Lars Edenbrandt

Skåne University Hospital, Malmö, Skåne, Sweden

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Publications (170)385.24 Total impact

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    ABSTRACT: ODM-201, a new-generation androgen receptor inhibitor, has shown clinical efficacy in prostate cancer (PCa). Quantitative methods are needed to accurately assess changes in bone as a measurement of treatment response. The Bone Scan Index (BSI) reflects the percentage of skeletal mass a given tumour affects.
    No preview · Article · Feb 2016
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    ABSTRACT: The interpretation of myocardial perfusion scintigraphy (MPS) largely relies on visual assessment by the physician of the localization and extent of a perfusion defect. The aim of this study was to introduce the concept of the perfusion vector as a new objective quantitative method for further assisting the visual interpretation and to test the concept using simulated MPS images as well as patients. The perfusion vector is based on calculating the difference between the anatomical centroid and the perfusion center of gravity of the left ventricle. Simulated MPS images were obtained using the SIMIND Monte Carlo program together with XCAT phantom. Four different-sized anterior and four lateral defects were simulated, and perfusion vector components x-, y-, and z-axes were calculated. For the patient study, 40 normal and 80 abnormal studies were included. Perfusion vectors were compared between normal and abnormal (apical, inferior, anterior, and lateral ischemia or infarction) studies and also correlated to the defect size. For simulated anterior defects, the stress perfusion vector component on the y-axis (anterior-inferior direction) increased in proportion to the defect size. For the simulated lateral defects, the stress perfusion vector component on the x-axis (septal-lateral direction) decreased in proportion to the defect size. When comparing normal and abnormal patients, there was a statistically significant difference for the stress perfusion vector on the x-axis for apical and lateral defects; on the y-axis for apical, inferior, and lateral defects; and on the z-axis (basal-apical direction) for apical, anterior, and lateral defects. A significant difference was shown for the difference vector magnitude (stress/rest) between normal and ischemic patients (p = 0.001) but not for patients with infarction. The correlation between the defect size and stress vector magnitude was also found to be significant (p < 0.001). The concept of the perfusion vector introduced in this study is shown to have potential in assisting the visual interpretation in MPS studies. Further studies are needed to validate the concept in patients.
    Preview · Article · Dec 2015 · EJNMMI Research
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    ABSTRACT: Myocardial perfusion scintigraphy (MPS) is a clinically useful noninvasive imaging modality for diagnosing patients with suspected coronary artery disease. By utilizing gated MPS, the end diastolic volume (EDV) and end systolic volume (ESV) can be measured and the ejection fraction (EF) calculated, which gives incremental prognostic value compared with assessment of perfusion only. The aim of this study was to evaluate the inter-departmental variability of EF, ESV, and EDV during gated MPS in Sweden. Seventeen departments were included in the study. The SIMIND Monte Carlo (MC) program together with the XCAT phantom was used to simulate three patient cases with different EDV, ESV, and EF. Individual simulations were performed for each department, corresponding to their specific method of performing MPS. Images were then sent to each department and were evaluated according to clinical routine. EDV, ESV, and EF were reported back. There was a large underestimation of EDV and ESV for all three cases. Mean underestimation for EDV varied between 26% and 52% and for ESV between 15% and 60%. EF was more accurately measured, but mean bias still varied between an underestimation of 24% to an overestimation of 14%. In general, the intra-departmental variability for EDV, ESV, and EF was small, whereas inter-departmental variability was larger. Left ventricular volumes were generally underestimated, whereas EF was more accurately estimated. There was, however, large inter-departmental variability.
