Rini Shintawati, Arifudin Achmad, Tetsuya Higuchi, Hirotaka Shimada, Hiromi Hirasawa, Yukiko Arisaka, Ayako Takahashi, Takahito Nakajima, Yoshito Tsushima


Objective, bone scintigraphy (bone scan) is useful in detecting metastatic bone lesions through visual assessment of hot spots. A semi quantitative analysis method that evaluates bone scan images has been eagerly anticipated. BONENAVI is software that enables automatic assessment of bone scan index (BSI). BSI is useful for stratifying cancer patients and monitoring their therapeutic response. The purpose of this study was to evaluate the efficacy of BONENAVI in determining BSI and hot spots at different time intervals after radioisotope injection. Methods, we evaluated 32 patients, including 22 males and 10 females. Ten patients had breast cancer, 20 patients had prostate cancer, and 2 had malignant phaeochromocytoma. Patients were injected with 20 mCi of 99mTc-methylene diphosphonate (99mTc-MDP) and bone scintigraphy was performed at 2, 4, and 6 hours after injection on each patient. The BSI and the number of hot spots were obtained from BONENAVI software. Bone scan images were also visually assessed to exclude false positives due to artifacts. Analyses were performed in all lesions, selected true lesions, segment-based and cancer-type-based. Non-parametric statistical analyses for pairwise multiple group comparison were performed using Friedman test followed with post-hoc analysis. Results, the BSIs and the number of hot spots were significantly increased with time, with significant differences between each of time points (P< 0.001). Analysis of regional BSI (rBSI) and hot spot number changes of selected 15 true lesions also showed similar increase (P<0.001). In general, the pelvic segment was the most prone to rBSI changes and the chest segment was the most prone to hot spot number changes. Visual assessment showed that BONENAVI diagnosed some typical artifacts as metastases (hot spots). Conclusion, BONENAVI reading of BSIs and hot spot numbers was highly affected by acquisitiontime. In serial or follow-up examinations (in particular, for monitoring therapeutic efficacy), acquisition time should be fixed for each patient. Cautious interpretation should be made on segments with high physiological uptake. BONENAVI reading was prone to misinterpretation of artifacts. Visual assessment is necessary to rule out this possibility.

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