|
1
|
Nomura K, Nakayama M, Okizaki A. Usefulness of the Automated Bone Scan Index in Arthritis: A Quantitative Approach for Evaluating Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis (SAPHO) Syndrome. Nucl Med Mol Imaging 2025; 59:147-153. [PMID: 40125022 PMCID: PMC11923344 DOI: 10.1007/s13139-024-00883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/16/2024] [Accepted: 08/28/2024] [Indexed: 03/25/2025] Open
Abstract
Purpose For several decades, bone scintigraphy (BS) has been used as a diagnostic tool for arthritis in patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome. Artificial intelligence (AI) diagnostic supporting systems are effective in BS. The bone scan index (BSI) on BS with AI diagnostic support systems has been used for bone tumors. However, its application in arthritis has not been validated. The current study aimed to evaluate the usefulness of BSI using an AI diagnostic supporting system for arthritis in patients with SAPHO syndrome. Methods The regional BSI (rBSI) of arthritis uptake around the sternoclavicular and sternocostal joints on BS in patients with SAPHO syndrome was calculated using an AI diagnostic supporting system (VSBONE BSI®). For comparison, patients with degenerative changes on BS in the same region were evaluated. rBSI was calculated using the same process. Results This study included 43 patients with SAPHO syndrome and 48 with degenerative changes. The rBSIs with the diagnostic supporting system were 0.19 ± 0.19 in patients with SAPHO syndrome and 0.043 ± 0.056 in those with degenerative changes. Patients with SAPHO syndrome had significantly higher rBSIs than those with degenerative changes (P < 0.001). A cutoff value of 0.030 for rBSI in the region of interest had a sensitivity of 0.98 and specificity of 0.63 for differentiating arthritis from degenerative changes (area under the curve: 0.87, 95% confidence interval: 0.81-0.92). Conclusion The objective evaluation of arthritis using rBSI calculated with an AI diagnostic supporting system may be useful.
Collapse
Affiliation(s)
- Kenta Nomura
- Department of Radiology, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510 Hokkaido Japan
| | - Michihiro Nakayama
- Department of Radiology, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510 Hokkaido Japan
| | - Atsutaka Okizaki
- Department of Radiology, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510 Hokkaido Japan
| |
Collapse
|
|
2
|
Rajadhas F, Imbert L, Fiorino M, Morizot C, Boucher V, Lamiral Z, Roch V, Marie PY, Loeuille D, Chary-Valckenaere I, Bahloul A. Standardized uptake value-based analysis of two-phase whole-body bone tomoscintigraphies recorded with a high-speed 360° CZT camera in patients with known or suspected inflammatory arthritis. Eur J Nucl Med Mol Imaging 2025:10.1007/s00259-025-07150-0. [PMID: 39969541 DOI: 10.1007/s00259-025-07150-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 02/10/2025] [Indexed: 02/20/2025]
Abstract
PURPOSE 360° CZT-cameras provide whole-body bone SPECT/CT recordings at delayed (DEL) and blood-pool (BP) phases with short recording times but long visual analysis times. This study aims to determine whether a standardized uptake value (SUV)-based detection of inflammatory arthritis (IA) could facilitate this analysis. METHODS We included 72 patients with known or suspected IA who underwent two-phase whole-body bone SPECT/CT after 550-650 MBq [99mTc]Tc-HDP injection. Forty-eight patients also had ultrasound (US) for peripheral IA, and 42 had MRI for axial IA. The skeleton was segmented into 26 joint areas and analyzed by trained observers using a visual consensus methodology and SUVmax measurements. RESULTS A total of 1836 joint areas were analyzed, including 1126 peripheral ones (limb joints excluding hips and shoulders). SUVmax was predictive of visually abnormal SPECT joints with high areas under receiver-operating-characteristic (ROC) curves for non-peripheral (BP-SPECT: 0.941 ± 0.017, DEL-SPECT: 0.910 ± 0.014) and especially peripheral (BP-SPECT: 0.980 ± 0.005, DEL-SPECT: 0.939 ± 0.012) joints. An SUVmax threshold-based prediction of visual SPECT abnormalities had high negative predictive values (BP-SPECT: 99.2% (1479/1491), DEL-SPECT: 97.2% (1333/1372)) but low positive predictive values (BP-SPECT: 35.1% (121/345), DEL-SPECT: 51.2% (237/463)). MRI- and US-defined IA were best predicted by a visually abnormal BP-SPECT due to higher specificities than SUVmax thresholds (all p < 0.05). CONCLUSION On two-phase whole-body bone SPECT/CT, an SUVmax-based IA detection may not replace the conventional visual method. However, given the high negative predictive values provided by SUVmax thresholds, the time-consuming visual analysis of SPECT/CT slices could be confined to the small proportion of joints exceeding these thresholds.