    Full-text · Article · Dec 2015
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    ABSTRACT: A reproducible and quantitative imaging biomarker to standardize the evaluation of changes in bone scans is an unmet need for prostate cancer patients with skeletal metastasis. Here we have performed a series of analytical validation studies to evaluate the performance of the automated Bone Scan Index (BSI) as an imaging biomarker in patients with metastatic prostate cancer (mPCa). Three separate analytical studies were performed to evaluate accuracy, precision, and reproducibility of automated BSI. Simulation Study: Bone scan simulations with pre-defined tumor burdens were created to assess accuracy and precision. Fifty bone scans were simulated with a tumor burden ranging from low to high disease confluence (0.10 to 13.0 BSI). A second group of 50 scans was divided into 5 subgroups, each containing 10 simulated bone scans, corresponding to BSI values of 0.5, 1.0, 3.0, 5.0 and 10.0. Repeat Bone Scan Study: To assess the reproducibility in routine clinical setting, two repeat bone scans were obtained from mPCa patients after a single 600 MBq (99m)Tc MDP injection. Follow-up Bone Scan Study: Two follow-up bone scans of mPCa patients were analyzed to compare the inter-observer variability of the automated BSI with that of the qualitative visual reads in assessing changes between the bone scans. The automated BSI was calculated using the software EXINI boneBSI. The results were evaluated using linear regression, Pearson's correlation, Cohen's kappa (κ) measurement, coefficient of variation and standard deviation (SD). Linearity of the automated BSI in the range of 0.10 to 13.0 was confirmed, and Pearson's correlation was observed at 0.995 (N = 50, 95% CI 0.99-0.99, P < 0.0001). The mean coefficient of variation was less than 20%. The mean BSI difference between the two repeat bone scans of 35 patients was 0.05 (SD=0.15), with an upper confidence limits at 0.30. The inter-observer agreement in the automated BSI was more consistent (κ=0.96, P < 0.0001) than the qualitative visual assessment of the changes (κ=0.70, P < 0.0001) in bone scans of 173 patients. The automated BSI is a consistent imaging biomarker with performance characteristics that can standardize the quantitative changes in bone scans of patients with mPCa. Copyright © 2015 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
    No preview · Article · Aug 2015 · Journal of Nuclear Medicine
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    ABSTRACT: Background: While area detector computed tomography (ADCT) is a useful tool for coronary artery disease (CAD) evaluation, myocardial perfusion imaging (MPI) with single photon emission computed tomography is a well-established method of predicting functional relevance of CAD. Purpose: We assess the usefulness for decision making using both ADCT and MPI and discussed from the standpoint of cost for diagnostic work-up and contrast agent. Method: Between January, 2013 to September, 2014, 78 patients underwent both ADCT and MPI within two months were analyzed their therapeutic strategy. From ADCT, severity of stenosis was divided non-significant(less than 50%), moderate (over or equal to 50% and less than 75%) and severe (over or equal to 75%). Summed difference score of MPI was judged as ischemia positive. Result: Table showed the result and executed treatment strategy. Patients with significant stenosis by ADCT were 40 patients (51.3%) and patients with ischemia positive were 25 patients (33.8%). Invasive revasculization was performed higher (82.3%, p<0.01) for the patients with significant stenosis and ischemia than moderate stenosis with ischemia (25%) or significant stenosis without ischemia (39.1%). Before taking invasive therapy, examination with ADCT and MPI saved 63700 yen and about 100ml of contrast agent in each case based study as it was compared with the case with ADCT and coronary angiography without MPI in spite of slightly higher radiation dose (4mSv). Conclusion: The combined use of ADCT and MPI could choose effectively treatment strategy of CAD with a reduction of cost and contrast agent.
    Full-text · Conference Paper · May 2015
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    ABSTRACT: To evaluate the Bone Scan Index (BSI) for prediction of castration resistance and prostate cancer specific survival. In a retrospective material, we used a novel computer-assisted software for automated detection/quantification of bone metastases by BSI. Prostate cancer patients are M-staged by whole-body bone scintigraphy (WBS) and categorized as M0 or M1. Within the M1 group, there is a wide range of clinical outcomes. The BSI was introduced a decade ago providing quantification of bone metastases by estimating the percentage of bone involvement. Being too time consuming, it never gained widespread clinical use. A total of 88 patients with prostate cancer awaiting initiation of androgen deprivation due to metastases were included. WBS was performed using a two-headed gamma camera. BSI was obtained using the automated platform EXINI bone (EXINI Diagnostics AB, Lund, Sweden). In Cox proportional hazard models, time to castration resistant prostate cancer (CRPC) and prostate cancer specific survival were modelled as the dependent variables, whereas PSA, Gleason score and BSI were used as explanatory factors. For Kaplan-Meier estimates, BSI groups were dichotomously split into: BSI <1 and BSI ≥ 1. Discrimination between prognostic models was explored using the concordance index (C-index). The mean age of the patients was 72 years (range 52-92), the median PSA level was 73 μg/L (range 4-5740), the average Gleason score was 7.7 (range 2-10), and the mean BSI was 1.0 (range 0-9.2). During a mean follow-up of 26 months (range 8-49), 48 patients became castration resistant and 15 died, the majority (13) of prostate cancer. In multivariate analysis including PSA, Gleason score and BSI, only prediction by BSI was statistically significant. This was true both in terms of time to CRPC (HR=1.45; 95%CI: 1.22-1.74; C-index increase from 0.49 to 0.69) and with regard to prostate cancer-specific survival (HR=1.34; 95%CI: 1.07-1.67; C-index increase from 0.76 to 0.95). BSI obtained by a novel automated computer-assisted algorithm appears to be a useful predictor of outcome with regard to time to CRPC and prostate cancer specific survival in patients with hormone sensitive metastatic prostate cancer. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    No preview · Article · Apr 2015 · BJU International
