Bone Scan Imaging Research Articles

Spectrum of magnetic resonance imaging findings in patients of low back pain at a tertiary care institute of West Bengal

Background: Several diagnostic modalities are being used for evaluation of low back pain (LBP) such as conventional radiography, computed tomography scan, bone scan, and ultrasonography. Magnetic resonance imaging (MRI) can give different and improved information about structures in the body. Through MRI, an attempt was made to identify the structural abnormalities at the lumbosacral region. Objectives: The objective of this study is to evaluate the causes of LBP with MRI scan as imaging modality in the adult age group. Materials and Methods: It was a hospital-based, crosssectional study. This study was done from May 2014 to April 2015 in the Department of Radiodiagnosis at a tertiary institute of West Bengal. The study population included all the patients above 18 years of age presenting with LBP in the hospital during the study period. During the study period, 158 patients were found eligible. Results: Majority (86.4%) of patients of LBP were aged below 60 years. Majority (88.3%) of the patients had lumbar spine degenerative disease, which was the most common pattern. Among lumbar degenerative findings, disc degeneration being the most frequent finding seen in 113 (83%) patients, followed by disc bulge 107 (78.6%), nerve root compression 103 (75.7%), disc herniation 59 (43.3%), and central canal stenosis 63 (46.3%). Odds ratio for disc degeneration was 2.6 (95% confidence interval: 1.2-5.5) times in age ≥40 years in comparison to age

Bone scintigraphy as a diagnostic tool in condylar hyperplasia

Unilateral condylar hyperplasia (UCH) is a pathological condition characterized by unrestrained growth of condyle unilaterally and is of idiopathic in nature. It is often diagnosed clinically but more frequently if not always is augmented by planar and single photon emission computed tomography bone scans to confirm the finding. Hence, bone scintigraphy using technetium-99 m methylene diphosphonate is the diagnostic tool to identify these active growth centers. Detection and excision of active growth center are the line of management for condylar hyperplasia. This article highlights the importance of using these radioactive scans to diagnose as well as to monitor the prognosis of UCH in two such cases.

A Statewide Intervention Improves Appropriate Imaging in Localized Prostate Cancer

We implemented a statewide intervention to improve imaging utilization for the staging of patients with newly diagnosed prostate cancer. MUSIC (Michigan Urological Surgery Improvement Collaborative) is a quality improvement collaborative comprising 42 diverse practices representing approximately 85% of the urologists in Michigan. MUSIC has developed imaging appropriateness criteria (prostate specific antigen greater than 20 ng/ml, Gleason score 7 or higher and clinical stage T3 or higher) which minimize unnecessary imaging with bone scan and computerized tomography. After baseline rates of radiographic staging were established in 2012 and 2013, we used multidimensional interventions to deploy these criteria in 2014. Imaging utilization was then remeasured in 2015 to evaluate for changes in practice patterns. A total of 10,554 newly diagnosed patients with prostate cancer were entered into the MUSIC registry from January 1, 2012 through December 31, 2013 and January 1, 2015 through December 31, 2015. Of these patients 7,442 (79%) and 7,312 (78%) met our criteria to avoid bone scan and computerized tomography imaging, respectively. The use of bone scan imaging when not indicated decreased from 11.0% at baseline to 6.5% after interventions (p<0.0001). The use of computerized tomography when not indicated decreased from 14.7% at baseline to 7.7% after interventions (p <0.0001). Variability among practices decreased substantially after the interventions as well. The use of recommended imaging remained stable during these periods. An intervention aimed at appropriate use of imaging was associated with decreased use of bone scans and computerized tomography among men at low risk for metastases.

