Bone Scintigram Research Articles

Bone metastasis scintigram generation using generative adversarial learning with multi-receptive field learning and two-stage training.

Deep learning is the primary method for conducting automated analysis of SPECT bone scintigrams. The lack of available large-scale data significantly hinders the development of well-performing deep learning models, as the performance of a deep learning model is positively correlated with the size of the dataset used. Therefore, there is an urgent demand for an automated data generation method to enlarge the dataset of SPECT bone scintigrams. We introduce a deep learning-based generation model that can generate realistic but not identical samples from the original SPECT bone scintigrams. Following the generative adversarial learning architecture, a bone metastasis scintigram generation model christened BMS-Gen is proposed. First, BMS-Gen takes multiple input conditions and employs multi-receptive field learning to ensure that the generated samples are as realistic as possible. Second, BMS-Gen adopts generative adversarial learning to retain the diversity of the generated samples. Last, BMS-Gen uses a two-stage training strategy to improve the quality of the generated samples. Experimental evaluation conducted on a set of clinical data of SPECT BM scintigrams has shown the performance of the proposed BMS-Gen, achieving the best overall scores of 1678.0, 69.33, and 19.51 for FID (Fréchet Inception Distance), MSE (Mean Square Error), and PSNR (Peak Signal-to-Noise Ratio) metrics. The introduction of samples generated by BMS-Gen contributes a maximum (minimum) increase of 3.01% (0.15%) on the F-1 score and a maximum (minimum) increase of 6.83% (2.21%) on the DSC score for the image classification and segmentation tasks, respectively. The proposed BMS-Gen model can be used as a promising tool for augmenting the data of bone scintigrams, greatly facilitating the development of deep learning-based automated analysis of SPECT bone scintigrams.

Automated Diagnosis of Bone Metastasis by Classifying Bone Scintigrams Using a Self-defined Deep Learning Model.

Patients with cancer can develop bone metastasis when a solid tumor invades the bone, which is the third most commonly affected site by metastatic cancer, after the lung and liver. The early detection of bone metastases is crucial for making appropriate treatment decisions and increasing survival rates. Deep learning, a mainstream branch of machine learning, has rapidly become an effective approach to analyzing medical images. To automatically diagnose bone metastasis with bone scintigraphy, in this work, we proposed to cast the bone metastasis diagnosis problem into automated image classification by developing a deep learning-based automated classification model. A self-defined convolutional neural network consisting of a feature extraction sub-network and feature classification sub-network was proposed to automatically detect lung cancer bone metastasis, with a feature extraction sub-network extracting hierarchal features from SPECT bone scintigrams and feature classification sub-network classifying high-level features into two categories (i.e., images with metastasis and without metastasis). Using clinical data of SPECT bone scintigrams, the proposed model was evaluated to examine its detection accuracy. The best performance was achieved if the two images (i.e., anterior and posterior scans) acquired from each patient were fused using pixel-wise addition operation on the bladder-excluded images, obtaining the best scores of 0.8038, 0.8051, 0.8039, 0.8039, 0.8036, and 0.8489 for accuracy, precision, recall, specificity, F-1 score, and AUC value, respectively. The proposed two-class classification network can predict whether an image contains lung cancer bone metastasis with the best performance as compared to existing classical deep learning models. The high accumulation of 99mTc MDP in the urinary bladder has a negative impact on automated diagnosis of bone metastasis. It is recommended to remove the urinary bladder before automated analysis.

Simulation of Postmarket Fine-tuning of a Computer-aided Detection System for Bone Scintigrams and Its Performance analysis

Simulation of Postmarket Fine-tuning of a Computer-aided Detection System for Bone Scintigrams and Its Performance analysis

Deep Learning for the Automatic Diagnosis and Analysis of Bone Metastasis on Bone Scintigrams.