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    ABSTRACT: The purpose of this study was to apply an artificial neural network (ANN) in patients with coronary artery disease (CAD) and to characterize its diagnostic ability compared with conventional visual and quantitative methods in myocardial perfusion imaging (MPI).Methods and Results:A total of 106 patients with CAD were studied with MPI, including multiple vessel disease (49%), history of myocardial infarction (27%) and coronary intervention (30%). The ANN detected abnormal areas with a probability of stress defect and ischemia. The consensus diagnosis based on expert interpretation and coronary stenosis was used as the gold standard. The left ventricular ANN value was higher in the stress-defect group than in the no-defect group (0.92±0.11 vs. 0.25±0.32, P<0.0001) and higher in the ischemia group than in the no-ischemia group (0.70±0.40 vs. 0.004±0.032, P<0.0001). Receiver-operating characteristics curve analysis showed comparable diagnostic accuracy between ANN and the scoring methods (0.971 vs. 0.980 for stress defect, and 0.882 vs. 0.937 for ischemia, both P=NS). The relationship between the ANN and defect scores was non-linear, with the ANN rapidly increased in ranges of summed stress score of 2-7 and summed defect score of 2-4. Although the diagnostic ability of ANN was similar to that of conventional scoring methods, the ANN could provide a different viewpoint for judging abnormality, and thus is a promising method for evaluating abnormality in MPI.
    Preview · Article · Apr 2015 · Circulation Journal
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    ABSTRACT: The report of an imaging procedure is a critical component of an examination, being the final and often the only communication from the interpreting physician to the referring or treating physician. Very limited evidence and few recommendations or guidelines on reporting imaging studies are available; therefore, an European position statement on how to report nuclear cardiology might be useful. The current paper combines the limited existing evidence with expert consensus, previously published recommendations as well as current clinical practices. For all the applications discussed in this paper (myocardial perfusion, viability, innervation, and function as acquired by single photon emission computed tomography and positron emission tomography or hybrid imaging), headings cover laboratory and patient demographics, clinical indication, tracer administration and image acquisition, findings, and conclusion of the report. The statement also discusses recommended terminology in nuclear cardiology, image display, and preliminary reports. It is hoped that this statement may lead to more attention to create well-written and standardized nuclear cardiology reports and eventually lead to improved clinical outcome.
    Full-text · Article · Feb 2015 · European Heart Journal Cardiovascular Imaging
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    Elin Trägårdh · Marcus Carlsson · Lars Edenbrandt

    Preview · Article · Dec 2014 · Journal of Nuclear Cardiology

  • No preview · Article · Nov 2014 · European Urology Supplements
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    ABSTRACT: Bone Scan Index (BSI) is a quantitative measurement of tumour burden in the skeleton calculated from bone scan images. When analysed at the time of diagnosis, it has been shown to provide prognostic information on survival in men with metastatic prostate cancer (PCa). In this study, we evaluated the prognostic value of BSI during androgen deprivation therapy (ADT). Prostate cancer patients who were at high risk of a poor outcome and who had undergone bone scan at the time of diagnosis and during ADT were recruited from two university hospitals for a retrospective study. BSI at baseline and follow-up were calculated using an automated software package (EXINIbonebsi). Associations between BSI, other prognostic biomarkers and overall survival (OS) were evaluated using a Cox proportional hazards regression model. One hundred forty-six PCa patients were included in the study. A total of 102 patient deaths were registered, with a median survival time after the follow-up bone scan of 2.4 years (interquartile range (IQR) =0.8 to 4.4). Both at baseline and during ADT, BSI was significantly associated with OS in univariate and multivariate analyses. When BSI was added to a prognostic base model including age, prostate-specific antigen, clinical tumour stage and Gleason score, the concordance index increased from 0.73 to 0.77 (p =0.0005) at baseline and from 0.77 to 0.82 (p <0.0001) during ADT. Automated BSI during ADT is an independent prognostic indicator of OS in PCa patients with bone metastasis. It represents an emerging imaging biomarker that can be used in a prognostic model for risk stratification of PCa patients at the time of diagnosis and at later stages of the disease. BSI could then help physicians identify patients who could benefit from more aggressive therapies.
