The bone scan index (BSI), initially introduced for metastatic prostate cancer, quantifies the osseous tumor load from planar bone scans. Following the basic idea of radiomics, this method incorporates specific deep-learning techniques (artificial neural network) in its development to provide automatic calculation, feature extraction, and diagnostic support. As its performance in tumor entities, not including prostate cancer, remains unclear, our aim was to obtain more data about this aspect. The results of BSI evaluation of bone scans from 951 consecutive patients with different tumors were retrospectively compared to clinical reports (bone metastases, yes/no). Statistical analysis included entity-specific receiver operating characteristics to determine optimized BSI cut-off values. In addition to prostate cancer (cut-off = 0.27%, sensitivity (SN) = 87%, specificity (SP) = 99%), the algorithm used provided comparable results for breast cancer (cut-off 0.18%, SN = 83%, SP = 87%) and colorectal cancer (cut-off = 0.10%, SN = 100%, SP = 90%). Worse performance was observed for lung cancer (cut-off = 0.06%, SN = 63%, SP = 70%) and renal cell carcinoma (cut-off = 0.30%, SN = 75%, SP = 84%). The algorithm did not perform satisfactorily in melanoma (SN = 60%). For most entities, a high negative predictive value (NPV ≥ 87.5%, melanoma 80%) was determined, whereas positive predictive value (PPV) was clinically not applicable. Automatically determined BSI showed good sensitivity and specificity in prostate cancer and various other entities. Particularly, the high NPV encourages applying BSI as a tool for computer-aided diagnostic in various tumor entities.

Background: in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET), the mTOR inhibitor everolimus is associated with significant improvement in progression-free survival (PFS). This study evaluated the lesional asphericity (ASP) in pretherapeutic somatostatin receptor (SSR) imaging as the first imaging-based prognostic marker for PFS. Methods: this retrospective bicentric cohort study included 30 patients (f = 13, median age, 66.5 (48–81) years) with pretherapeutic [¹¹¹In-DTPA⁰]octreotide scintigraphy (Octreoscan^®). ASP of functional volumes of up to three leading lesions per patient (n = 74) was calculated after semiautomatic, background-adapted segmentation. Uni- and multivariable Cox regression regarding PFS for clinical factors and the maximum ASP per patient was obtained. Results: all 30 patients showed metachronous or progressive liver metastases. ASP, primary tumor site, metastases pattern, and prior peptide receptor radionuclide therapy (PRRT) were significantly associated with PFS in univariable Cox regression. Only ASP > 12.9% (hazard ratio (HR), 3.33; p = 0.024) and prior PRRT (HR, 0.35; p = 0.043) remained significant in multivariable Cox. Median PFS was 6.7 months for ASP > 12.9% (95% confidence interval (CI), 2.1–11.4 months) versus 14.4 (12.5–16.3) months for ASP ≤ 12.9% (log-rank, p = 0.028). Conclusion: pretherapeutic ASP of SSR positive lesions independently predicted PFS for treatment with everolimus in GEP-NET. ASP may supplement risk-benefit assessment before patient inclusion to treatment.

To analyze the impact of functional magnetic resonance urography (fMRU) on the therapeutic management in infants with complex obstructive uropathy (OU) compared to the conventional diagnostic algorithm [CDA, ultrasound, radioisotope nephrography (RN)]. Retrospective analysis on 10 consecutive infants [female, n=3; male, n=7; age, 10.7 (2–17) months] with OU. Patients were examined according to CDA. If CDA revealed inconclusive results, fMRU was performed additionally. Split kidney function was assessed by RN [single kidney function (SKF)] and fMRU [volumetric differential renal function (vDRF)]. Findings were presented to an interdisciplinary truth-panel in a 2-step decision process (with and without fMRU). Clinical decision was determined. CDA indicated surgical intervention in 8 patients and conservative treatment in 2. Information by fMRU changed treatment strategy in 3 patients and led to the modification of the initially chosen surgical approach in 8 cases. The comparison of SKF and vDRF was not possible in 1 patient, whereas concordance was observed in 7 patients. SKF and vDRF differed >5% in 2 patients. fMRU has potential to improve therapeutic management of OU in infants. If surgical treatment is advised, the morphological information by fMRU has to be emphasized. Regarding kidney function estimation preliminary results are encouraging. Analyse des Einflusses der funktionellen Magnetresonanz-Urografie (fMRU) auf das Therapiemanagement bei Kindern mit komplexer obstruktiver Uropathie im Vergleich zum konventionellen diagnostischen Algorithmus [KDA, Ultraschall, Nierensequenzszintigrafie (NSS)] Retrospektive Analyse von 10 pädiatrischen Patienten mit obstruktiver Uropathie [weiblich, n=3; männlich, n=7; Alter, 10,7 (2–17) Monate]. Die Patienten wurden gemäß dem KDA untersucht. Bei uneindeutigen Ergebnissen des KDA wurde zusätzlich eine fMRU-Untersuchung durchgeführt. Die seitengetrennte Nierenfunktion wurde mittels NSS und fMRU ermittelt und einander gegenübergestellt. Die Befunde wurden einem interdisziplinären Truth-Panel in einem 2-stufigen Entscheidungsprozess zur Verfügung gestellt (mit und ohne fMRU). Gemäß KDA wurde durch das Truth-Panel bei 8 Patienten eine chirurgische und in 2 Patienten eine konservative Therapie vorgeschlagen. Die Informationen aus der fMRU änderten die Therapiestrategie bei 3 Patienten und führten bei 8 Patienten zu einer Modifikation der initial gewählten chirurgischen Herangehensweise. Der Vergleich der seitengetrennten Nierenfunktion aus NSS und fMRU zeigte bei 7 Patienten konkordante und bei 2 Patienten diskordante (Differenz > 5%) Werte. In einem Fall war ein Vergleich nicht möglich. Die fMRU hat das Potenzial, das therapeutische Management einer obstruktiven Uropathie im Kindesalter zu verbessern. Im Falle einer chirurgischen Behandlung müssen vor allem die detaillierten morphologischen Informationen, die die fMRU zur Verfügung stellt, berücksichtigt werden. Bezüglich der Abschätzung der seitengetrennten Nierenfunktion sind diese initialen Ergebnisse ermutigend. ^* Both authors contributed equally.