CXR, CT thorax and bone scan images of a 55-year-old man who presented with chronic cough, chest pain and weight loss

CXR, CT thorax and bone scan images of a 55-year-old man who presented with chronic cough, chest pain and weight loss

Value of radionuclide bone imaging and MRI in locating responsible vertebrae after osteoporotic vertebral compressive fractures

Objective To compare the effect of radionuclide bone imaging and MRI in locating responsible vertebrae after osteoporotic vertebral compressive fractures (OVCF). Methods A retrospective analysis was made on 25 patients with OVCF treated by percutaneous kyphoplasty (PKP) from May 2015 to December 2015. There were 4 males and 21 females, at age range of 63-87 years [(73.3±6.16)years]. The fractured vertebrae included 2 T4, 3 T5, 2 T6, 2 T7, 5 T8, 3 T9, 3 T10, 7 T11, 9 T12, 11 L1, 10 L2, 2 L3, 5 L4 and 1 L5. Cervical imaging examinations (X-ray, bone mineral density, MRI, radionuclide bone imaging) were performed on admission. Oswestry disability index (ODI) and visual analogue scale (VAS) were estimated before operation and 1 d after operation. Results of MRI and radionuclide bone imaging were compared. Results A total of 64 vertebrae were included in our study. Thirty-six vertebrae were recognized as fresh OVCFs by MRI, and 40 by radionuclide bone imaging. Kappa-test indicated the results of the examination methods were statistically significant (P<0.05). Specificity (96.6%) and accuracy (98.4%) of MRI were higher than radionuclide bone imaging bone scan (82.8%, 92.2%). Conclusions Radionuclide bone imaging has a high consistency with MRI in locating responsible vertebrae after OVCF, but MRI is associated with higher specificity and accuracy. In exceptional cases, radionuclide bone imaging can partly replace MRI as a way to locate OVCF. Key words: Osteoporotic fractures; Vertebroplasty; Radionuclide bone imaging

A Preanalytic Validation Study of Automated Bone Scan Index: Effect on Accuracy and Reproducibility Due to the Procedural Variabilities in Bone Scan Image Acquisition.

Two separate preanalytical studies were performed: a patient study and a simulation study. In the patient study, to evaluate the effect on BSI reproducibility, repeated bone scans were prospectively obtained from metastatic prostate cancer patients enrolled in 3 groups (Grp). In Grp1, the repeated scan speed and the γ-camera vendor were the same as that of the original scan. In Grp2, the repeated scan was twice the speed of the original scan. In Grp3, the repeated scan used a different γ-camera vendor than that used in the original scan. In the simulation study, to evaluate the effect on BSI accuracy, bone scans of a virtual phantom with predefined skeletal tumor burden (phantom-BSI) were simulated against the range of image counts (0.2, 0.5, 1.0, and 1.5 million) and separately against the resolution settings of the γ-cameras. The automated BSI was measured with a computer-automated platform. Reproducibility was measured as the absolute difference between the repeated BSI values, and accuracy was measured as the absolute difference between the observed BSI and the phantom-BSI values. Descriptive statistics were used to compare the generated data. In the patient study, 75 patients, 25 in each group, were enrolled. The reproducibility of Grp2 (mean ± SD, 0.35 ± 0.59) was observed to be significantly lower than that of Grp1 (mean ± SD, 0.10 ± 0.13; P < 0.0001) and that of Grp3 (mean ± SD, 0.09 ± 0.10; P < 0.0001). However, no significant difference was observed between the reproducibility of Grp3 and Grp1 (P = 0.388). In the simulation study, the accuracy at 0.5 million counts (mean ± SD, 0.57 ± 0.38) and at 0.2 million counts (mean ± SD, 4.67 ± 0.85) was significantly lower than that observed at 1.5 million counts (mean ± SD, 0.20 ± 0.26; P < 0.0001). No significant difference was observed in the accuracy data of the simulation study with vendor-specific γ-cameras (P = 0.266). In this study, we observed that the automated BSI accuracy and reproducibility were dependent on scanning speed but not on the vendor-specific γ-cameras. Prospective BSI studies should standardize scanning speed of bone scans to obtain image counts at or above 1.5 million.