    Full-text · Article · Oct 2014 · EJNMMI Research
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    ABSTRACT: Assessment of image analysis methods and computer software used in 99mTc-MAG3 dynamic renography is important to ensure reliable study results and ultimately the best possible care for patients. In this work, we present a national multicentre study of the quantification accuracy in 99mTc-MAG3 renography, utilizing virtual dynamic scintigraphic data obtained by Monte Carlo-simulated scintillation camera imaging of digital phantoms with time-varying activity distributions. Three digital phantom studies were distributed to the participating departments, and quantitative evaluation was performed with standard clinical software according to local routines. The differential renal function (DRF) and time to maximum renal activity (Tmax) were reported by 21 of the 28 Swedish departments performing 99mTc-MAG3 studies as of 2012. The reported DRF estimates showed a significantly lower precision for the phantom with impaired renal uptake than for the phantom with normal uptake. The Tmax estimates showed a similar trend, but the difference was only significant for the right kidney. There was a significant bias in the measured DRF for all phantoms caused by different positions of the left and right kidney in the anterior–posterior direction. In conclusion, this study shows that virtual scintigraphic studies are applicable for quality assurance and that there is a considerable uncertainty associated with standard quantitative parameters in dynamic 99mTc-MAG3 renography, especially for patients with impaired renal function.
    No preview · Article · Oct 2014 · Clinical Physiology and Functional Imaging
  • L. Augustinsson · O. Thorsson · M. Reza · P. Wollmer · L. Edenbrandt

    No preview · Conference Paper · Oct 2014
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    ABSTRACT: Introduction Drug development and clinical decision making for patients with metastatic prostate cancer (PC) have been hindered by a lack of quantitative methods of assessing changes in bony disease burden that are associated with overall survival (OS). Bone scan index (BSI), a quantitative imaging biomarker of bone tumor burden, is prognostic in men with metastatic PC. We evaluated an automated method for BSI calculation for the association between BSI over time with clinical outcomes in a randomized double-blind trial of tasquinimod (TASQ) in men with metastatic castration-resistant PC (mCRPC). Methods Bone scans collected during central review from the TASQ trial were analyzed retrospectively using EXINIboneBSI, an automated software package for BSI calculation. Associations between BSI and other prognostic biomarkers, progression-free survival, OS, and treatment were evaluated over time. Results Of 201 men (57 TASQ and 28 placebo), 85 contributed scans at baseline and week 12 of sufficient quality. Baseline BSI correlated with prostate-specific antigen and alkaline phosphatase levels and was associated with OS in univariate (hazard ratio [HR] = 1.42, P = 0.013) and multivariate (HR = 1.64, P<0.001) analyses. BSI worsening at 12 weeks was prognostic for progression-free survival (HR = 2.14 per BSI doubling, P<0.001) and OS (HR = 1.58, P = 0.033) in multivariate analyses including baseline BSI and TASQ treatment. TASQ delayed BSI progression. Conclusions BSI and BSI changes over time were independently associated with OS in men with mCRPC. A delay in objective radiographic bone scan progression with TASQ is suggested; prospective evaluation of BSI progression and response criteria in phase 3 trials of men with mCRPC is warranted.