ObjectiveTo develop an approach for automatically analyzing bone metastases (BMs) on bone scintigrams based on deep learning technology.MethodsThis research included a bone scan classification model, a regional segmentation model, an assessment model for tumor burden and a diagnostic report generation model. Two hundred eighty patients with BMs and 341 patients with non-BMs were involved. Eighty percent of cases were randomly extracted from two groups as training set. Remaining cases were as testing set. A deep residual convolutional neural network with different structures was used to determine whether metastatic bone lesions existed, regions of lesions were automatically segmented. Bone scan tumor burden index (BSTBI) was calculated; finally, diagnostic report could be automatically generated. The sensitivity, specificity and accuracy of classification model were compared with three physicians with different clinical experience. The Dice coefficient evaluated the effect of segmentation model and compared to the result of nnU-Net model. The correlation between BSTBI and blood alkaline phosphatase (ALP) level was analyzed to verify the efficiency of BSTBI. The performance of report generation model was evaluated by the accuracy of interpretation of report.ResultsIn testing set, the sensitivity, specificity and accuracy of classification model were 92.59%, 85.51% and 88.62%, respectively. The accuracy showed no statistical difference with moderately and experienced physicians and obviously outperformed the inexperienced. The Dice coefficient of BMs area was 0.7387 in segmentation stage. Based on the whole model frame, our segmentation model outperformed the nnU-Net. BSTBI value changed as the BMs changed. There was a positive correlation between BSTBI and ALP level. The accuracy of report generation model was 78.05%.ConclusionDeep learning based on automatic analysis frameworks for BMs can accurately identify BMs, preliminarily realize a fully automatic analysis process from raw data to report generation. BSTBI can be used as a quantitative evaluation indicator to assess the effect of therapy on BMs in different patients or in the same patient before and after treatment.

Not just weight loss

Renal cancer (RC) – associated increased calcium is rather frequent among cases of kidney neoplasia; it may be the first sign of presentation that allows the detection of the malignancy; typically representing a poor prognostic factor. Weight loss is part of the panel underling hypercalcemia - related signs, but also of the malignancy – associated phenotype. We aim to introduce a male case who was admitted for a clinical picture (including weight loss) correlated with alarming high calcium levels; the biochemistry anomaly was actually a paraneoplastic syndrome due to RC. When admitted as emergency, the assays revealed hypercalcemia of 16.9 mg/dl (normal levels between 8.4 and 10.2 mg/dl) with low PTH (Parathormone) and high CrossLaps as bone turnover marker of resorption. Intravenous contrast computed tomography showed a large left retroperitoneal tumor (involving the kidney and adrenal gland) with iodophil pattern, and post-contrast heterogeneous structure of 8.06/11.09 cm (axial), 10.58/12.16 cm (coronal-reconstruction), 9.12/10.59 cm (sagittal - reconstruction), also associating a mixt structure and micro-calcifications as well as hypodense areas. Whole body bone scintigram did not show metastasis. The calcium levels were controlled under subcutaneous denosumab 60 mg in addition to IV fluids replacement; then the patient was referred to nephrectomy; postoperative confirmation confirmed a clear cell renal cell carcinoma (T4N1Mx). A normalization of calcium and PTH levels was found immediately after surgery. Unintentional weight loss might become a valuable tool in order to assess a routine biochemistry panel that will detect hypercalcemia. Low PTH represents the next step in order to further look for a tumor. Symptomatic control of hypercalcemia in addition to targeted approach of originating tumor are essential to improve the outcome.

Extraction of metastasis hotspots in a whole-body bone scintigram based on bilateral asymmetry.

A hotspot of bone metastatic lesion in a whole-body bone scintigram is often observed as left-right asymmetry. The purpose of this study is to present a network to evaluate bilateral difference of a whole-body bone scintigram, and to subsequently integrate it with our previous network that extracts the hotspot from a pair of anterior and posterior images. Input of the proposed network is a pair of scintigrams that are the original one and the flipped version with respect to body axis. The paired scintigrams are processed by a butterfly-type network (BtrflyNet). Subsequently, the output of the network is combined with the output of another BtrflyNet for a pair of anterior and posterior scintigrams by employing a convolutional layer optimized using training images. We evaluated the performance of the combined networks, which comprised two BtrflyNets followed by a convolutional layer for integration, in terms of accuracy of hotspot extraction using 1330 bone scintigrams of 665 patients with prostate cancer. A threefold cross-validation experiment showed that the number of false positive regions was reduced from 4.30 to 2.13 for anterior and 4.71 to 2.62 for posterior scintigrams on average compared with our previous model. This study presented a network for hotspot extraction of bone metastatic lesion that evaluates bilateral difference of a whole-body bone scintigram. When combining the network with the previous network that extracts the hotspot from a pair of anterior and posterior scintigrams, the false positives were reduced by nearly half compared to our previous model.

