In our opinion, the proven method of skeletal scintigraphy, which has been optimized over the years, has not been appreciated as much as it deserves in the review (1).
The article rightfully notes the following: “The sensitivity and specificity of scintigraphy are both markedly increased with the use of contemporary types of SPECT and SPECT-CT apparatus […]”, “raised the negative predictive value […] to 98%“ and “[…] the sensitivity and specificity […] rises above 90%”; however, these percentages are neither stated in the abstract (“specificity 81%, sensitivity 86%”) nor in Table 3. If the “current state of the art” is used with regard to computed tomography (CT) and magnetic resonance imaging (MRI), it should be applied to scintigraphy as well (or stated in the abstract and table that there is a lack of data as such) instead of limiting the analysis of nuclear medicine procedures to planar images that “do no longer represent the current state of the art.”
From a pathophysiological perspective, it is difficult to conceive that the MRI-detected tissue water should precede the scintigraphy-detected increased mineralization in the bone affected by metastatic disease; in this matter, a fair comparison has yet to be performed. In addition, we would like to criticize that PET-MRI, which is very much highlighted in the review, has definitely not yet established its role in the current healthcare system; especially since information on the costs of PET-MRI is missing altogether in the review. The paper is flawed by its purely academic perspective, exemplified by the definitely unsupportable statement that in patients with “malignant melanoma PET-CT with FDG has replaced other techniques for the detection of bone metastases”—as we know, PET is not available to patients covered by statutory health insurance.
Footnotes
Conflict of interest statement
The authors of both letters declare that no conflict of interest exists.
The authors of the review have chosen not to reply
References
- 1.Heindel W, Gübitz R, Vieth V, Weckesser M, Schober O, Schöfers M. The diagnostic imaging of bone metastases. Dtsch Arztebl Int. 2014;111:741–747. doi: 10.3238/arztebl.2014.0741. [DOI] [PMC free article] [PubMed] [Google Scholar]