    No preview · Article · Sep 2014 · Urologic Oncology
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    Jonas Kalderstam · May Sadik · Lars Edenbrandt · Mattias Ohlsson
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    ABSTRACT: Background A bone scan is a common method for monitoring bone metastases in patients with advanced prostate cancer. The Bone Scan Index (BSI) measures the tumor burden on the skeleton, expressed as a percentage of the total skeletal mass. Previous studies have shown that BSI is associated with survival of prostate cancer patients. The objective in this study was to investigate to what extent regional BSI measurements, as obtained by an automated method, can improve the survival analysis for advanced prostate cancer. Methods The automated method for analyzing bone scan images computed BSI values for twelve skeletal regions, in a study population consisting of 1013 patients diagnosed with prostate cancer. In the survival analysis we used the standard Cox proportional hazards model and a more advanced non-linear method based on artificial neural networks. The concordance index (C-index) was used to measure the performance of the models. Results A Cox model with age and total BSI obtained a C-index of 70.4%. The best Cox model with regional measurements from Costae, Pelvis, Scapula and the Spine, together with age, got a similar C-index (70.5%). The overall best single skeletal localisation, as measured by the C-index, was Costae. The non-linear model performed equally well as the Cox model, ruling out any significant non-linear interactions among the regional BSI measurements. Conclusion The present study showed that the localisation of bone metastases obtained from the bone scans in prostate cancer patients does not improve the performance of the survival models compared to models using the total BSI. However a ranking procedure indicated that some regions are more important than others.
    Preview · Article · Jul 2014 · BMC Medical Imaging
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    ABSTRACT: The aim of this study was to investigate the diagnostic ability of a completely automated computer-assisted diagnosis (CAD) system to detect metastases in bone scans by two patterns: one was per region, and the other was per patient. This study included 406 patients with suspected metastatic bone tumors who underwent whole-body bone scans that were analyzed by the automated CAD system. The patients were divided into four groups: a group with prostatic cancer (N = 71), breast cancer (N = 109), males with other cancers (N = 153), and females with other cancers (N = 73). We investigated the bone scan index and artificial neural network (ANN), which are parameters that can be used to classify bone scans to determine whether there are metastases. The sensitivities, specificities, positive predictive value (PPV), negative predictive value (NPV), and accuracies for the four groups were compared. Receiver operating characteristic (ROC) analyses of region-based ANN were performed to compare the diagnostic performance of the automated CAD system. There were no significant differences in the sensitivity, specificity, or NPV between the four groups. The PPVs of the group with prostatic cancer (51.0 %) were significantly higher than those of the other groups (P < 0.01). The accuracy of the group with prostatic cancer (81.5 %) was significantly higher than that of the group with breast cancer (68.6 %) and the females with other cancers (65.9 %) (P < 0.01). For the evaluation of the ROC analysis of region-based ANN, the highest Az values for the groups with prostatic cancer, breast cancer, males with other cancers, and females with other cancers were 0.82 (ANN = 0.4, 0.5, 0.6, 0.7, and 0.8), 0.83 (ANN = 0.7), 0.81 (ANN = 0.5), and 0.81 (ANN = 0.6), respectively. The special CAD system "BONENAVI" trained with a Japanese database appears to have significant potential in assisting physicians in their clinical routine. However, an improved CAD system depending on the primary lesion of the cancer is required to decrease the proportion of false-positive findings.
    No preview · Article · Feb 2014 · Annals of Nuclear Medicine
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    ABSTRACT: The European Society of Cardiology recommends that patients with >10% area of ischemia should receive revascularization. We investigated inter-observer variability for the extent of ischemic defects reported by different physicians and by different software tools, and if inter-observer variability was reduced when the physicians were provided with a computerized suggestion of the defects. Twenty-five myocardial perfusion single photon emission computed tomography (SPECT) patients who were regarded as ischemic according to the final report were included. Eleven physicians in nuclear medicine delineated the extent of the ischemic defects. After at least two weeks, they delineated the defects again, and were this time provided a suggestion of the defect delineation by EXINI HeartTM (EXINI). Summed difference scores and ischemic extent values were obtained from four software programs. The median extent values obtained from the 11 physicians varied between 8% and 34%, and between 9% and 16% for the software programs. For all 25 patients, mean extent obtained from EXINI was 17.0% (+/- standard deviation (SD) 14.6%). Mean extent for physicians was 22.6% (+/- 15.6%) for the first delineation and 19.1% (+/- 14.9%) for the evaluation where they were provided computerized suggestion. Intra-class correlation (ICC) increased from 0.56 (95% confidence interval (CI) 0.41-0.72) to 0.81 (95% CI 0.71-0.90) between the first and the second delineation, and SD between physicians were 7.8 (first) and 5.9 (second delineation). There was large variability in the estimated ischemic defect size obtained both from different physicians and from different software packages. When the physicians were provided with a suggested delineation, the inter-observer variability decreased significantly.
