Evaluation of bone scan index change over time on automated calculation in bone scintigraphy

e639 Background: Bone management is extremely important for maintaining QOL of prostate or renal cancer patients with bone metastasis. Physicians often administrate bone modifying agents (BMA), zoledronic acid or denosumab, to prevent skeletal-related event and bone pain for such patients. However, osteonecrosis of the jaw (ONJ) is one of sever adverse events of BMA (Medication-related ONJ; MRONJ). The early detection and follow-up of ONJ is extremely important issue. In order to achieve this issue, we utilized bone scintigraphy and a computer-aided diagnosis using a bone scan index (BSI). Methods: A total of 22 patients with either prostate cancer or renal cancer (27 lesions) diagnosed with MRONJ after treatment with BMA were investigated. Median age was 72.5 years (range 52-82 years). The primary disease was prostate cancer (81.8%), renal cancer (18.2%). Regarding the treatment, 86.4% of the patients were treated with bisphosphonate drugs, none in denosumab, and both in 13.6%, respectively. The median duration of medication was 33 months (range 7-70 months) by the time of MRONJ diagnosis. All patients underwent Tc-99m methylene diphosphonate bone scintigraphy. Bone uptake in the jaw was analyzed using BSI, which was calculated by BONENAVI (FUJIFILM RI Pharma, Japan; EXINIbone, EXINI Diagnostics, Sweden). Significant hot spots were manually selected according to both serial scintigraphic images and dental records, and the fraction of them to the entire skeleton was referred as BSI of the jaw (BSIJ). The level of BSIJ was evaluated in comparison with stage of ONJ and inflammation marker, C-reactive protein (CRP). Results: The median BSIJ of lesions was 0.14 (range 0.00-0.43) at the time of MRONJ diagnosis. If MRONJ is not treated appropriately, BSIJ tended to increase during treatment with BMA. When patients were classified according to their clinical stages of MRONJ, higher stage MRONJ lesions had significantly higher BSIJ (p < 0.01). In addition, BSIJ was correlated with CRP. Conclusions: Evaluation of BSIJ using BONENAVI on bone scintigraphy was helpful for early detection and follow-up of MRONJ. Furthermore, increased BSIJ on bone scintigraphy were related to CRP and stage of ONJ.

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Evaluation of bone metastasis of castration-resistant prostate cancer after enzalutamide and abiraterone using Bone Scan Index on bone scintigraphy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.e596 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. e596-e596

Author(s):

Suguru Kadomoto ◽

Kouji Izumi ◽

Takahiro Nohara ◽

Konaka Hiroyuki ◽

Yoshifumi Kadono ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Metastasis ◽

Bone Metastases ◽

Bone Scintigraphy ◽

Bone Scan ◽

Average Rate ◽

Castration Resistant Prostate Cancer ◽

Bone Scan Index ◽

Castration Resistant ◽

Better Than

e596 Background: It was ambiguous till now to evaluate the change of bone metastasis by various treatments. To quantify the change of bone metastases by enzalutamide, abiraterone, and docetaxel for the castration-resistant prostate cancer (CRPC) with bone metastases (bmCRPC), we employed Bone Scan Index (BSI) on bone scintigraphy. Methods: We retrospectively evaluated the change of PSA and bone metastases of CRPC patients who were treated with enzalutamide (Enz), abiraterone (Abi) and/or docetaxel (DOC) in our hospital. All patients underwent Tc-99m MDP bone scintigraphy. The degree of bone metastases was analyzed using BSI, which was calculated by BONENAVI (FUJIFILM RI Pharma, Japan; EXINIbone, EXINI Diagnostics, Sweden). 19 patients were treated with enzalutamide (8 cases: pre-docetaxel, 11 cases: post-docetaxel). The median PSA of patients treated with Enz was 12.64 ng/ml (1.63-199 ng/ml). And 11 patients were treated with abiraterone (5 cases: pre-docetaxel, 6 cases: post-docetaxel). The median PSA of patients treated with Abi was 26.37 ng/ml (2.29-199 ng/ml). Results: We observed decline of PSA in 18/30 cases (9 cases: pre-DOC, 9 cases: post-DOC). Decline of PSA to 50% or more was observed in 14 cases. In contrast, decline of BSI was observed in 53.3% (16/30) cases and decline of PSA to 25% or more was observed in only 6 cases. BSI decreased in 84.6% (11/13) of pre-DOC setting and in 29.4% (5/17) of post-DOC setting indicating that change of BSI was poor in post-DOC setting. However, DOC had already decreased BSI in 91.7% (11/12) before Abi or Enz treatment. Moreover, the average rate of BSI decline in the patients that BSI decreased by DOC was better than the patients that BSI decreased by Abi/Enz (-48.46% vs -28.56%). Finally, although the rate of BSI change by Enz was weakly correlated with the rate of PSA decline (y = 0.3906x + 25.35, R2 = 0.3423), BSI continued to increase in four cases in spite of PSA decline. Conclusions: BSI using BONENAVI on bone scintigraphy was helpful for evaluating the effectiveness of treatment and following-up of bmCRPC.

