The clinical value of xSPECT/CT Bone versus SPECT/CT. A prospective comparison of 200 scans

Purpose To prospectively evaluate the clinical utility of xSPECT/CT Bone, a new reconstruction algorithm for single photon emission tomography (SPECT), and compare it with standard SPECT/CT reconstruction. Methods Sequential reporting of SPECT/CT followed by xSPECT/CT images in 200 sequential cases commencing August 2015. Differences between the initial SPECT/CT and the final report (after xSPECT/CT reconstruction) were documented and analysed. 12–18 months after the initial study follow-up, clinical data was sought from a subset of cases in which xSPECT/CT changed the primary diagnosis and imaging correlation undertaken in all patients who subsequently had MRI or CT scans of the same region. Results A majority of the 200 cases were related to assessment of musculoskeletal complaints. The final (scan) diagnosis was changed after reviewing the xSPECT/CT images in 40 (20%) of cases. The reporting physician (Iain Duncan) assessed that the xSPECT/CT had provided more diagnostic information in 71% of cases. A total of 470 additional lesions were found, equivalent to 2.4 lesions per case. In 33 cases of imaging follow-up there was a high degree of correlation with bone scan findings and xSPECT correlated better than SPECT in regard to detailed findings. In only 15/40 cases of diagnostic change could the outcome be verified and in 12/15 the xSPECT/CT revised diagnosis was confirmed. Conclusions In this observational evaluation xSPECT/CT Bone reconstruction offers identifiable imaging improvements over standard SPECT/CT reconstruction algorithms. xSPECT/CT Bone provides an improvement in diagnostic confidence and identifies a greater number of lesions.