Collapse
Affiliation(s)
- Franklin Rajadhas
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Vandoeuvre-Les-Nancy, 54000, France
| | - Laetitia Imbert
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Vandoeuvre-Les-Nancy, 54000, France
- Université de Lorraine, INSERM U1254, IADI, Nancy, 54000, France
| | - Mathilde Fiorino
- Department of Rheumatology, CHRU Nancy, Vandoeuvre-Les-Nancy, 54500, France
| | - Caroline Morizot
- Department of Rheumatology, CHRU Nancy, Vandoeuvre-Les-Nancy, 54500, France
- UMR 7365 CNRS- ImoPA Nancy University Hospital and University of Lorraine, Vandoeuvre-Les-Nancy, 54500, France
| | - Victor Boucher
- Department of Rheumatology, CHRU Nancy, Vandoeuvre-Les-Nancy, 54500, France
| | - Zohra Lamiral
- Université de Lorraine, CHRU-Nancy, INSERM, CIC 1433, Nancy, 54000, France
| | - Véronique Roch
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Vandoeuvre-Les-Nancy, 54000, France
| | - Pierre-Yves Marie
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Vandoeuvre-Les-Nancy, 54000, France
- Université de Lorraine, INSERM U1254, IADI, Nancy, 54000, France
| | - Damien Loeuille
- Department of Rheumatology, CHRU Nancy, Vandoeuvre-Les-Nancy, 54500, France
- UMR 7365 CNRS- ImoPA Nancy University Hospital and University of Lorraine, Vandoeuvre-Les-Nancy, 54500, France
| | - Isabelle Chary-Valckenaere
- Department of Rheumatology, CHRU Nancy, Vandoeuvre-Les-Nancy, 54500, France
- UMR 7365 CNRS- ImoPA Nancy University Hospital and University of Lorraine, Vandoeuvre-Les-Nancy, 54500, France
| | - Achraf Bahloul
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU-Nancy, Vandoeuvre-Les-Nancy, 54000, France.
- Université de Lorraine, INSERM U1254, IADI, Nancy, 54000, France.
| |
Collapse
|
|
3
|
Yew DSY, Lai CL. "Motion Capture Suit Sign" for Immunotherapy-Induced Inflammatory Arthritis on 99mTc-MDP Bone Scintigraphy. Clin Nucl Med 2025; 50:179-180. [PMID: 39774156 DOI: 10.1097/rlu.0000000000005591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
ABSTRACT We report the 99mTc-MDP bone scan of a 44-year-old man with a history of lung adenocarcinoma and recent multiple joint pain after completing pembrolizumab immunotherapy treatment. This interesting image of symmetric uptakes around bilateral joints throughout the skeleton resembles the ball sensors on a motion capture suit. Hence, we recommend naming this distinctive imaging appearance as the "motion capture suit" sign.
