Ankara Med J. 2020; 20(4): 1041-1052 | DOI: 10.5505/amj.2020.25932

Prostat Kanserli Hastalarda Evreleme ve Tedavi Planýnda Lumbopelvik SPECT/BT’nin Tüm Vücut Kemik Sintigrafisine Katkýsý

Nilüfer Yýldýrým
Ankara Yýldýrým Beyazýt Üniversitesi, Nükleer Týp Ana Bilim Dalý, Ankara

GÝRÝÞ ve AMAÇ: Prostat kanserli hastalarda kemik metastaz taramasýnda lumbopelvik SPECT/BT görüntülemenin TVKS’ye katkýsýný belirlemek ve tedavi yöntemine etkisini araþtýrmaktý.
YÖNTEM ve GEREÇLER: 184 hastanýn verileri geriye dönük olarak incelendi. TVKS, lumbopelvik SPECT/BT ve her ikisinin birlikte deðerlendirilmesiyle tüm hastalar normal, benign, þüpheli ve metastatik olarak yorumlandý. Her metodun kemik metastazýný belirlemedeki tanýsal parametreleri hesaplandý. Ayrýca lumbopelvik SPECT/BT’nin hasta bazýnda tanýya katkýsý ve tedavi yönetimine etkisi belirlendi.
BULGULAR: TVKS ile hastalarýn %22,82’si metastaz açýsýndan þüpheli olarak deðerlendirilmiþ olup bu oran lumbopelvik SPECT/BT’nin eklenmesiyle belirgin olarak düþmüþtür (%22,82 ve %7,61; p<0,001). Lumbopelvik bölge özelinde deðerlendirildiðinde SPECT/BT ile net yorum yapýlamayan hasta oraný planar görüntülemeye göre belirgin olarak düþük bulunmuþtur (%4,89 ve %21,73; p<0,001). TVKS+lumbopelvik SPECT/BT’nin duyarlýlýk ve özgüllük deðerleri %100 ve %97,61 olarak bulunmuþtur. Lumbopelvik SPECT/BT ile hastalarýn %23,36’sýnda metastaz tanýsý kesinleþmiþ veya deðiþmiþ, diðer bazý hastalarda ise tedavi yönetimini etkileyecek metastaz yaygýnlýðý veya semptomatik benign patolojiler saptanmýþtýr. Sonuçta hastalarýn %41,84’ünde lumbopelvik SPECT/BT’nin tedavi yönetimine katkýsý olmuþtur.

TARTIÞMA ve SONUÇ: Lumbopelvik SPECT/BT, prostat kanserinde kemik metastaz taramasýnda þüpheli yorumlarý azaltýr ve tedavi yönetimine belirgin katký saðlar. Bu nedenle ileri evre ve semptomatik hastalarýn metastaz taramasýnda TVKS ile birlikte rutin lumbopelvik SPECT/BT görüntülemeyi öneriyoruz.

Anahtar Kelimeler: Prostat kanseri, kemik sintigrafisi, SPECT/BT, hibrit görüntüleme.

---

The Contribution of Lumbopelvic SPECT/CT to Whole Body Scanning in Staging and Therapy Management in Prostate Cancer Patients

Nilüfer Yýldýrým
Department of Nuclear Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey

INTRODUCTION: The study aimed to determine the contribution of lumbopelvic SPECT/CT and investigate its effect on management of therapy.
METHODS: The data of 184 patients were analyzed retrospectively. All patients were interpreted as normal, benign, suspicious, and metastatic by evaluating WBS, lumbopelvic SPECT/CT, and both. Each method's diagnostic parameters and the contribution of lumbopelvic SPECT/CT to diagnosis and therapy management were determined on a patient basis.
RESULTS: With WBS, %22.82 of the patients were evaluated as suspicious for metastasis, and this rate decreased significantly with the addition of lumbopelvic SPECT/CT (%22.82 and %7.61; p <0.001). When evaluated specifically for the lumbopelvic region, the rate of suspicious findings with SPECT/CT was found to be significantly lower than planar imaging (%4.89 vs. %21.73; p <0.001). The sensitivity and specificity values of WBS + lumbopelvic SPECT/CT were found to be 100% and %97.61. With lumbopelvic SPECT/CT, the metastasis diagnosis was confirmed or changed in %23.36 of the patients. Besides, the extent of metastasis was changed, or symptomatic benign pathologies were determined in some patients. As a result, lumbopelvic SPECT/CT contributed to the therapy management in %41.84 of the patients.
DISCUSSION AND CONCLUSION: Lumbopelvic SPECT/CT reduces suspicious comments in screening for bone metastases in prostate cancer and significantly contributes to treatment management. For this reason, we recommend routine lumbopelvic SPECT / CT imaging together with WBS for metastasis screening in an advanced stage and symptomatic patients.

Keywords: Prostate cancer, bone scintigraphy, SPECT/BT, hybrid imaging.

---

ATIF KOPYALA