Role of 18-fluoro-2-deoxyglucose positron emission tomography in detecting acute inflammatory lesions of non-bacterial osteitis in patients with a fever of unknown origin: A comparative study of 18-fluoro-2-deoxyglucose positron emission tomography, bone scan, and magnetic resonance imaging

We report three patients with non-bacterial osteitis (NBO) who had fever of unknown origin (FUO) as an initial symptom. 18-Fluoro-2-deoxyglucose positron emission tomography (18F-FDG–PET) can be used to detect acute inflammatory lesions. There seems to be variation among the results of 18F-FDG–PET, a bone scan, and magnetic resonance imaging (MRI). Therefore, it would be useful to perform a bone scan to detect all lesions, combined with MRI to confirm the diagnosis of NBO, followed by 18F-FDG–PET.

Bone Scan Index as an imaging biomarker to predict overall survival in the Zeus/SPCG11 study.

e16599Background: The Zeus/SPCG11 study is a randomized controlled clinical trial with the aim to assess the efficacy of zoledronic acid (ZA) in preventing bone metastases in high-risk prostate cancer (PCa) patients. Bone Scan Index (BSI) reflects the tumour burden in bone calculated from bone scintigraphy, and has recently been validated as an imaging biomarker in metastatic PCa patients. The purpose of this study was to investigate if change in BSI during treatment may serve as a useful imaging biomarker to predict clinical outcome in the Zeus/SPCG11 study population. Methods: We retrospectively selected as our BSI-study cohort all patients with bone scan image data of sufficient quality to allow for both baseline and 48-months follow-up BSI-assessments. BSI data was obtained by using the automated quantification software EXINI boneBSI, in a blind fashion, without knowledge of any clinical data or treatment randomization. Clinical data on age, overall survival (OS) and prostate-specific antigen (PSA) co...

MP03-12 STAGING ADVANCED AND METASTATIC CLEAR CELL RENAL CELL CARCINOMA WITH 68 GALLIUM PSMA PET FOR TREATMENT PLANNING

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I1 Apr 2016MP03-12 STAGING ADVANCED AND METASTATIC CLEAR CELL RENAL CELL CARCINOMA WITH 68 GALLIUM PSMA PET FOR TREATMENT PLANNING Handoo Rhee, Chui Ming Tham, Paul Thomas, John Blazak, Hema Samaratunga, Keng Lim Ng, Glenda Gobe, Ian Vela, and Simon Wood Handoo RheeHandoo Rhee More articles by this author , Chui Ming ThamChui Ming Tham More articles by this author , Paul ThomasPaul Thomas More articles by this author , John BlazakJohn Blazak More articles by this author , Hema SamaratungaHema Samaratunga More articles by this author , Keng Lim NgKeng Lim Ng More articles by this author , Glenda GobeGlenda Gobe More articles by this author , Ian VelaIan Vela More articles by this author , and Simon WoodSimon Wood More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1905AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Positron emission tomography (PET) using novel inhibitors of prostate specific membrane antigen (PSMA) has recently been used to detect localized and metastatic prostate cancer lesions with high sensitivity and specificity in comparison to standard imaging. PSMA is also known to be highly expressed in the neovasculature of clear cell renal cell carcinoma. In this study, we explore the PSMA expression in renal cell carcinoma foci to help stage patients with advanced and metastatic clear cell renal cell carcinoma. METHODS Sixteen patients with advanced renal cell carcinoma was imaged using 68 Gallium PSMA PET in addition to standard imaging such as computer tomography (CT), ultrasound, bone scan or magnetic resonance imaging. Eleven patients had primary renal tumour with local invasion, inferior vena cava extension, whilst four patients were known to have metastatic disease after treatment of primary renal tumour. In 12 patients, histopathological tissue was available for correlation. RESULTS In all 16 patients, PET avid lesions were identified in primary and putative metastatic lesions. Avidity and SUVmax was particularly elevated in patients with metastatic lesions and vascular extension into renal vein, vena cava, and lumbar veins. In all patients, CT images were available for direct comparison. Overall, a significantly larger number of lesions were identified using PET, resulting in change of treatment approaches for six patients (37.5%, n=6/16) (surgical margins or additional therapy such as stereotactic radiotherapy or targeted therapy). On histopathological correlation, 100% of PET avid lesions (n=24) were positive for renal cell carcinoma. CONCLUSIONS PSMA avidity in the neovasculature of clear cell renal cell carcinoma foci can be used as an opportunity to stage patients with metastatic or advanced renal cell carcinoma, which may result in change of surgical margins or further treatment. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e23 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Handoo Rhee More articles by this author Chui Ming Tham More articles by this author Paul Thomas More articles by this author John Blazak More articles by this author Hema Samaratunga More articles by this author Keng Lim Ng More articles by this author Glenda Gobe More articles by this author Ian Vela More articles by this author Simon Wood More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incidentalomas associated with abdominal and pelvic CT angiograms for abdominal-based breast free flap reconstruction