Femoral Neck Stress Fractures in South Korean Male Military Recruits.

BackgroudFemoral neck stress fractures (FNSFs) are rare but potentially disabling injuries if the diagnosis is missed or delayed and proper treatment is not provided. The aim of this study was to investigate and describe the characteristics and clinical course of FNSFs in South Korean male military recruits.MethodsBetween May 2015 and October 2019, 16 fractures in 12 young male military recruits were reviewed. The characteristics of the fractures were ascertained by detailed analysis of the history and clinical course, as well as radiographs, bone scintigrams, and magnetic resonance images.ResultsThe median duration between endurance training and the development of hip pain was 5 weeks, while the median duration of pain before the patient sought medical attention was 3 weeks. Four patients (33.3%) exhibited bilateral fractures, and concomitant lesions involving the proximal tibia were found in 3 patients (25%). Fourteen of the 16 fractures (87.5%) were compression-type fractures, and surgery was performed for 7 hips. Complete union without malunion or osteonecrosis was achieved in all cases, and all cadets returned to their full activity levels in an average of 10 weeks.ConclusionsWe observed excellent prognosis of FNSFs. Our report highlights the importance of early reporting, detection, and treatment regarding the challenging management of FNSFs. When a military recruit reports hip pain, a FNSF should be considered; furthermore, the bilaterality of the fracture and the presence of concomitant lesions should also be investigated.

Serial Changes in Image Findings of Herniation Pits from the First Appearance.

BackgroudHerniation pits (HPs) have been considered to be an incidental finding, but recently femoroacetabular impingement (FAI) has been proposed as a possible cause of their formation. The findings on bone scans of HPs are variable in the literature: some showed increased uptake; the majority did not. We hypothesized that serial changes in image findings of HPs would explain the reason for the variable bone scan findings.MethodsFour patients (5 hips) were followed up for more than 7 years. All patients were women and regularly underwent bone scintigraphy after the diagnosis of breast cancer. Small lesions with increased uptake were first detected on bone scintigraphy at the age of 44 to 64 years. In all cases, the lesions were confirmed by magnetic resonance imaging and follow-up bone scintigrams were taken regularly. Four lesions were also evaluated by computed tomography. Changes in the size of the pits and the intensity of the increased uptake on bone scintigraphy were evaluated.ResultsOn the bone scintigrams, the lesions with increased uptake were detected in the femoral neck at 5–20 months after previous negative bone scintigraphy. There had been no events or symptoms associated with the newly detected increased uptake. On follow-up scans, the intensity of the uptake decreased gradually and the areas of increased uptake disappeared completely at 14–50 months after their first appearance. In 3 cases (2 patients), the pit size increased during follow-up.ConclusionsThe areas of increased uptake on bone scintigraphy gradually disappeared in all cases and the increase in pit size was frequent. There was no case in which signs or symptoms suggestive of FAI were noticed.

Automated measurement of bone scan index from a whole-body bone scintigram

PurposeWe propose a deep learning-based image interpretation system for skeleton segmentation and extraction of hot spots of bone metastatic lesion from a whole-body bone scintigram followed by automated measurement of a bone scan index (BSI), which will be clinically useful.MethodsThe proposed system employs butterfly-type networks (BtrflyNets) for skeleton segmentation and extraction of hot spots of bone metastatic lesions, in which a pair of anterior and posterior images are processed simultaneously. BSI is then measured using the segmented bones and extracted hot spots. To further improve the networks, deep supervision (DSV) and residual learning technologies were introduced.ResultsWe evaluated the performance of the proposed system using 246 bone scintigrams of prostate cancer in terms of accuracy of skeleton segmentation, hot spot extraction, and BSI measurement, as well as computational cost. In a threefold cross-validation experiment, the best performance was achieved by BtrflyNet with DSV for skeleton segmentation and BtrflyNet with residual blocks. The cross-correlation between the measured and true BSI was 0.9337, and the computational time for a case was 112.0 s.ConclusionWe proposed a deep learning-based BSI measurement system for a whole-body bone scintigram and proved its effectiveness by threefold cross-validation study using 246 whole-body bone scintigrams. The automatically measured BSI and computational time for a case are deemed clinically acceptable and reliable.

