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Research Article: Diagnostic performance of 18 F-FDG PET-CT and SPECT for bone metastases from colorectal cancer: a retrospective study

Date Published: 2026-06-12

Abstract:
To compare the diagnostic performance of 18F-FDG PET-CT and SPECT whole-body bone imaging for detecting bone metastases in patients with colorectal cancer. A retrospective analysis was performed on 118 patients with pathologically confirmed colorectal cancer who underwent both 18F-FDG PET-CT and SPECT whole-body bone imaging within one month during follow-up for newly suspected bone metastases. The cohort included 62 males and 56 females, with a mean age of 59.1 ± 7.6 years. The final diagnosis of bone metastases was established based on comprehensive imaging follow-up, including CT, MRI, SPECT, PET-CT, and clinical progression over more than 6 months. Diagnostic performance was evaluated on a lesion-based basis. A total of 533 abnormal lesions were detected in 118 patients, including 469 metastatic lesions and 64 benign lesions. PET-CT detected 423 lesions, whereas SPECT detected 398 lesions, with 288 lesions identified by both modalities. PET-CT correctly identified 428 metastatic lesions, yielding a sensitivity of 91.3%, while SPECT identified 280 metastatic lesions, with a sensitivity of 59.7%. Among the benign lesions, PET-CT correctly identified 60 lesions, resulting in a specificity of 93.8%, whereas SPECT correctly identified 30 lesions, with a specificity of 46.9%. The overall diagnostic accuracy of PET-CT and SPECT was 91.6% and 58.2%, respectively. 18F-FDG PET-CT demonstrated significantly higher sensitivity, specificity, and diagnostic accuracy than SPECT for detecting bone metastases from colorectal cancer. PET-CT may provide superior diagnostic value for predominantly osteolytic bone metastases in colorectal cancer, while SPECT remains an important and widely available first-line screening modality in routine clinical practice.

Introduction:
Colorectal cancer is a malignant tumor that seriously threatens human health and has now become the third leading cause of cancer-related deaths worldwide ( 1 ). In recent years ( 2 ), due to the changes in risk factors for colorectal cancer and the dual effects of population growth and aging, colorectal cancer has become one of the most common and most significantly increasing malignant tumors in China ( 3 ). With the prolongation of the survival time of patients with colorectal cancer and the advancement of…

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