Translate this page into:
Utility of hybrid SPECT-CT in the detection of unsuspected single lytic vertebral metastases in renal cell carcinoma
Address for correspondence: Dr. Bhagwant Mittal, Department of Nuclear Medicine, PGIMER, Chandigarh – 160 012, India. E-mail:brmittal@yahoo.com
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article was originally published by Medknow Publications and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Authors describe the incremental value of hybrid SPECT-CT in upstaging disease and changing the management strategy of a case of renal cell carcinoma
Keywords
Bone scan
metastasis
renal cell carcinoma
SPECT-CT
INTRODUCTION
Bone scintigraphy is less sensitive for detection of osteolytic lesions. We describe the utility of hybrid modality SPECT-CT in demonstrating the osteolytic lesion on morphological (CT) component of SPECT-CT associated with focal subtle tracer uptake.[1‐3]
CASE REPORT
We report the case of a 47-year-old male patient who presented with abdominal pain, lower urinary symptoms and hematuria for three months. He was diagnosed as a case of renal cell carcinoma and subjected to radical nephrectomy. The patient also underwent a whole body bone scan for a metastatic workup. A planar whole body bone scan along with a hybrid single photon emission computed tomography (SPECT) / Computed Tomography (CT) imaging was performed. The planar imaging showed an area of mildly increased tracer uptake in the second lumbar vertebra [Figure 1]. Subsequent SPECT / CT imaging revealed a lytic lesion in the L2 vertebra, with increased uptake in the rest of the vertebral body; the findings more likely to be with metastatic involvement [Figure 2]. Thus, SPECT / CT upstaged the disease and changed the management strategy. In conclusion the present case report emphasizes the importance of a hybrid SPECT / CT imaging for suspicious bone lesions on planar images.
- Planar bone scintigraphy performed after I.V. injection of technetium labeled MDP showing very mild increase in the L 2 vertebra prompted a hybrid SPECT-CT imaging of the lumbar spine. Post Left nephrectomy status is also noticed
- Hybrid SPECT-CT images revealing cortical destruction of the L2 vertebra. The photopenic region in SPECT images corresponding to the site of destruction
Source of Support: Nil
Conflict of Interest: None declared.
REFERENCES
- The role of single photon emission computed tomography/computed tomography in benign and malignant bone disease. Semin Nucl Med. 2006;36:286-94.
- [Google Scholar]
- Imaging of malignant bone involvement by morphologic, scintigraphic and hybrid modalities. J Nucl Med. 2005;46:1356-67.
- [Google Scholar]
- The diagnostic value of bone scan in patients with renal cell carcinoma. J Urol. 2001;166:2126-8.
- [Google Scholar]