Association Between New Unconfirmed Bone Lesions and Outcomes in Men With Metastatic Castration-Resistant Prostate Cancer Treated With Enzalutamide

For men with metastatic castration-resistant prostate cancer (mCRPC) whose condition is responding to enzalutamide, new unconfirmed bone lesions detected at posttreatment scinitigraphy may reflect an osteoblastic reaction that represents healing, known as pseudoprogression, which can lead to premature discontinuation of therapy. To determine the association between new unconfirmed lesions detected on a follow-up bone scintigram (bone scan) and outcomes in enzalutamide-treated men with mCRPC. This post hoc, retrospective secondary analysis of 1672 enzalutamide-treated men from 2 phase 3, randomized mCRPC studies (PREVAIL and AFFIRM) before or after treatment with docetaxel was conducted from April 12, 2018, to July 25, 2019. Participants were men from the enzalutamide groups of the 2 studies with a decrease in prostate-specific antigen level at any time or with stable disease or soft-tissue disease responding to treatment based onradiologic findings. Enzalutamide, 160 mg once daily. The clinical significance of new lesions detected on the first (early) or second (late) posttreatment bone scan, without an unfavorable change in prostate-specific antigen level or soft-tissue progression, was investigated. Associations of new unconfirmed lesions with radiographic progression-free survival, overall survival, decrease in prostate-specific antigen level, objective response in soft tissue, and quality of life were evaluated. Among the 643 men (median age, 72 years [range, 43-93 years]) in PREVAIL, early and late unconfirmed lesions were observed in 177 men (27.5%) with stable disease or disease responding to enzalutamide. Among the 404 men (median age, 70 years [range, 41-88 years]) in AFFIRM, early and late unconfirmed lesions were observed in 73 men (18.1%) with stable disease or disease responding to enzalutamide. In PREVAIL, men with new unconfirmed lesions had median radiographic progression-free survival (hazard ratio [HR], 1.37 [95% CI, 0.81-2.30]; P = .23) and median overall survival (HR, 1.25 [95% CI, 0.85-1.83]) in the chemotherapy-naive setting similar to men those of men without such new lesions. In AFFIRM, the median overall survival (HR, 1.94 [95% CI, 1.10-3.44]) was reduced among men with unconfirmed bone lesions, but the median radiographic progression-free survival was not reduced (HR, 1.21 [95% CI, 0.83-1.75]; P = .32). Quality of life over time was similar regardless of the presence of new unconfirmed lesions detected on a follow-up bone scan in either setting. These results suggest that new unconfirmed lesions detected on follow-up bone scans may represent pseudoprogression in men with mCRPC and are indicative of a favorable treatment response to enzalutamide. The detection of new unconfirmed bone lesions in men with mCRPC that responded to treatment with enzalutamide after docetaxel appears to be associated with worse overall survival and may represent true progression, thus highlighting the need for improved functional bone metastasis imaging. ClinicalTrials.gov Identifiers: NCT01212991 and NCT00974311.

Japanese Expert Panel Meeting on the Management of Prostate Cancer with Bone Metastases.

IntroductionThe incidence of prostate cancer in Japan continues to increase, necessitating the continued development of effective therapies and strategies. Recent advances in treatments have improved the prognosis of metastatic disease and highlighted the importance of treating bone metastases to reduce the incidence of skeletal complications and improve patients’ quality of life. With the increasing number of treatment options that have become available, including bone-targeted therapy with the alpha emitter radium-223 dichloride (Ra-223), Japanese clinicians are faced with making difficult decisions on the choice of optimal treatment strategy. In such situations, guidance based on expert opinions can be beneficial.MethodsA panel meeting of 27 Japanese experts in the management of prostate cancer was held to share opinions and to establish consensus recommendations on key clinical questions. Panelists were asked to vote on more than 40 questions pertinent to prostate cancer, and the answers helped guide a comprehensive discussion.ResultsThe panel reached a consensus on key topics related to the optimal treatment strategy for Ra-223 therapy, namely, that patients with symptomatic, metastatic castration-resistant prostate cancer (CRPC) would benefit most from the use of this agent and that this treatment therapy should be provided before chemotherapy. Other topics that achieved consensus included: monitoring for osteoporosis and providing treatment if necessary during androgen deprivation therapy; performing magnetic resonance imaging in the presence of discrepancies in bone scintigram and computed tomography scans; monitoring alkaline phosphatase during CRPC treatment; using osteoclast-targeting in patients with CRPC with bone metastases; and using osteoclast-targeted agents combined with Ra-223.ConclusionThese consensus recommendations and the updated information which became available subsequent to the panel meeting included here provide useful information for clinicians to aid in designing optimal treatment strategies for their patients.FundingBayer Yakuhin Ltd.Electronic supplementary materialThe online version of this article (10.1007/s40487-018-0088-0) contains supplementary material, which is available to authorized users.