Collapse
Affiliation(s)
- Dallas Shun-Yu Yew
- From the Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Chun-Liang Lai
- Division of Chest and Critical Care, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| |
Collapse
|
|
4
|
Kian Ara H, Alemohammad N, Paymani Z, Ebrahimi M. Machine learning diagnosis of active Juvenile Idiopathic Arthritis on blood pool [ 99M Tc] Tc-MDP scintigraphy images. Nucl Med Commun 2024; 45:355-361. [PMID: 38312058 DOI: 10.1097/mnm.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
PURPOSE Neural network has widely been applied for medical classifications and disease diagnosis. This study employs deep learning to best discriminate Juvenile Idiopathic Arthritis (JIA), a pediatric chronic joint inflammatory disease, from healthy joints by exploring blood pool images of 2phase [ 99m Tc] Tc-MDP bone scintigraphy. METHODS Self-deigned multi-input Convolutional Neural Network (CNN) in addition to three available pre-trained models including VGG16, ResNet50 and Xception are applied on 1304 blood pool images of 326 healthy and known JIA children and adolescents (aged 1-16). RESULTS The self-designed model ROC analysis shows diagnostic efficiency with Area Under the Curve (AUC) 0.82 and 0.86 for knee and ankle joints, respectively. Among the three pertained models, VGG16 ROC analysis reveals AUC 0.76 and 0.81 for knee and ankle images, respectively. CONCLUSION The self-designed model shows best performance on blood pool scintigraph diagnosis of patients with JIA. VGG16 was the most efficient model rather to other pre-trained networks. This study can pave the way of artificial intelligence (AI) application in nuclear medicine for the diagnosis of pediatric inflammatory disease.
Collapse
|
|
5
|
Lee JW, Chang SH, Jang SJ, Park HJ, Lee SM, Jung KJ. Clinical utility of quantitative analysis of bone scintigraphy in detecting clinically active joint and high disease activity in patients with rheumatoid arthritis. BMC Med Imaging 2021; 21:177. [PMID: 34814863 PMCID: PMC8611961 DOI: 10.1186/s12880-021-00712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to investigate the efficiency of quantitative parameters of bone scintigraphy in detecting clinically active joint and high disease activity in patients with rheumatoid arthritis. Methods We retrospectively enrolled 65 patients with rheumatoid arthritis who underwent bone scintigraphy for diagnostic work-up. Quantitative analysis of bone scintigraphy images was conducted using an in-house software, and joint uptake ratio of 28 joints was measured for the calculation of the disease activity score of 28 joints using erythrocyte sedimentation rate (DAS28-ESR). The relationship between joint uptake ratio and clinical findings and the efficiency of joint uptake ratio in detecting clinically active joint and high disease activity were assessed. Results Clinically active joint (tender and/or swollen joints) showed significantly higher joint uptake ratio than did other non-affected joints (p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of joint uptake ratio for identifying clinically active joint were 78.7%, 52.0%, 32.9%, and 89.1%, respectively, and those of the summed joint uptake ratio for detecting high disease activity were 92.9%, 66.8%, 43.3%, and 97.1%, respectively; the joint uptake ratio showed high detection ability, especially for active joints of the elbow, wrist, and metacarpo-phalangeal joint areas. The summed joint uptake ratio of 28 joints showed a significantly strong positive correlation with DAS28-ESR (p < 0.001; correlation coefficient, 0.725). Conclusion Quantitative parameters of bone scintigraphy showed high sensitivity and NPV for detecting clinically active joint and high disease activity in patients with rheumatoid arthritis.