Computed tomography angiography (CTA) is routinely performed prior to breast reconstruction using deep inferior epigastric perforator (DIEP) flaps to provide better surgical planning and improve preoperative decision making. These investigations occasionally result in unexpected findings in otherwise asymptomatic women. Unexpected findings on imaging in a population of women with previous breast cancer or strong breast cancer risk factors can lead to undue stress and anxiety. The aim of this study is to determine the incidence of unexpected findings in preoperative CT angiograms and to correlate these with patient and breast cancer characteristics. A retrospective chart review from May 2008 to December 2012 was performed reviewing all patients who underwent DIEP flap breast reconstruction. Radiology reports of their preoperative CT angiograms, details of unexpected findings, patients' past medical and cancer history, additional radiological investigations, outcomes, and interventions were reviewed. In total, 360 patients met the inclusion criteria for the study. Sixty-four percent of the patients who underwent CTA imaging had incidental findings. Further imaging was suggested in 48% of this group. The most common incidentalomas were hepatic (47%), bone (24%), and renal (20%). "Incidentalomas" were associated with patients' underlying comorbidities (p=0.001) and age (p=0.01). "Radiographically suspicious incidentalomas" were associated with the underlying comorbidities (p=0.001). The radiologists most commonly suggested investigation methods such as ultrasound (41%), another CT (28%), bone scan (21%), and magnetic resonance imaging (MRI; 14%). No incidentalomas were found to be malignant on further recommended investigation in this study and no breast cancer reconstruction was delayed as a result of the discovery of incidentalomas or their subsequent investigations. It is important to counsel patients of the possibility of incidental findings and the resulting sequelae prior to CTA investigations for breast cancer reconstruction and involve them in shared decision making if additional investigations are required.

Bone Scan Index and Progression-free Survival Data for Progressive Metastatic Castration-resistant Prostate Cancer Patients Who Received ODM-201 in the ARADES Multicentre Study