A Study of the Effect of Rapid Fluid Intake on Quality of the Bone Scintigraphy Image

Background: Currently the best intervention after injection of 99mTc-HDP is drinking plenty of fluid with no specific amount or time limit. The previous studies did show some but not significant improvement between image qualities of patients who drank water compared to those who did not drink. We aim to investigate if increased and more rapid fluid intake results in better image quality. Methods: In this study, all patients who had a bone scintigram were questioned about how much fluid they had in the two hours between injection and imaging, and how much of that was taken in the first hour post injection The images were acquired two hour +/- 10min post intravenous injection of 99mTc-HDP using GE Infinia Hawkeye 4. The operator, equipment and radiopharmaceutical were the same for all studies and quality was assessed by measuring bone to soft tissue ratio using Xeleris 3 program. Results: 146 adult patients with total of 156 images who had bone scan imaging at Auckland Radiology Group were assessed. These patients aged between 30 and 78 (median, 51), were mostly men (61%) and 10 (about 6.5%) had two bone scans. The overall result, although a small change, was in favor of increasing fluid intake in the first hour which improved the bone to soft tissue ratio by an average of 2.5%. This was especially noticeable in patients who had two scans within few months of each other which could be compared, in this group nearly all the variables remain the same except the amount of fluid intake, this group had an average improvement of 9.65% (range, 2%-19.5%). Conclusion: Rapid hydration post injection of 99mTc-HDP showed a small contribution on the quality of bone scan images however this together with increased likelihood of voiding earlier on post injection, which contributes to reducing radiation dose to the bladder wall, makes this method appealing to adopt for routine use.

Enhanced bone healing and decreased pain in sacral insufficiency fractures after teriparatide treatment: retrospective clinical-based observational study.

The purpose of this retrospective clinical-based observational study was to evaluate the effects of teriparatide (TPTD) on clinical outcomes and radiologic findings of sacral insufficiency fractures (SIFs). Seven elderly women with SIFs received TPTD for at least 6 months. We evaluated the symptoms, pain, and radiological findings. At their initial clinic visit, 86% patients could not walk or sit. Computed tomography (CT) images revealed sacral wing fracture in 6 patients, and bone scintigram showed H-shaped uptake over the bilateral sacral wings in 1 patient. After the treatment, 5 patients could walk. Mean visual analog scale score was significantly lower after (12.9 mm) than before (87.4 mm) TPTD treatment (p < 0.0001). CT images revealed bone union (four patients) and sclerotic changes (three patients) at the fracture sites. Seven elderly women with SIFs had significant improvement in pain and demonstrated bone union or sclerotic changes at fracture sites by TPTD.

Chondrosarcomas of the hands and feet: A case series and systematic review of the literature