Collapse
Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, 25 Simgok-ro 100-gil, Seo-gu, Incheon, 22711, Korea
| | - Sung Hae Chang
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Chuncheongnam-do, Korea
| | - Su Jin Jang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, 13496, Gyeonggi-do, Korea
| | - Hee Jin Park
- Division of Rheumatology, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, 25 Simgok-ro 100-gil, Seo-gu, Incheon, 22711, Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Chungcheongnam-do, Korea.
| | - Ki Jin Jung
- Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, 31151, Chungcheongnam-do, Korea.
| |
Collapse
|
|
6
|
Reappraisal of bone scintigraphy as a new tool for the evaluation of disease activity in patients with rheumatoid arthritis. Sci Rep 2021; 11:21809. [PMID: 34750402 PMCID: PMC8575878 DOI: 10.1038/s41598-021-01104-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022] Open
Abstract
We aimed to compare the reliability of bone scintigraphy (BS) and fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)-derived parameters in the detection of active arthritis in 28-joint areas and evaluate the reliability of joint counts between BS and clinical assessment in patients with rheumatoid arthritis (RA). We enrolled 106 patients (67 in the development group and 39 in the validation groups) with active RA who underwent BS, 18F-FDG PET/computed tomography (CT), and clinical evaluation of disease activity. We compared the results of BS-derived joint assessment with those of PET-derived and clinical joint assessments. Subsequently we developed a disease activity score (DAS) using BS-positive joints and validated it in an independent group. The number of BS-positive joints in 28-joint areas significantly correlated with the swollen /tender joint counts (SJC/TJC) and PET-derived joint counts. A BS uptake score of 2 (strong positive) was significantly more sensitive compared with a BS uptake score of 1 (weak positive) in detecting a PET-positive joint among the 28-joints. After conducting multivariate analyses including erythrocyte sediment rate (ESR) and patient global assessment (PGA) in addition to BS-derived parameters, BS/DAS was obtained as follows: 0.056 × number of BS-positive joints in 28 joints + 0.012 × ESR + 0.030 × PGA. A significant correlation between BS/DAS and DAS28-ESR was confirmed in the validation group. Strong positive uptake of BS is sensitive and reproducible for the detection of active joints, and can complement the clinical assessment of disease activity in RA.
Collapse
|
|
7
|
Abdelhafez YG, Godinez F, Sood K, Hagge RJ, Boutin RD, Raychaudhuri SP, Badawi RD, Chaudhari AJ. Feasibility of dual-phase 99mTc-MDP SPECT/CT imaging in rheumatoid arthritis evaluation. Quant Imaging Med Surg 2021; 11:2333-2343. [PMID: 34079705 DOI: 10.21037/qims-20-996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background To prospectively demonstrate the feasibility of performing dual-phase SPECT/CT for the assessment of the small joints of the hands of rheumatoid arthritis (RA) patients, and to evaluate the reliability of the quantitative and qualitative measures derived from the resulting images. Methods A SPECT/CT imaging protocol was developed in this pilot study to scan both hands simultaneously in participants with RA, in two phases of 99mTc-MDP radiotracer uptake, namely the soft-tissue blood pool phase (within 15 minutes after radiotracer injection) and osseous phase (after 3 hours). Joints were evaluated qualitatively (normal vs. abnormal uptake) and quantitatively [by measuring a newly developed metric, maximum corrected count ratio (MCCR)]. Qualitative and quantitative evaluations were repeated to assess reliability. Results Four participants completed seven studies (all four were imaged at baseline, and three of them at follow-up after 1-month of arthritis therapy). A total of 280 joints (20 per hand) were evaluated. The MCCR from soft-tissue phase scans was significantly higher for clinically abnormal joints compared to clinically normal ones; P<0.001, however the MCCR from the osseous phase scans were not different between the two joint groups. Intraclass Correlation Coefficient (ICC) for MCCR was excellent [0.9789, 95% confidence interval (CI): 0.9734-0.9833]. Intra-observer agreement for qualitative SPECT findings was substantial for both the soft-tissue phase (kappa =0.78, 95% CI: 0.72-0.83) and osseous-phase (kappa =0.70, 95% CI: 0.64-0.76) scans. Conclusions Extracting reliable quantitative and qualitative measures from dual-phase 99mTc-MDP SPECT/CT hand scans is feasible in RA patients. SPECT/CT may provide a unique means for assessing both synovitis and osseous involvement in RA joints using the same radiotracer injection.