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Study of the Usefulness of Bone Scan Index Calculated From 99m-Technetium-Hydroxymethylene Diphosphonate (99mtc-HMDP) Bone Scintigraphy for Bone Metastases from Prostate Cancer Using Deep Learning Algorithms

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666200528153453 ◽

2020 ◽

Vol 16 ◽

Author(s):

Shigeaki Higashiyama ◽

Atsushi Yoshida ◽

Joji Kawabe

Keyword(s):

Prostate Cancer ◽

Deep Learning ◽

Bone Metastasis ◽

Bone Metastases ◽

Bone Scintigraphy ◽

Bone Scan ◽

Learning Algorithms ◽

Bone Imaging ◽

Bone Scan Index ◽

Metabolic Biomarkers

Background: BSI calculated from bone scintigraphy using 99mtechnetium-methylene diphosphonate (99mTc-MDP) is used as a quantitative indicator of metastatic bone involvement in bone metastasis diagnosis, therapeutic effect assessment, and prognosis prediction. However, the BONE NAVI, which calculates BSI, only supports bone scintigraphy using 99mTc-MDP. Aims: We developed a method in collaboration with the Tokyo University of Agriculture and Technology to calculate bone scan index (BSI) employing deep learning algorithms with bone scintigraphy images using 99mtechnetiumhydroxymethylene diphosphonate (99mTc-HMDP). We used a convolutional neural network (CNN) enabling the simultaneous processing of anterior and posterior bone scintigraphy images named CNNapis. Objectives: The purpose of this study is to investigate the usefulness of the BSI calculated by CNNapis as bone imaging and bone metabolic biomarkers in patients with bone metastases from prostate cancer. Methods: At our hospital, 121 bone scintigraphy scans using 99mTc-HMDP were performed and analyzed to examine bone metastases from prostate cancer, revealing the abnormal accumulation of radioisotope (RI) at bone metastasis sites. Blood tests for serum prostate-specific antigen (PSA) and alkaline phosphatase (ALP) were performed concurrently. BSI values calculated by CNNapis were used to quantify the metastatic bone tumor involvement. Correlations between BSI and PSA and between BSI and ALP were calculated. Subjects were divided into four groups by BSI values (Group 1, 0 to <1; Group 2, 1 to <3; Group 3, 3 to <10; Group 4, >10), and the PSA and ALP values in each group were statistically compared. Results: Patients diagnosed with bone metastases after bone scintigraphy were also diagnosed with bone metastases using CNNapis. BSI corresponding to the range of abnormal RI accumulation was calculated. PSA and BSI (r = 0.2791) and ALP and BSI (r = 0.6814) correlated positively. Significant intergroup differences in PSA between Groups 1 and 2, Groups 1 and 4, Groups 2 and 3, and Groups 3 and 4 and in ALP between Groups 1 and 4, Groups 2 and 4, and Groups 3 and 4 were found. Conclusion : BSI calculated using CNNapis correlated with ALP and PSA values and is useful as bone imaging and bone metabolic biomarkers, indicative of the activity and spread of bone metastases from prostate cancer.

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Association of bone scan index (BSI) with prognostic biomarkers and survival in men with metastatic castration-resistant prostate cancer (mCRPC) enrolled in a prospective randomized controlled trial of tasquinimod.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.5081 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 5081-5081 ◽

Cited By ~ 2

Author(s):

Andrew J. Armstrong ◽

Reza Kaboteh ◽

Michael Anthony Carducci ◽

Jan-Erik Damber ◽

Walter Michael Stadler ◽

...