ObjectiveTo review the imaging features of chondrosarcomas (CS) of the hands and feet, with pathologic correlation. Materials and methodsFor 24 histologically-confirmed CS of the hands (n=14) and feet (n=10), 23 studies were retrospectively reviewed by two musculoskeletal radiologists in consensus. Radiographs (n=23), bone scintigrams (n=2), and magnetic resonance (MR) (n=7) images were evaluated for lesion location, cortical and medullary involvement, presence of perilesional signal abnormalities and soft tissue masses (STM). Pathologic specimens were reviewed for tumor grade (grade 1–3). Descriptive statistics were reported. ResultsCS occurred in adults (age range 32–92) and most were located in the digits (22/23 (95.6%)) rather than tarsal/carpal bones (1/23 (4.4%)). For digital CS, 21/22 (95.45%) involved the epiphysis in addition to the metadiaphysis, 22/23 (95.6%) exhibited >2/3 endosteal scalloping, and 16/23 (69.5%) were expansile (>50% of the bone width). Pathologic fractures (7/23 (30.4%)) and STMs (16/23 (69.6%)) were frequent. By MR, perilesional abnormalities were common (bone marrow edema in 6/7 (85%), soft tissue edema in 5/7 (71.4%), STM in 7/7 (100%)). Following contrast administration (n=6), there was solid (3/6 (50%)) or lobular (3/6 (50%)) enhancement. Bone scintigrams showed increased uptake on all phases (>anterior superior iliac spine (ASIS)). Pathology specimens revealed 17 grade 2 and 7 grade 3CS, with increased cellularity, necrosis and myxoid features. ConclusionCS of the hands and feet have common distinctive features, including involvement of the end-of-bone, significant endosteal scalloping, expansile appearance, a frequent STM, and intermediate to high grade histologic features. Additional aggressive imaging features are identified by MR (perilesional signal abnormalities) and bone scintigraphy (increased uptake>ASIS) that may be helpful clues to the diagnosis.

MP87-11 ALKALINE PHOSPHATASE VELOCITY AS A PREDICTOR OF BONE METASTASIS AND OVERALL SURVIVAL IN CASTRATE RESISTANT PROSTATE CANCER PATIENTS

from aggressive treatment. Ryan et al reported bone scan flare in 11 of 23 (48%) evaluable patients treated with abiraterone plus prednisone for metastatic and chemotherapy naive CRPC patients. To our knowledge this is the first report about ALP flare following enzalutamide treatment. METHODS: 40 patients with CRPC were treated with enzalutamide 160 mg, 20 patients were chemotherapy naive and 20 patients were chemotherapy (Docetaxel) resistant. RESULTS: 2 of 40(5%) patients experienced ALP flare. ALP began to increase 2 weeks after initiation of enzalutamide, peaked at 4 weeks and began to decrease afterwards. PSA decreased in both cases and 90% decrease was observed. In both patients, bone pain completely alleviated and the patients became analgesic drugs free. In one case. PSA value decreased from 957 to 111 ng/ml and ALP value increased 382 IU/l to 1442 in 4 weeks then decreased to 400 after 16 weeks. Bone scan flare was also found. The patient does well maintaining good ADL. CONCLUSIONS: A flare phenomenon, defined by an increase in skeletal radionuclide uptake, shortly after initiating hormonal therapy or chemotherapy was first described in the mid 1970s in patients with breast carcinoma metastatic to the skeleton using 87mstrontium and later 99mtechnetium bone scintigrams. This flare phenomenon has also been described in patients with prostate carcinoma metastatic to the skeleton 2 weeks after castration, with a return to baseline levels 2 months later. However, the reported frequency of a flare is variable, depending on timing of posttreatment scintigram. The simplicity, ready availability and cost-effectiveness of serum alkaline phosphatase activity as a prognostic index render it attractive to the clinician, particularly early in the course of prostatic carcinoma. Measuring the flare in alkaline phosphatase activity within 1 month of orchiectomy may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from aggressive treatment.

MP87-10 ALP AND BONE SCAN FLARE FOLLOWING ENZALUTAMIDE TREATMENT OF CASTRATION RESISTANT PROSTATE CANCER (CRPC) WITH BONE METASTASIS