Collapse
Affiliation(s)
- Yasser G Abdelhafez
- Department of Radiology, University of California Davis, Sacramento, CA, USA.,Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Felipe Godinez
- Department of Radiology, University of California Davis, Sacramento, CA, USA.,School of Biomedical Engineering and Imaging Science, King's College, London, UK
| | - Kanika Sood
- Rheumatology Section, Sacramento Veterans Affairs Medical Center, Mather, CA, USA
| | - Rosalie J Hagge
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - Robert D Boutin
- Department of Radiology, University of California Davis, Sacramento, CA, USA.,Department of Radiology, Stanford University, Stanford, CA, USA
| | - Siba P Raychaudhuri
- Rheumatology Section, Sacramento Veterans Affairs Medical Center, Mather, CA, USA.,Department of Internal Medicine, University of California Davis, Sacramento, CA, USA
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - Abhijit J Chaudhari
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
|
8
|
Park HJ, Chang SH, Lee JW, Lee SM. Clinical utility of F-18 sodium fluoride PET/CT for estimating disease activity in patients with rheumatoid arthritis. Quant Imaging Med Surg 2021; 11:1156-1169. [PMID: 33816157 DOI: 10.21037/qims-20-788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background The present study aimed to investigate the clinical implication of F-18 sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) for assessing the disease activity of rheumatoid arthritis. Methods Seventeen patients with rheumatoid arthritis according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria were prospectively enrolled. All enrolled patients underwent F-18 NaF PET/CT along with physical examination, blood test, and ultrasonography. On PET/CT images, two quantitative parameters, F-18 NaF uptake of the joint (joint SUV) and joint-to-bone uptake ratio, were measured for each of the 28 joints included in calculating the disease activity score in 28 joints using erythrocyte sedimentation rate (DAS28-ESR). The relationship between PET/CT parameters and clinical factors and the predictive values of PET/CT parameters for joints with synovitis and high disease activity were evaluated. Results Tender joints (joint SUV, 13.6±8.4; joint-to-bone uptake ratio, 1.70±1.02) and both tender and swollen joints (joint SUV, 13.9±5.4; joint-to-normal bone uptake ratio, 1.81±0.76) had significantly higher joint SUV and joint-to-bone uptake ratio than joints without synovitis (joint SUV, 6.0±2.4; joint-to-bone uptake ratio, 0.74±0.31; P<0.001). On correlation analysis, summed joint SUV (P=0.002, correlation coefficient=0.705) and summed joint-to-bone uptake ratio (P<0.001, correlation coefficient=0.861) of 28 joints showed strong positive correlation with DAS28-ESR after adjustment for age and body mass index. Summed joint SUV showed significant positive correlations with ultrasonography findings (grey scale ultrasonography: P=0.047, correlation coefficient =0.468; power Doppler ultrasonography: P=0.045, correlation coefficient =0.507). On the receiver operating characteristic curve analysis, the sensitivity and specificity for predicting synovitis were 83.2% and 92.7%, respectively, for joint SUV and 81.5% and 90.7%, respectively, for joint-to-bone uptake ratio. Moreover, the summation of both PET/CT parameters of 28 joints showed a diagnostic accuracy of 100.0% for predicting high disease activity in rheumatoid arthritis. Conclusions Summed joint uptake on F-18 NaF PET/CT had a strong positive correlation with DAS28-ESR and accurately predicted high disease activity. F-18 NaF PET/CT parameters might be used as an imaging biomarker for disease activity in rheumatoid arthritis. Trial registration This study was registered at the Clinical Research Information Service of the Korea (CRIS, http://cris.nih.go.kr/cris/en; registry number, KCT0002597; registered November 2017).
