Direct comparison of fast single-shot whole-body 360°CZT-SPECT/CT and conventional Anger camera imaging for detection and classification of bone metastases

ABSTRACT Purpose Whole-body bone SPECT/CT acquisition time can be reduced using high-speed 360° cadmium zinc telluride (CZT) cameras. However, diagnostic agreement with conventional multi-phase Anger camera protocols remains incompletely established. This prospective study compared fast single-shot whole-body CZT-SPECT/CT (Fast-CZT) and conventional Anger camera imaging (Conv-Anger) for the detection and therapeutically relevant classification of bone metastases. Methods Patients referred for bone scintigraphy for detection or follow-up of bone metastases were prospectively enrolled. Three to four hours after injection of 569±41 MBq of [ 99 ᵐTc]Tc-HDP, each patient underwent two imaging protocols in randomized order: (i) a single-shot whole-body 360° CZT-SPECT acquisition preceded by low-dose whole-body CT, and (ii) a conventional Anger camera protocol combining whole-body planar imaging with targeted SPECT/CT acquisitions. Images were independently reviewed and analyzed by consensus by three experienced, blinded observers. Patients were classified as having no bone metastases, oligometastatic disease (≤5 lesions), or polymetastatic disease (>5 lesions). Results A total of 133 patients (mean age 67±10 years; 76 breast, 47 prostate, and 10 other cancers) were included. Mean cumulative acquisition time was significantly shorter with Fast-CZT than with Conv-Anger (33±3 vs. 52±7 min; p