Keyword(s):

Clinical Trial ◽

Alkaline Phosphatase ◽

Bone Scan ◽

Univariate Analysis ◽

Bone Alkaline Phosphatase ◽

Prognostic Biomarkers ◽

Bone Lesions ◽

Bone Scan Index ◽

Phase 3 ◽

Over Time

5081 Background: Tasquinimod (T) is an oral immunomodulatory and anti-angiogenic agent currently in phase 3 testing in mCRPC. In a randomized, double-blind phase 2 multicenter study, 201 men with mCRPC who received T had improved radiographic PFS vs. placebo (P), with a more pronounced effect seen in men with bone metastases. Given the subjectivity/variability of bone scan measurements, we sought to evaluate the bone scan index (BSI), a quantitative and objective measure of BS activity, over time in this controlled clinical trial. Post-treatment BSI changes were examined given their prior association with survival. Methods: In this retrospective analysis, Exini bone™, an automated software package that generates the BSI (percent tumor involvement) from 99Tc BS, was used to calculate BSI over time from BS collected during central review in this randomized trial of T vs. P. Associations between baseline and on-treatment BSI, survival, prognostic biomarkers, and treatment effect were evaluated. Results: 108 men contributed baseline scans for BSI analysis that met quality control metrics (74 T vs. 34 P), 85 of whom (57 T vs. 28 P) had at least 1 evaluable follow-up week 12 scan. Median baseline BSI was 0.90% and after 3 months median BSI was 1.21%. In univariate analysis (n=85) baseline BSI correlated with OS (HR 1.41; p=0.01). Both baseline BSI (HR 1.62; p=0.006) and week 12 BSI change (HR 1.95; p=0.002) remained associated with OS after adjustment for bone alkaline phosphatase, PSA, pain score, hemoglobin, and treatment arm. BSI correlated with baseline PSA, LDH, bone alkaline phosphatase, and the number of bone lesions. The increase in BSI at week 12 vs. baseline was slower with T vs. placebo (0.16% vs. 0.26% increase). Conclusions: BSI and BSI changes were associated with OS in men with mCRPC in this prospective trial. BSI correlates with known biomarkers of OS, but adds independent prognostic information. While underpowered, a delay in objective radiographic bone scan progression with tasquinimod is suggested and the evaluation of BSI and BSI changes in the context of phase 3 trials of men with mCRPC is warranted. Clinical trial information: NCT00560482.

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Bone Scan Index: A Quantitative Treatment Response Biomarker for Castration-Resistant Metastatic Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2011.36.5791 ◽

2012 ◽

Vol 30 (5) ◽

pp. 519-524 ◽

Cited By ~ 113

Author(s):

Elizabeth R. Dennis ◽

Xiaoyu Jia ◽

Irina S. Mezheritskiy ◽

Ryan D. Stephenson ◽

Heiko Schoder ◽

...

Keyword(s):

Prostate Cancer ◽

Bone Scintigraphy ◽

Bone Scan ◽

Metastatic Prostate Cancer ◽

Univariate Analysis ◽

Imaging Biomarker ◽

Bone Scan Index ◽

Risk Of Death ◽

Percent Change ◽

Castration Resistant

Purpose There is currently no imaging biomarker for metastatic prostate cancer. The bone scan index (BSI) is a promising candidate, being a reproducible, quantitative expression of tumor burden seen on bone scintigraphy. Prior studies have shown the prognostic value of a baseline BSI. This study tested whether treatment-related changes in BSI are prognostic for survival and compared BSI to prostate-specific antigen (PSA) as an outcome measure. Patients and Methods We retrospectively examined serial bone scans from patients with castration-resistant metastatic prostate cancer (CRMPC) enrolled in four clinical trials. We calculated BSI at baseline and at 3 and 6 months on treatment and performed univariate and bivariate analyses of PSA, BSI, and survival. Results Eighty-eight patients were scanned, 81 of whom have died. In the univariate analysis, the log percent change in BSI from baseline to 3 and 6 months on treatment prognosticated for survival (hazard ratio [HR], 2.44; P = .0089 and HR, 2.54; P < .001, respectively). A doubling in BSI resulted in a 1.9-fold increase in risk of death. Log percent change in PSA at 6 months on treatment was also associated with survival (HR, 1.298; P = .013). In the bivariate analysis, change in BSI while adjusting for PSA was prognostic at 3 and 6 months on treatment (HR, 2.368; P = .012 and HR, 2.226; P = .002, respectively), but while adjusting for BSI, PSA was not prognostic. Conclusion These data furnish early evidence that on-treatment changes in BSI are a response indicator and support further exploration of bone scintigraphy as an imaging biomarker in CRMPC.

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