Collapse
Affiliation(s)
- Hee Jin Park
- Division of Rheumatology, Department of Internal Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, 25, Simgok-ro 100-gil, Seo-gu, Incheon, Korea
| | - Sung Hae Chang
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, 25, Simgok-ro 100-gil, Seo-gu, Incheon, Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do, Korea
| |
Collapse
|
|
9
|
Lee JW, Jung KJ, Lee SM, Chang SH. Clinical Use of Quantitative Analysis of Bone Scintigraphy to Assess the Involvement of Arthritis Diseases in Patients with Joint Symptoms. Diagnostics (Basel) 2020; 10:diagnostics10121000. [PMID: 33255422 PMCID: PMC7761348 DOI: 10.3390/diagnostics10121000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022] Open
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.
Collapse
Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary’s Hospital, 25, Simgok-ro 100-gil, Seo-gu 22711, Incheon, Korea;
| | - Ki Jin Jung
- Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Chungcheongnam-do, Korea;
| | - Sang Mi Lee
- Department of Nuclear Medicine. Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Chungcheongnam-do, Korea
- Correspondence: (S.M.L.); (S.H.C.); Tel.: +82-415-703-540 (S.M.L.); +82-41-530-2971 (S.H.C.)
| | - Sung Hae Chang
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan 31151, Chungcheongnam-do, Korea
- Correspondence: (S.M.L.); (S.H.C.); Tel.: +82-415-703-540 (S.M.L.); +82-41-530-2971 (S.H.C.)
| |
Collapse
|
|
10
|
Choi HJ, Lee SJ, Kim JY, Sung YK, Choi YY. The Correlation Between Tenosynovitis Pattern on Two-Phase Bone Scintigraphy and Clinical Manifestation in Patients with Suspected Rheumatoid Arthritis. Nucl Med Mol Imaging 2019; 53:278-286. [PMID: 31456861 DOI: 10.1007/s13139-019-00596-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/24/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To investigate the correlation between the tenosynovitis pattern on two-phase bone scintigraphy (2P-BS) and clinical manifestation in patients with suspected rheumatoid arthritis (RA). Method 2P-BS including technetium-99m-methylene diphosphonate blood pool and bone phase imaging in 402 consecutive patients with clinically suspected RA were retrospectively reviewed. According to 2010 RA Classification Criteria, patients were grouped as RA and non-RA. Visual assessment of all fingers, toes, wrists, and ankles on 2P-BS was performed. Clinical suspected tenosynovitis was evaluated on physical examination. Rheumatoid factor, anti-cyclic citrullinated protein antibody, C-reactive protein, and estimated sedimentation rate were obtained. Radiographic findings were also used to define early and established arthritis. Results Tenosynovitis pattern was detected in 12.7% (51/402 patients) on 2P-BS. A total of 94.1% (48/51) were diagnosed as RA vs. 5.9% (3/51) as non-RA. Of the 48 RA patients with positive 2P-BS finding, 85.4% (41/48) had early arthritis and 14.6% (7/48) had established arthritis. On physical examination, tenosynovitis was suspected in 21.9% (88/402). A total of 56.8% (50/88) belonged to the RA group and 43.2% (38/88) to the non-RA group. The tenosynovitis pattern of 2P-BS and physical examination showed statistical difference and moderate agreement. The positive tenosynovitis pattern on 2P-BS represented up to 26.408 of odds ratio which was highest among the RA-associated factors. Conclusion Tenosynovitis pattern on 2P-BS was more commonly detected in the RA group and was more frequently associated with early arthritis pattern. Therefore, 2P-BS could give additional information for the detection of subclinical tenosynovitis in early or preclinical RA patients.