BackgroundODM-201, a new-generation androgen receptor inhibitor, has shown clinical efficacy in prostate cancer (PCa). Quantitative methods are needed to accurately assess changes in bone as a measurement of treatment response. The Bone Scan Index (BSI) reflects the percentage of skeletal mass a given tumour affects. ObjectiveTo evaluate the predictive value of the BSI in metastatic castration-resistant PCa (mCRPC) patients undergoing treatment with ODM-201. Design, setting, and participantsFrom a total of 134 mCRPC patients who participated in the Activity and Safety of ODM-201 in Patients with Progressive Metastatic Castration-resistant Prostate Cancer clinical trial and received ODM-201, we retrospectively selected all those patients who had bone scan image data of sufficient quality to allow for both baseline and 12-wk follow-up BSI-assessments (n=47). We used the automated EXINI bone BSI software (EXINI Diagnostics AB, Lund, Sweden) to obtain BSI data. Outcome measurements and statistical analysisWe used the Cox proportional hazards model and Kaplan-Meier estimates to investigate the association among BSI, traditional clinical parameters, disease progression, and radiographic progression-free survival (rPFS). Results and limitationsIn the BSI assessments, at follow-up, patients who had a decrease or at most a 20% increase from BSI baseline had a significantly longer time to progression in bone (median not reached vs 23 wk, hazard ratio [HR]: 0.20; 95% confidence interval [CI], 0.07–0.58; p=0.003) and rPFS (median: 50 wk vs 14 wk; HR: 0.35; 95% CI, 0.17–0.74; p=0.006) than those who had a BSI increase >20% during treatment. ConclusionsThe on-treatment change in BSI was significantly associated with rPFS in mCRPC patients, and an increase >20% in BSI predicted reduced rPFS. BSI for quantification of bone metastases may be a valuable complementary method for evaluation of treatment response in mCRPC patients. Patient summaryAn increase in Bone Scan Index (BSI) was associated with shorter time to disease progression in patients treated with ODM-201. BSI may be a valuable method of complementing treatment response evaluation in patients with advanced prostate cancer.

Evaluating the effect of a third-party implementation of resolution recovery on the quality of SPECT bone scan imaging using visual grading regression.

The aim of this study was to evaluate the benefits to SPECT bone scan image quality when applying resolution recovery (RR) during image reconstruction using software provided by a third-party supplier. Bone SPECT data from 90 clinical studies were reconstructed retrospectively using software supplied independent of the gamma camera manufacturer. The current clinical datasets contain 120×10 s projections and are reconstructed using an iterative method with a Butterworth postfilter. Five further reconstructions were created with the following characteristics: 10 s projections with a Butterworth postfilter (to assess intraobserver variation); 10 s projections with a Gaussian postfilter with and without RR; and 5 s projections with a Gaussian postfilter with and without RR. Two expert observers were asked to rate image quality on a five-point scale relative to our current clinical reconstruction. Datasets were anonymized and presented in random order. The benefits of RR on image scores were evaluated using ordinal logistic regression (visual grading regression). The application of RR during reconstruction increased the probability of both observers of scoring image quality as better than the current clinical reconstruction even where the dataset contained half the normal counts. Type of reconstruction and observer were both statistically significant variables in the ordinal logistic regression model. Visual grading regression was found to be a useful method for validating the local introduction of technological developments in nuclear medicine imaging. RR, as implemented by the independent software supplier, improved bone SPECT image quality when applied during image reconstruction. In the majority of clinical cases, acquisition times for bone SPECT intended for the purposes of localization can safely be halved (from 10 s projections to 5 s) when RR is applied.

The analysis of whole-body bone scan images by using quantitative improvement in brightness

Today's, the image processing applications are obvious in the various sciences. The medical image processing has achieved to acceptable results in the field of diagnosing disease. One of these applications which is discussed in this paper is diagnosis injury in whole body bone scan. Whole body bone scan has some applications in the diagnosis of benign lesions such as cardiovascular disease and metabolic bone and sports injuries and also to investigate the pervasiveness of bone. One of the main criteria to diagnose complications in the body is area with high brightness ‎to the brightness of adjacent areas in the image or asymmetry of the brightness in the two-sided areas of the body. In this study, a software has been implemented about the detection of disease-suspected areas that strategies to increase the pixel intensity have been considered to make easier the image segmentation and innovative methods of researcher have been implemented in image preparation to convert to binary mode and find suspected areas. In addition, the software automatically creates reports, this feature will be a big contribution to the doctor. Software assessment has been done on 11 whole body bone scan images and provided the results to the physician, the software succeeded to find the 41 correct areas from 44 injured areas, 93.18% of cases have been successfully identified. In terms of the number of errors in the areas of diagnosis, 30 cases were observed in 11 images which shows an average of 2.72 errors on each image.

