NIMSA

Bone Scan Index (BSI)

Bone Scan Index (BSI) was developed by a research group at the Memorial Sloan Kettering Cancer Center in New York as a method of expressing the tumour burden in bone as a percentage of the total skeletal mass and they showed that on-treatment change in BSI was strongly associated with overall survival for patients receiving chemotherapy. Their method of calculating BSI is manual, subjective, time-consuming and tedious, and this has limited the use of BSI outside the institution where it was developed.

Our contributions in this field have been innovative in that we have developed a fully automated method of bone scan analysis eliminating the need for operator manipulation. With our approach the BSI value will be the same in all hospitals performing this examination − an important feature for an imaging biomarker. We are currently working on analytical and clinical validation of BSI as part of an evidentiary process qualifying BSI as an imaging biomarker for prostate cancer in the context of clinical care and clinical trials.

The work has been performed in close collaboration with EXINI diagnostics AB and researchers at the Memorial Sloan Kettering Cancer Center in New York, Skåne University hospital in Malmö, Odense University Hospital in Malmö and Kanazawa University Hospital in Japan.

More info

A software for automated calculation of BSI is provided by EXINI diagnostics AB.

Publications

• Anand A, Heller G, Fox J, Danila DC, Bjartell A, Edenbrandt L, Larson SM, Scher HI, Morris MJ. Automated Bone Scan Index to Optimize Prostate Cancer Working Group Radiographic Progression Criteria for Men With Metastatic Castration-Resistant Prostate Cancer. Clin Genitourin Cancer. 2022 Feb 9 Online ahead of print.
• Anand A, Tragardh E, Edenbrandt L, Beckman L, Svensson JH, Thellenberg C, Widmark A, Kindblom J, Ullén A, Bjartell A. Radiographic Response to Ra-223 with Automated Bone Scan Index (aBSI) in Metastatic Castration Resistant Prostate Cancer (mCRPC) Patients. J Nucl Med. 2020 May;61(5):671-675.
• Reza M, Wirth M, Tammela T, Cicalese V, Veiga FG, Mulders P, Miller K, Tubaro A, Debruyne F, Patel A, Caris C, Witjes W, Thorsson O, Wollmer P, Edenbrandt L, Ohlsson M, Trägårdh E, Bjartell A. Automated Bone Scan Index as an Imaging Biomarker to Predict Overall Survival in the Zometa European Study/SPCG11. Eur Urol Oncol. 2019 Jun 8:S2588-9311(19)30069-0.
• Armstrong AJ, Anand A, Edenbrandt L, Bondesson E, Bjartell A, Widmark A, Sternberg CN, Pili R, Tuvesson H, Nordle Ö, Carducci MA, Morris MJ. Phase 3 Assessment of the Automated Bone Scan Index as a Prognostic Imaging Biomarker of Overall Survival in Men With Metastatic Castration-Resistant Prostate Cancer: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol. 2018;4(7):944-951.
• Nakajima K, Edenbrandt L, Mizokami A. Bone scan index: A new biomarker of bone metastasis in patients with prostate cancer. Int J Urol. 2017 Sep;24(9):668-673.
• Anand A, Morris MJ, Kaboteh R, Reza M, Trägårdh E, Matsunaga N, Edenbrandt L, Bjartell A, Larson SM, Minarik D. A Preanalytic Validation Study of Automated Bone Scan Index: Effect on Accuracy and Reproducibility Due to the Procedural Variabilities in Bone Scan Image Acquisition. J Nucl Med. 2016 Dec;57(12):1865-71.
• Anand A, Morris MJ, Larson SM, Minarik D, Josefsson A, Helgstrand JT, Oturai PS, Edenbrandt L, Røder MA, Bjartell A. Automated Bone Scan Index as a quantitative imaging biomarker in metastatic castration-resistant prostate cancer patients being treated with enzalutamide. EJNMMI Res. 2016 Dec;6(1):23.
• Reza M, Ohlsson M, Kaboteh R, Anand A, Franck-Lissbrant I, Damber JE, Widmark A, Thellenberg-Karlsson C, Budäus L, Steuber T, Eichenauer T, Wollmer P, Edenbrandt L, Trägårdh E, Bjartell A. Bone Scan Index as an Imaging Biomarker in Metastatic Castration-resistant Prostate Cancer: A Multicentre Study Based on Patients Treated with Abiraterone Acetate (Zytiga) in Clinical Practice. European Urology Focus 2016;2(5):540-546
• Reza M, Jones R, Aspegren J, Massard C, Mattila L, Mustonen M, Wollmer P, Trägårdh E, Bondesson E, Edenbrandt L, Fizazi, K, Bjartell A. 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. European Urology Focus 2016;2(5):547-552