Collapse
Affiliation(s)
- Hyung Jin Choi
- 1Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04764 South Korea
| | - Soo Jin Lee
- 1Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04764 South Korea
| | - Ji Young Kim
- 2Department of Nuclear Medicine, Hanyang University Guri Hospital, 153 Kyougchun-ro, Guri-si, Gyeonggi-do 11923 South Korea
| | - Yoon-Kyoung Sung
- 3Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04764 South Korea
| | - Yun Young Choi
- 1Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04764 South Korea
| |
Collapse
|
|
11
|
Rong Y, Ren H, Ding X. MRI and Bone Scintigraphy for Breast Cancer Bone Metastase: A Meta-analysis. Open Med (Wars) 2019; 14:317-323. [PMID: 30931397 PMCID: PMC6434664 DOI: 10.1515/med-2019-0029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/09/2019] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to compare the diagnostic value of magnetic resonance image (MRI) and bone scintigraphy (BS) in the diagnosis of breast cancer bone metastases. Methods Searching in the databases including PubMed, Embase about the comparative study of MRI and bone scintigraphy in the diagnosis of breast cancer bone metastases during 2000~2018. After we screened further, the extracted effective data were calculated by Meta-Disc 1.4 software. Results We obtained 4 articles. The pooled estimates for sensitivity of MRI, BS were 0.99 (95% CI, [0.95, 1.00]) and 0.93 (95% CI, [0.88, 0.97]) respectively; For specificity were 0.99 (95% CI, [0.95, 1.00]) and 0.86 (95% CI, [0.79, 0.92]) respectively. The AUC of SROC curve for MRI and BS were 0.9948 and 0.9675 respectively. Conclusion MRI remains to be a satisfactory method for the diagnosis of breast cancer bone metastases and should first be considered for patients.
Collapse
Affiliation(s)
- Yue Rong
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Hangzhou China
| | - Hong Ren
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Hangzhou China
| | - Xianjun Ding
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Hangzhou China
| |
Collapse
|
|
12
|
Early and Delayed 99mTc-MDP SPECT/CT Findings in Rheumatoid Arthritis and Osteoarthritis. Clin Nucl Med 2018; 42:e480-e481. [PMID: 28872556 DOI: 10.1097/rlu.0000000000001839] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of a 74-year-old man with seropositive rheumatoid arthritis (RA) and radiographic osteoarthritis (OA) who underwent dual-phase high-resolution Tc-MDP SPECT/CT. Early radiotracer enhancement was noted in 2 RA joints of the right hand, both presenting with a ring-like uptake pattern around the joint, consistent with synovitis. Insignificant early enhancement was noted at the first carpometacarpal joint, despite presentation of CT features of OA. The delayed-phase enhancement patterns were distinct, showing asymmetry in RA joints, but a symmetric, joint-centered pattern for the OA joint.
Collapse
|
|
13
|
Snekhalatha U, Rajalakshmi T, Gopikrishnan M, Gupta N. Computer-based automated analysis of X-ray and thermal imaging of knee region in evaluation of rheumatoid arthritis. Proc Inst Mech Eng H 2017; 231:1178-1187. [PMID: 29076764 DOI: 10.1177/0954411917737329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim and objectives of the study are as follows: (1) to perform automated segmentation of knee X-ray images using fast greedy snake algorithm and feature extraction using gray level co-occurrence matrix method, (2) to implement automated segmentation of knee thermal image using RGB segmentation method and (3) to compare the features extracted from the segmented knee region of X-ray and thermal images in rheumatoid arthritis patients using a biochemical method as standard. In all, 30 rheumatoid arthritis patients and 30 age- and sex-matched healthy volunteers were included in the study. X-ray and thermography images of knee regions were acquired, and biochemical tests were carried out subsequently. The X-ray images were segmented using fast greedy snake algorithm, and feature extractions were performed using gray level co-occurrence matrix method. The thermal image was segmented using RGB-based segmentation method and statistical features were extracted. Statistical features extracted after segmentation from X-ray and thermal imaging of knee region were correlated with the standard biochemical parameters. The erythrocyte sedimentation rate shows statistically significant correlations (p < 0.01) with the X-ray parameters such as joint space width and % combined cortical thickness. The skin surface temperature measured from knee region of thermal imaging was highly correlated with erythrocyte sedimentation rate. Among all the extracted features namely mean, variance, energy, homogeneity and difference entropy depict statistically significant percentage differences between the rheumatoid arthritis and healthy subjects. From this study, it was observed that thermal infrared imaging technique serves as a potential tool in the evaluation of rheumatoid arthritis at an earlier stage compared to radiography. Hence, it was predicted that thermal imaging method has a competency in the diagnosis of rheumatoid arthritis by automated segmentation methods.
