Abstract
We aimed to compare the diagnostic ability of quantitative analysis of bone scintigraphy with that of visual analysis for identifying arthritis disease involvement in patients with joint symptoms. We retrospectively included 93 patients with joint symptoms who underwent Tc-99m methylene diphosphonate bone scintigraphy for evaluating arthritis disease involvement. Bone scintigraphy images were visually and quantitatively analyzed using an in-house software by two reviewers. On quantitative analysis, joint uptake ratio was measured for 64 joints in 14 joints areas. The inter-rater agreement of visual and quantitative analyses was assessed, and diagnostic abilities were compared based on the area under the receiver operating characteristic (ROC) curve (AUC) values. Regarding visual analysis, there was a moderate degree of inter-rater agreement (kappa coefficient of 0.597), while there was a substantial inter-rater agreement (concordance correlation coefficient of 0.987) in the measurement of the joint uptake ratio. The comparisons of ROC curves for the total 5941 joints revealed that the joint uptake ratio had a significantly higher AUC value (0.789) to detect the affected joint than that of the visual analysis (p < 0.001). Quantitative analysis using joint uptake ratio showed substantial reproducibility and higher diagnostic ability to detect joints involving arthritis diseases than visual analysis on bone scintigraphy.
Highlights
Bone scintigraphy using Tc-99m labeled diphosphonate is widely used to evaluate bone and joint diseases given its good availability, low medical cost, and ability to obtain whole-body bone and joint images [1,2,3,4]
Sacroiliac, thumb IP, and hand distal interphalangeal (DIP) joint areas, there were no significant differences in the diagnostic ability between visual assessment and joint uptake ratio, whereas joint uptake ratio showed a high diagnostic ability for the knee, ankle, tarsal, wrist, MCP, and hand proximal interphalangeal (PIP) joint areas
Our findings implied that quantitative parameters measured on bone scintigraphy might have better clinical utility in the assessment of arthritis disease compared with visual analysis, but the quantitative analytic method should be applied based on the sites of joint symptoms
Summary
Bone scintigraphy using Tc-99m labeled diphosphonate is widely used to evaluate bone and joint diseases given its good availability, low medical cost, and ability to obtain whole-body bone and joint images [1,2,3,4]. It has a high sensitivity for the detection of joint involvement in various joint disorders, its potential clinical benefits for evaluating arthritis involvement in individuals with joint symptoms remain contentious [1,5,6,7,8]. The diagnostic abilities of the quantitative parameter of bone scintigraphy and visual analysis to detect joints with arthritic disease involvement in the whole-body area have not been compared
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