Non-invasive Quantitative Characterization of Skeletal Metastasis in Carcinoma Prostate by Tc99m MDP Bone Scans Using Dr. V. Siva’s Retention Ratio in Correlation with Serum PSA Levels

Background: In patients suffering from carcinoma prostate the incidence of skeletal metastases had been found to be very high. The presence of skeletal metastasis could be inferred by the multiple focal hotspots in the skeletal tissue. The metastatic nature of the hotspots could be inferred by multiple lesions, asymmetric distribution with increased tracer concentration. In the case of Solitary focal spot in the bone scan metastatic nature could not be attributed to it. The invasive biopsy procedure could only confirm or discard the metastatic involvement. A new non-invasive Scintimetric characterization and evaluation of skeletal hot spots in bone scans of carcinoma prostate patients was proposed and tested. Materials and methods: The bone scan was done 4 and 24 hours after intravenous injection of 15 to 25 mCi of Tc99m Methylene Di-Phosponate with adequate hydration using the e-cam Siemens dual head gamma camera with e-cam whole body acquisition protocol in 75 patients with biopsy proven carcinoma prostate. Metastatic involvement was seen in 53 patients and was negative in 22. The Serum PSA levels were obtained from the Patient medical records were tabulated. The 185 focal hotspots in various sites in 34 patients were characterized using the temporal scintimetric method. Both 4 and 24hr bone scan images were selected using the general display protocol. Then with the help of the region ratio processing protocol the 4 and 24hr anterior and posterior images were selected separately. Maximum counts in the selected regions were then tabulated. Then the 4/24hr Dr. V. Siva’s retention ratio was derived by dividing the 4hr counts of the focal hotspots with 24hr counts along with the Israel’s 24/4hr ratio as well. Similarly 4/24hr Dr.V.Siva’s retention ratio of whole body scan total counts at 4 and 24hr scans was also calculated.The results were compared and analysed. Results: The mean of 4/24hr Dr. V. Siva’s retention ratio was found to be 12.32 ± 3.3 and that of 24/4hr Israel’s ratio to be 0.08 ± 0.02 for Focal hot spot evaluation. The 4/24hr Dr. V. Siva’s retention ratio was derived by dividing the total whole body counts at 4 and 24hr whole body bone scan was 12.21 ± 2.78 which wascloser to the Focal hot spot retention ratio. The Total PSA, Free PSA and the %PSA Values were 61.8, 19.2 and 26.8 in the Metastatic positive group and 34.5, 6.8 and 12.8 in the negative group respectively. Conclusion: Scintimetric characterization of the skeletal hot spots provided a non-invasive means for identifying the underlying pathology to enable proper management decisions. The 4/24hr Dr. V. Siva’s retention ratio was useful clinically because of its whole integer value, unlike the Israel’s 24/4hr ratio which was in decimal value. The utility of the scintimetric characterization in inferring the metastatic nature of the lesion was confirmed through biopsy of the site afflicted followed by histopathological examination.

Uptake of 18F-DCFPyL in Paget's Disease of Bone, an Important Potential Pitfall in Clinical Interpretation of PSMA PET Studies.

Prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) imaging is an emerging technique for evaluating patients with prostate cancer (PCa) in a variety of clinical contexts. As with any new imaging modality, there are interpretive pitfalls that are beginning to be recognized. In this report, we describe the findings in a 63-year-old male with biochemically recurrent PCa after radical prostatectomy who was imaged with 2-(3-{1-carboxy-5-[(6-[18F]fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid ([18F]DCFPyL), a small-molecule inhibitor of PSMA. Diffuse radiotracer uptake was noted throughout the sacrum, corresponding to imaging findings on contrast-enhanced computed tomography (CT), bone scan, and pelvic magnetic resonance imaging consistent with Paget's disease of bone. The uptake of [18F]DCFPyL in Paget's disease most likely results from hyperemia and increased radiotracer delivery. In light of the overlap in patients affected by PCa and Paget's disease, it is important for nuclear medicine physicians and radiologists to be aware of the potential for this diagnostic pitfall when interpreting PSMA PET/CT scans. Correlating findings on conventional imaging such as diagnostic CT and bone scan can help confirm the diagnosis.