You have accessJournal of UrologyProstate Cancer: Advanced III1 Apr 2015MP87-10 ALP AND BONE SCAN FLARE FOLLOWING ENZALUTAMIDE TREATMENT OF CASTRATION RESISTANT PROSTATE CANCER (CRPC) WITH BONE METASTASIS Senji Hoshi, Kunihisa Nezu, Hidenori Kanno, Teppei Ookubo, Mituharu Sasaki, Kenji Numahata, Kiyotugu Hoshi, Satoru Kanto, Isoji Sasagawa, Yuuichi Ishizuka, Hideaki Izumi, Kunio Ono, and Vladimir Bilim Senji HoshiSenji Hoshi More articles by this author , Kunihisa NezuKunihisa Nezu More articles by this author , Hidenori KannoHidenori Kanno More articles by this author , Teppei OokuboTeppei Ookubo More articles by this author , Mituharu SasakiMituharu Sasaki More articles by this author , Kenji NumahataKenji Numahata More articles by this author , Kiyotugu HoshiKiyotugu Hoshi More articles by this author , Satoru KantoSatoru Kanto More articles by this author , Isoji SasagawaIsoji Sasagawa More articles by this author , Yuuichi IshizukaYuuichi Ishizuka More articles by this author , Hideaki IzumiHideaki Izumi More articles by this author , Kunio OnoKunio Ono More articles by this author , and Vladimir BilimVladimir Bilim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1955AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES An increase in alkaline phosphatase (ALP) activity has been described in patients with metastatic prostatic carcinoma within weeks of medical or surgical castration, and is believed to be of positive prognostic value for the success of systemic therapy. Measuring the flare in ALP activity within 1 month of orchiectomy may facilitate early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from aggressive treatment. Ryan et al reported bone scan flare in 11 of 23 (48%) evaluable patients treated with abiraterone plus prednisone for metastatic and chemotherapy naive CRPC patients. To our knowledge this is the first report about ALP flare following enzalutamide treatment. METHODS 40 patients with CRPC were treated with enzalutamide 160 mg, 20 patients were chemotherapy naive and 20 patients were chemotherapy (Docetaxel) resistant. RESULTS 2 of 40(5%) patients experienced ALP flare. ALP began to increase 2 weeks after initiation of enzalutamide, peaked at 4 weeks and began to decrease afterwards. PSA decreased in both cases and 90% decrease was observed. In both patients, bone pain completely alleviated and the patients became analgesic drugs free. In one case. PSA value decreased from 957 to 111 ng/ml and ALP value increased 382 IU/l to 1442 in 4 weeks then decreased to 400 after 16 weeks. Bone scan flare was also found. The patient does well maintaining good ADL. CONCLUSIONS A flare phenomenon, defined by an increase in skeletal radionuclide uptake, shortly after initiating hormonal therapy or chemotherapy was first described in the mid 1970s in patients with breast carcinoma metastatic to the skeleton using 87mstrontium and later 99mtechnetium bone scintigrams. This flare phenomenon has also been described in patients with prostate carcinoma metastatic to the skeleton 2 weeks after castration, with a return to baseline levels 2 months later. However, the reported frequency of a flare is variable, depending on timing of posttreatment scintigram. The simplicity, ready availability and cost-effectiveness of serum alkaline phosphatase activity as a prognostic index render it attractive to the clinician, particularly early in the course of prostatic carcinoma. Measuring the flare in alkaline phosphatase activity within 1 month of orchiectomy may permit early identification of patients in whom the disease is likely to progress rapidly and who would potentially benefit from aggressive treatment. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1087-e1088 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Senji Hoshi More articles by this author Kunihisa Nezu More articles by this author Hidenori Kanno More articles by this author Teppei Ookubo More articles by this author Mituharu Sasaki More articles by this author Kenji Numahata More articles by this author Kiyotugu Hoshi More articles by this author Satoru Kanto More articles by this author Isoji Sasagawa More articles by this author Yuuichi Ishizuka More articles by this author Hideaki Izumi More articles by this author Kunio Ono More articles by this author Vladimir Bilim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Clinical utility of bone scintigraphy in patients with limb pain of suspected musculoskeletal origin.

To determine the clinical utility of bone scintigraphy in patients with limb pain of suspected musculoskeletal origin. All patients aged ≥18 years who were referred for diagnosis and management of limb pain were diagnosed on the basis of history, physical examination, and investigations excluding bone scintigraphy. After the presumptive diagnosis was made (the pre-test diagnosis), all subjects underwent bone scintigraphy, or if they had a previous bone scintigram for their pain condition, the results of that scintigram were reviewed. Then, the pre-test diagnosis was reviewed in light of the bone scintigraphy findings and repeat clinical assessment as needed. The post-test diagnosis was considered either as unchanged diagnosis or changed diagnosis for the region or regions of interest. There were 118 females (54.8%) and 97 males (45.2%). The mean age of the entire group was 36±8.1 years (range: 18-87 years). The mean duration of the symptoms was 17.4±11.2 months (range: 1-264 months). Of the 215 subjects, 212 had a bone scintigram. Of these 212 subjects, none had a changed diagnosis. In the evaluation of limb pain of suspected musculoskeletal origin, scintigraphy is unlikely to alter the pre-test diagnosis or affect treatment decisions after history, physical examination, and non-scintigraphic investigations. The clinical utility of scinitigraphy in this setting is low.

