal Radiol 2010; 39: 147-153
• 13 Abikhzer G, Srour S, Keidar Z. et al. Added Value of SPECT/CT in the Evaluation of Benign Bone Diseases of the Appendicular Skeleton. Clin Nucl Med 2016; 41: e195-e199
• 14 Scharf SC. Bone SPECT/CT in skeletal trauma. Semin Nucl Med 2015; 45: 47-57
• 15 Ha S, Hong SH, Paeng JC. et al. Comparison of SPECT/CT and MRI in diagnosing symptomatic lesions in ankle and foot pain patients: diagnostic performance and relation to lesion type. PLoS One 2015; 10: e0117583
• 16 Papathanassiou D, Bruna-Muraille C, Jouannaud C. et al. Single-photon emission computed tomography combined with computed tomography (SPECT/CT) in bone diseases. Joint Bone Spine 2009; 76: 474-480
• 17 Duan R, Shi H. Clinical study of the application of SPECT, CT, and SPECT/CT for diagnosing rib diseases. Jpn J Radiol 2015; 33: 131-139
• 18 Kakhki VD, Zavaki SR. Age-related normal variants of sternal uptake on bone scintigraphy. Clin Nucl Med 2006; 31: 63-67
• 19 Mourad G, Alwin J, Stromberg A. et al. Societal costs of non-cardiac chest pain compared with ischemic heart disease – a longitudinal study. BMC Health Services Research 2013; 13: 403
• 20 Spalding L, Reay E, Kelly C. Cause and outcome of atypical chest pain in patients admitted to hospital. J R Soc Med 2003; 96: 122-125
• 21 Webster R, Norman P, Goodacre S. et al. Illness representations, psychological distress and non-cardiac chest pain in patients attending an emergency department. Psychol Health 2014; 29: 1265-1282
• 22 Järvinen J, Niinimäki J, Karppinen J. et al. Does bone scintigraphy show Modic changes associated with increased bone turnover?. Eur J Radiol Open 2020; 7: 100222
• 23 Russo VM, Dhawan RT, Dharmarajahet N al. Hybrid bone single photon emission compured tomography imaging in evluation of chronic low back pain: correlation with Modic changes and degenerative disc disease. World Neurosurg 2017; 104: 816-823
• 24 Lee I, Budiawan H, Moon JY. et al. The value of SPECT/CT in localizing pain site and prediction of treatment reponse in patients with chronic low back pain. J Korean Med Sci 2014; 29: 1711-1716
• 25 Van de Kelft E, Verleye G, Van de Kelft A. et al. Validation of topographic hybrid single-photon emission computerized tomography with computerized tomography scan in patients with and without nonspecific chronic low back pain. A prospective comparative study. The Spine Journal 2017; 17: 1457-1463
• 26 Schleich FS, Schürch M, Huellner MW. et al. Diagnostic and therapeutic impact of SPECT/CT in patients with unspecific pain of the hand and wrist. EJNMMI Research 2012; 2: 53
• 27 Mendelson G, Mendelson H, Horowitz SF. et al. Can 99mtechnetium methylene diphosphonate bone scans objectively document costochondritis?. Chest 1997; 111: 1600-1602
• 28 Koc ZP, Balci TA, Ozyurtkan MO. The role of the three phase bone scintigraphy in the management of the patients with costochondral pain. Mol Imaging Radionucl Ther 2013; 22: 90-93
• 29 Proulx AM, Zryd TW. Costochondritis: diagnosis and treatment. Am Fam Physician 2009; 80: 617-620
• 30 Patel U, Skingle S, Campbell GA. et al. Clinical profile of acute vertebral compression fractures in osteoporosis. Br J Rheumatol 1991; 30: 418-421