Effect of prostate-specific membrane antigen positron emission tomography on the decision-making of radiation oncologists.

BackgroundPositron emission tomography (PET) imaging is routinely used in many cancer types, although is not yet a standard modality for prostate carcinoma. Prostate-specific membrane antigen (PSMA) PET is a promising new modality for staging prostate cancer, with recent studies showing potential advantages over traditional computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine bone scan imaging. However, the impact of PSMA PET on the decision-making of radiation oncologists and outcomes after radiotherapy is yet to be determined. Our aim was to determine the impact of PSMA PET on a radiation oncologist’s clinical practice.FindingsPatients in a radiation oncology clinic who underwent PSMA PET were prospectively recorded in an electronic oncology record. Patient demographics, outcomes of imaging, and impact on decision-making were evaluated.Fifty-four patients underwent PSMA PET between January and May 2015. The major reasons for undergoing PET included staging before definitive (14.8 %) or post-prostatectomy (33.3 %) radiotherapy, and investigation of PSA failures following definitive (16.7 %) or post-prostatectomy (33.3 %) radiotherapy. In 46.3 % of patients PSMA was positive after negative traditional imaging, in 9.3 % PSMA was positive after equivocal imaging, and in 13.0 % PSMA was negative after equivocal imaging. PSMA PET changed radiotherapy management in 46.3 % of cases, and hormone therapy in 33.3 % of patients, with an overall change in decision-making in 53.7 % of patients.ConclusionsPSMA PET has the potential to significantly alter the decision-making of radiation oncologists, and may become a valuable imaging tool in the future.

Determination of the painful level in osteoporotic vertebral fractures—Retrospective comparison between plain film, bone scan, and magnetic resonance imaging

BackgroundDetermining the actual painful vertebral level is difficult when evaluating osteoporotic vertebral fracture, especially when there are acute and chronic fractures simultaneously. In this study, we retrospectively evaluated and compared the findings between plain film, bone scan, and magnetic resonance imaging (MRI) in the diagnosis of new fracture in osteoporotic vertebral fractures. MethodsThis is a retrospective clinical study of patients who were diagnosed with osteoporotic vertebral fractures using plain film, bone scan, and MRI within a 1-month interval between February 2008 and December 2012. The findings in plain film, the extent of increased uptake in bone scan, and signal change in MRI were compared to evaluate the actual level of pain. All patients received percutaneous vertebroplasty according to MR finding. Pain scores (visual analog scale) of the study patients were compared prior to and after the procedure. ResultsA total of 52 patients with a mean age of 79.1 years (range 59–92 years) were enrolled in this study, and were treated by vertebroplasty confirmed by MRI. It was observed that patient pain score (visual analog scale) improved from 7.6 to 2.8. Plain film examination revealed 79 vertebrae that were suspected to be compression fractures. Among the suspected vertebrae, 62 showed increased uptake in bone scan, and MRI showed bony edema change in 58 vertebrae. The consistency between bone scan and MRI was 96.9% in patients with single-level suspected fracture on plain film. There was moderate agreement (kappa was 0.56) in patients where multiple levels were noted. Fifteen vertebrae with vacuum cleft sign on plain film showed total concordance in both bone scan and MRI. ConclusionFor patients with single-level compression fracture, the painful level in osteoporotic vertebral fractures can be determined by plain film and bone scan testing. Vacuum cleft sign noted on plain film may be enough to localize the level of pain. However, MRI testing is further needed in multiple osteoporotic vertebral fracture patients.