Bone Scan Index Is a Prognostic Factor for Breast Cancer Patients with Bone Metastasis Being Treated with Zoledronic Acid

Bone scan index (BSI) has been used to quantify the spread of bone metastasis and be a prognostic indicator in prostate cancer with bone metastases. However, the utility of BSI in breast cancer patients with bone metastasis has not been yet established. We retrospectively reviewed 57 female breast cancer patients with osteoblastic/lytic combined type bone metastases and treated with zoledronic acid after bone metastasis was identified. Serial bone scintigrams were taken at the time of bone metastasis detection and during the 6- and 12-month follow-ups. The scintigrams were analyzed by BONE NAVITM version 1 and the BSI value was calculated. Additionally, serum cancer antigen 15-3 (CA15-3) and carcinoembryonic antigen (CEA) were measured. The patients were divided in 2 distinct groups—group A representing all follow-up BSI values ≤ initial BSI values and group B representing all follow-up BSI values ≥ initial BSI values. The interval changes of CA15-3 and CEA were divided in the same fashion. Kaplan-Meier method and log-rank test revealed that the overall survival rate was significantly greater in group A than those of group B after 6 months (p = 0.011) and 12 months (p = 0.016). Univariate analysis revealed that the overall survival rate was significantly greater in group A than those of group B, after a 6 month period (Hazard Ratio [HR] 5.841; 95% confidence interval [CI] 1.248 - 27.34; p = 0.025) and 12 month period (HR: 4.22; 95% CI 1.17615.15; p = 0.027). Multivariate analysis demonstrated that BSI changes after 6 and 12 months trended toward significance regarding parameters affecting survival rate (age and CA15-3) with a HR = 12.760 (95%CI 1.8110 - 89.850) at 6 months with a p = 0.010 and a HR = 5.0640 (95%CI 1.0590 - 24.220) at 12 months with a p = 0.042. BSI changes after 6 and 12 months appear to be a prognostic factor in breast cancer patients with bone metastasis treated with zoledronic acid.

Evaluation of osteoblastic activity in extraction sockets treated with platelet-rich fibrin.

Objective: The aim of this study was to determine whether the use of platelet rich fibrin (PRF) improved the healing of extraction sockets. Study Design: A total of 20 patients with bilateral soft tissue impacted mandibular third molars were included in this study. The left and right third molars were extracted during the same session. Subsequently, the PRF membrane was randomly administered to one of the extraction sockets, whereas the contra lateral sockets were left without treatment. On postoperative 30. and 90. days, panoramic images and bone scintigrams were taken to evaluate the bone healing between PRF-treated and non-PRF-treated sockets. Also, periodontal evaluation was performed in the same control sessions. Dependent group t test for paired samples was used for statistical analysis. Results: The average increase in technetium-99m methylene diphosphonate uptake as an indication of enhanced bone healing did not differ significantly between PRF-treated and non-PRF-treated sockets 30 and 90 days post operatively. Radio opacity that can show the bone healing on panoramic images were measured by Image J programmer and they did not differ significantly. Also periodontal values did not differ significantly. Conclusions: PRF might not lead to enhanced bone healing in impacted mandibular third molar extraction sockets 30 and 90 days after surgery. It is thought that PRF has the potential characteristics of an autologous fibrin matrix and can accelerate the healing. To better understand the effects of PRF on healing, further research is warranted with larger sample sizes. Key words:PRF, scintigraphy, healing, extraction sockets.

Radiation Therapy for Symptomatic Bone Metastases: The Effect of Calculated Dose and Dose Distribution on Intensity of Pain Relief and Time of Pain Relief

Radiation Therapy for Symptomatic Bone Metastases: The Effect of Calculated Dose and Dose Distribution on Intensity of Pain Relief and Time of Pain Relief