title: Longitudinal analysis of bone metabolism using SPECT/CT and (99m)Tc-diphosphono-propanedicarboxylic acid: comparison of visual and quantitative analysis.
abstract: BACKGROUND
  The therapy response of osseous metastases (OM) is commonly monitored by bone scintigraphies (BS). The aim of this study was to compare visual evaluation of changes in tracer uptake with quantitation in absolute units in OMs; 52 OMs from 19 patients who underwent BS with SPECT/CT at time points one and two (TP1/2) were analyzed retrospectively, with an average of 10.3 months between TP1 and 2. Tracer uptake in lesions was visually compared by two independent readers in both planar scintigraphies and SPECT/CT across both TPs and classified as regressive, stable, or progressive. Quantitative analysis was performed by measuring peak standardized uptake values (SUV). Based on quantitation, lesions were similarly classified as regressive (>30 % decrease), progressive (>30 % increase), or stable (rest). If available, uptake in reference regions in the lower thoracic or lumbar spine was used for normalization.
  
  
  RESULTS
  In OMs at TP1 and TP2, mean SUVpeak (±SD) was found to be 20.4 (±20.8) and 16.4 (±11.5), respectively. For the reference region, mean SUVmean was 5.6 (±1.9) and 4.9 (±2.2). Agreement between quantitative and visual assessment was only moderate, with an average Cohen's kappa of 0.42 for planar scintigraphy and 0.62 for SPECT/CT. Discrepancies occurred in between 11 and 22 of the 52 lesions, depending on the reader and whether planar or SPECT imaging was considered.
  
  
  CONCLUSIONS
  Compared to measuring uptake in absolute units, visual evaluation of skeletal scintigraphies for change in tumor metabolism yields inconsistent results in roughly one third of the cases.
authors.affiliation: Clinic of Nuclear Medicine, University of Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany. michael.beck@uk-erlangen.de.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0003-2523-6266
authors.initials: M
authors.lastname: Beck
authors.affiliation: Clinic of Nuclear Medicine, University of Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany.|Pattern Recognition Lab, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: James C
authors.initials: JC
authors.lastname: Sanders
authors.affiliation: Clinic of Nuclear Medicine, University of Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Ritt
authors.affiliation: Clinic of Nuclear Medicine, University of Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Reinfelder
authors.affiliation: Clinic of Nuclear Medicine, University of Erlangen-Nuremberg, Ulmenweg 18, 91054, Erlangen, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Kuwert
keywords: Absolute quantification; Bone scintigraphy; SPECT/CT; SUV