Collapse
Affiliation(s)
- U Snekhalatha
- 1 Department of Biomedical Engineering, Faculty of Engineering and Technology, SRM University, Chennai, India
| | - T Rajalakshmi
- 1 Department of Biomedical Engineering, Faculty of Engineering and Technology, SRM University, Chennai, India
| | - M Gopikrishnan
- 1 Department of Biomedical Engineering, Faculty of Engineering and Technology, SRM University, Chennai, India
| | - Nilkantha Gupta
- 2 Center for Environmental Nuclear Research, SRM University, Chennai, India
| |
Collapse
|
|
14
|
Martín Noguerol T, Luna A, Gómez Cabrera M, Riofrio AD. Clinical applications of advanced magnetic resonance imaging techniques for arthritis evaluation. World J Orthop 2017; 8:660-673. [PMID: 28979849 PMCID: PMC5605351 DOI: 10.5312/wjo.v8.i9.660] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/18/2017] [Accepted: 05/05/2017] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance imaging (MRI) has allowed a comprehensive evaluation of articular disease, increasing the detection of early cartilage involvement, bone erosions, and edema in soft tissue and bone marrow compared to other imaging techniques. In the era of functional imaging, new advanced MRI sequences are being successfully applied for articular evaluation in cases of inflammatory, infectious, and degenerative arthropathies. Diffusion weighted imaging, new fat suppression techniques such as DIXON, dynamic contrast enhanced-MRI, and specific T2 mapping cartilage sequences allow a better understanding of the physiopathological processes that underlie these different arthropathies. They provide valuable quantitative information that aids in their differentiation and can be used as potential biomarkers of articular disease course and treatment response.
Collapse
Affiliation(s)
| | - Antonio Luna
- MRI Unit, Clínica Las Nieves, SERCOSA, Health Time, 23007 Jaén, Spain
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH 44106, United States
| | | | - Alexie D Riofrio
- Department of Radiology, Duke Regional Hospital, Durham, NC 27710, United States
| |
Collapse
|
|
15
|
Shin SH, Kim SJ. Bone scintigraphy in patients with pain. Korean J Pain 2017; 30:165-175. [PMID: 28757916 PMCID: PMC5532523 DOI: 10.3344/kjp.2017.30.3.165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 11/24/2022] Open
Abstract
Nuclear medicine imaging is widely used in pain medicine. Low back pain is commonly encountered by physicians, with its prevalence from 49% to 70%. Computed tomography (CT) or magnetic resonance imaging (MRI) are usually used to evaluate the cause of low back pain, however, these findings from these scans could also be observed in asymptomatic patients. Bone scintigraphy has an additional value in patients with low back pain. Complex regional pain syndrome (CRPS) is defined as a painful disorder of the extremities, which is characterized by sensory, autonomic, vasomotor, and trophic disturbances. To assist the diagnosis of CRPS, three-phase bone scintigraphy is thought to be superior compared to other modalities, and could be used to rule out CRPS due to its high specificity. Studies regarding the effect of bone scintigraphy in patients with extremity pain have not been widely conducted. Ultrasound, CT and MRI are widely used imaging modalities for evaluating extremity pain. However, SPECT/CT has an additional role in assessing pain in the extremities.
Collapse
Affiliation(s)
- Seung Hyeon Shin
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Korea
| | - Seong Jang Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.,BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
|
16
|
Affiliation(s)
- Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Korea
| |
Collapse
|
|
17
|
|