• Anand A, Morris MJ, Kaboteh R, Båth L, Sadik M, Gjertsson P, Lomsky M, Edenbrandt L, Minarik D, Bjartell A. Analytic Validation of the Automated Bone Scan Index as an Imaging Biomarker to Standardize Quantitative Changes in Bone Scans of Patients with Metastatic Prostate Cancer. J Nucl Med. 2016 Jan;57(1):41-5.
• Poulsen MH, Rasmussen J, Edenbrandt L, Høilund-Carlsen PF, Gerke O, Johansen A, Lund L. Bone Scan Index predicts outcome in patients with metastatic hormone-sensitive prostate cancer. BJU Int. 2016 May;117(5):748-53.
• Reza M, Bjartell A, Ohlsson M, Kaboteh R, Wollmer P, Edenbrandt L, Trägårdh E. Bone Scan Index as a prognostic imaging biomarker during androgen deprivation therapy. EJNMMI Res. 2014 Oct 17;4:58.
• Armstrong AJ, Kaboteh R, Carducci MA, Damber JE, Stadler WM, Hansen M, Edenbrandt L, Forsberg G, Nordle Ö, Pili R, Morris MJ. Assessment of the bone scan index in a randomized placebo-controlled trial of tasquinimod in men with metastatic castration-resistant prostate cancer (mCRPC). Urol Oncol. 2014 Nov;32(8):1308-16.
• Kalderstam J, Sadik M, Edenbrandt L, Ohlsson M. Analysis of regional bone scan index measurements for the survival of patients with prostate cancer. BMC Med Imaging. 2014 Jul 10;14:24.
• Tokuda O, Harada Y, Ohishi Y, Matsunaga N, Edenbrandt L. Investigation of computer-aided diagnosis system for bone scans: a retrospective analysis in 406 patients. Ann Nucl Med. 2014 May;28(4):329-39.
• Nakajima K, Nakajima Y, Horikoshi H, Ueno M, Wakabayashi H, Shiga T, Yoshimura M, Ohtake E, Sugawara Y, Matsuyama H, Edenbrandt L. Enhanced diagnostic accuracy for quantitative bone scan using an artificial neural network system: a Japanese multi-center database project. EJNMMI Res. 2013 Dec 26;3(1):83.
• Kaboteh R, Gjertsson P, Leek H, Lomsky M, Ohlsson M, Sjöstrand K, Edenbrandt L. Progression of bone metastases in patients with prostate cancer - automated detection of new lesions and calculation of bone scan index. EJNMMI Res. 2013 Aug 16;3(1):64.
• Kaboteh R, Damber JE, Gjertsson P, Höglund P, Lomsky M, Ohlsson M, Edenbrandt L. Bone Scan Index: a prognostic imaging biomarker for high-risk prostate cancer patients receiving primary hormonal therapy. EJNMMI Res. 2013 Feb 6;3(1):9.
• Kikuchi A, Onoguchi M, Horikoshi H, Sjöstrand K, Edenbrandt L. Automated segmentation of the skeleton in whole-body bone scans: influence of difference in atlas. Nucl Med Commun. 2012 Sep;33(9):947-53.
• Horikoshi H, Kikuchi A, Onoguchi M, Sjöstrand K, Edenbrandt L. Computer-aided diagnosis system for bone scintigrams from Japanese patients: importance of training database. Ann Nucl Med. 2012 Oct;26(8):622-6.
• Ulmert D, Kaboteh R, Fox JJ, Savage C, Evans MJ, Lilja H, Abrahamsson PA, Björk T, Gerdtsson A, Bjartell A, Gjertsson P, Höglund P, Lomsky M, Ohlsson M, Richter J, Sadik M, Morris MJ, Scher HI, Sjöstrand K, Yu A, Suurküla M, Edenbrandt L, Larson SM. A novel automated platform for quantifying the extent of skeletal tumour involvement in prostate cancer patients using the Bone Scan Index. Eur Urol. 2012 Jul;62(1):78-84.
• Levren G, Sadik M, Gjertsson P, Lomsky M, Michanek A, Edenbrandt L. Relation between pain and skeletal metastasis in patients with prostate or breast cancer. Clin Physiol Funct Imaging. May;31(3):193-5, 2011.
• Sjöstrand K, Ohlsson M, Edenbrandt L. Statistical regularization of deformation fields for atlas-based segmentation of bone scintigraphy images. Med Image Comput Assist Interv. 12 (Pt 1): 664-71, 2009.
• Sadik M, Suurkula M, Höglund P, Järund A, Edenbrandt L. Improved classifications of planar whole-body bone scans using a computer-assisted diagnosis system: a multicenter, multiple-reader, multiple-case study. J Nucl Med 50(3):368-75, 2009
• Sadik M, Hamadeh I, Nordblom P, Suurkula M, Höglund P, Ohlsson M, Edenbrandt L. Computer-Assisted Interpretation of Planar Whole-Body Bone Scans. J Nucl Med. Dec;49(12):1958-65, 2008
• Sadik M, Suurkula M, Höglund P, Järund A, Edenbrandt L. Quality of planar whole-body bone scan interpretations-a nationwide survey. Eur J Nucl Med Mol Imaging. Aug;35(8):1464-72, 2008
• Sadik M, Jakobsson D, Olofsson F, Ohlsson M, Suurkula M, Edenbrandt L. A new computer-based decision-support system for the interpretation of bone scans. Nucl Med Commun. May;27(5):417-23, 2006