Objective: The purpose of this study was to evaluate the diagnostic performance of SPECT/CT fusion bone imaging in pediatric neuroblastoma patients with metastases bone lesions of the skeleton.Methods: Twenty-four pediatric neuroblastoma patients were included in this prospective study.All patients were underwent planar scintigraphy, SPECT through the focal lesions, and SPECT-guided CT.Image fusion was performed with a dedicated workstation.The three types of images were evaluated separately from one another by two experienced reviewers working to consensus.Visibility of the lesions, diagnostic performance, and certainty in diagnosis were evaluated.Histological findings, other imaging methods, and clinical follow-up findings were used as the reference standard.Results: Visibility of the lesions was significantly better with SPECT/CT and SPECT than with planar scintigraphy (P <0.05).SPECT/CT and SPECT detected five more bone lesions than planar bone imaging.The diagnostic sensitivity of planar scintigraphy, SPECT and SPECT/CT fusion imaging for malignant lesions was 53.19 %, 66.67 % and 82.35 %, respectively.Specificity was 40.00 %, 53.85 %, and 88.46 %, respectively.Accuracy was 45.45 %, 62.34 %, and 97.00 %,respectively.The sensitivity, specificity and accuracy of SPECT/CT fusion imaging for the diagnosis malignant bone lesions were all significantly higher than those of planar scintigraphy (P <0.05).The accuracy of SPECT imaging for the diagnosis malignant bone lesions were significantly higher than those of planar scintigraphy (P < 0.05).The specificity and accuracy of SPECT/CT fusion imaging for the diagnosis of malignant bone lesions were significantly higher than those of SPECT alone (P <0.05).The sensitivity differences between the SPECT/CT and SPECT for the diagnosis of malignant bone lesions had no statistical significance (P > 0.05, P =0.069).Certainty in diagnosis was significantly higher for SPECT/CT than for SPECT (P <0.05)and planar scintigraphy (P <0.05).Conclusions: SPECT/ CT detected more bone lesions, and significantly increased diagnostic performance and certainty in diagnosis bone leisions through improvement of image contrast and detailed anatomic localization.It is the best tool for making a specific diagnosis of bone metastasis of pediatric neuroblastoma.