Local validation of the use of Evolution for Bone for bone SPECT imaging.

In order to locally validate the technique, a retrospective review of a cohort of randomly selected single-photon emission computed tomography (SPECT) bone scans reconstructed with ordered subsets expectation maximization (OSEM) and Evolution for Bone was undertaken. Thirty consecutive bone SPECT patient data sets (17 spine, nine pelvis, and four spine and pelvis) were chosen. Poisson resampling was used to simulate reduced count data at 50, 75, and 100% of the original number of counts. Evolution for Bone applied resolution recovery to the reduced count images. All images were compared with the original OSEM images, currently used as the standard for clinical use. A qualitative blinded assessment was made by two independent observers, who assessed for noise, contrast, and resolution. Both radiologists saw an improvement in resolution (P = 0.776), noise (P = 0.007), and image quality with all data sets, compared with images processed purely with OSEM and viewed in Volumetrix. However, they completely disagreed on contrast, as the two radiologists scored contrast differently; however, the results are understandable. Images with 50, 75, and 100% of the original counts viewed using Evolution for Bone have improved image quality compared with images processed purely with OSEM and viewed in Volumetrix. Evolution for Bone therefore has great potential in departments for reducing either patient doses, waiting lists, or both.

Utility of [18F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) in the Initial Staging and Response Assessment of Locally Advanced Breast Cancer Patients Receiving Neoadjuvant Chemotherapy.

In India up to 50% of breast cancer patients still present as locally advanced breast cancer (LABC). The conventional methods of metastatic work up include physical examination, bone scan, chest & abdominal imaging, and biochemical tests. It is likely that the conventional staging underestimates the extent of initial spread and there is a need for more sophisticated staging procedure. The PET/CT can detect extra-axillary and occult distant metastases and also aid in predicting response to chemotherapy at an early point in time. To evaluate the utility of FDG PET/CT in initial staging and response assessment of patients with LABC receiving NACT. A prospective study of all biopsy confirmed female patients diagnosed with LABC receiving NACT from April 2013 to May 2014. The conventional work up included serum chemistry, CECT chest and abdomen and bone scan. A baseline whole body PET/CT was done in all patients. A repeat staging evaluation and a whole body PET/CT was done after 2/3rd cycle of NACT in non-responders and after 3/4cycles in clinical responders. The histopathology report of the operative specimen was used to document the pathological response. The FDG PET/CT reported distant metastases in 11 of 38 patients, where as conventional imaging revealed metastases in only 6. Almost all thedistant lesions detected by conventional imaging were detected with PET/CT, which showed additional sites of metastasis in 3 patients. In 2 patients, PET/CT detected osteolytic bone metastasis which were not detected by bone scan. In 5 patients PET CT detected N3 disease which were missed on conventional imaging. A total of 14 patients had second PET/CT done to assess the response to NACT and 11 patients underwent surgery. Two patients had complete pathological response. Of these 1 patient had complete metabolic and morphologic response and other had complete metabolic and partial morphologic response on second PET/CT scan. The 18 FDG PET/CT can detect more number of metastasis as well as additional sites of metastasis compared to conventional methods. The response assessment resulted in change of treatment regimen in 14% of patients.

Multifocal osteoarticular tuberculosis of the extremities in an immunocompetent young man without pulmonary disease: A case report

Osteoarticular tuberculosis (TB), an uncommon form of extrapulmonary TB, is a universal mimicker and thus represents a potential differential diagnosis of any osteolytic lesion. The present study describes a case of multifocal osteoarticular TB in an immunocompetent young man who presented with swelling and extremity pain. The patient underwent plain radiography, bone scan and magnetic resonance imaging. A diagnosis was ultimately made based on the pathology results from his second left toe. The patient responded well to anti-TB medication. The radiological findings of multifocal osteoarticular TB are described in this report. To the best of our knowledge, this is the first reported case of multifocal osteoarticular TB symmetrically affecting all the extremities.