    Full-text · Article · Jan 2014 · BMC Medical Imaging
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    Asal Shafi · Ola Thorsson · Lars Edenbrandt
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    ABSTRACT: Bone scintigraphy is usually obtained as a whole-body scan producing 2 images: an anterior view and a posterior view. Sometimes abnormal findings in the spine are difficult to distinguish on whole-body bone scans. SPECT/CT may be performed to localize and interpret a lesion correctly and to help differentiate between benign and metastatic lesions. The assessment of whether SPECT/CT is needed is usually made by a physician. The aim of this study was to evaluate our new routine for nuclear medicine technologists to determine when to add SPECT/CT to whole-body bone scintigraphy. A 3-part educational course was developed for the nuclear medicine technologists. The first part was to learn criteria for when SPECT/CT should be added to a whole-body bone scan. The second part was to review a selection of training whole-body bone scans illustrating the criteria. The third part was to pass a test of whether whole-body bone scans should be supplemented by SPECT/CT. The nuclear medicine technologists and the physicians agreed that SPECT/CT was required in 63 cases and not required in 27 cases. The resulting percentage agreement was 90%, and the κ value was 0.77. There was disagreement in 10 cases. In 6 of these cases only the nuclear medicine technologists wanted to add SPECT/CT, and in 4 of these cases only the physicians wanted to add SPECT/CT. After participating in the training course developed in this project, the nuclear medicine technologists were able to decide whether a SPECT/CT study is needed. An implication of this result is that the effectiveness of the nuclear medicine department should be improved after our new routine is implemented. The successful outcome of this project may stimulate departments to take on similar quality-improvement projects in the future.
    Preview · Article · Jan 2014 · Journal of Nuclear Medicine Technology
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    ABSTRACT: The aim of this myocardial perfusion imaging (MPI) study was to compare the diagnostic performance of two computer-aided diagnosis (CAD) systems, EXINI Heart(TM) (EXINI), and PERFEX(TM) (PERFEX) Emory Cardiac Toolbox (ECT), and the summed stress score (SSS) values from both software packages. We studied 1,052 consecutive patients who underwent 2-day stress/rest (99m)Tc-sestamibi MPI studies. The reference standard classifications for the MPI studies were obtained from three experienced physicians who separately classified all cases regarding the presence or absence of ischemia and/or infarction. Automatic processing was carried out using EXINI and PERFEX to obtain CAD results and SSS values based on the 17-segment model. The three experts' classifications showed ischemia in 257 patients and abnormal studies, i.e., either ischemia or infarction or both, in 318 patients. Accuracy was significantly higher in EXINI than in PERFEX, regarding both the detection of ischemia (87.4 vs 77.6%; P < 0.0001) and the detection of abnormal studies (91.6 vs 67.9%; P < 0.0001). EXINI's CAD system showed a higher specificity than its SSS values (86.8 vs 73.6%; P < 0.0001) at the same level of sensitivity. EXINI demonstrated greater diagnostic accuracy for detection of ischemia and abnormal studies than did PERFEX. EXINI CAD also outperformed its SSS analysis.
    No preview · Article · Jan 2014 · Journal of Nuclear Cardiology
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    ABSTRACT: Artificial neural network (ANN)-based bone scan index (BSI), a marker of the amount of bone metastasis, has been shown to enhance diagnostic accuracy and reproducibility but is potentially affected by training databases. The aims of this study were to revise the software using a large number of Japanese databases and to validate its diagnostic accuracy compared with the original Swedish training database. The BSI was calculated with EXINIbone (EB; EXINI Diagnostics) using the Swedish training database (n = 789). The software using Japanese training databases from a single institution (BONENAVI version 1, BN1, n = 904) and the revised version from nine institutions (version 2, BN2, n = 1,532) were compared. The diagnostic accuracy was validated with another 503 multi-center bone scans including patients with prostate (n = 207), breast (n = 166), and other cancer types. The ANN value (probability of abnormality) and BSI were calculated. Receiver operating characteristic (ROC) and net reclassification improvement (NRI) analyses were performed. The ROC analysis based on the ANN value showed significant improvement from EB to BN1 and BN2. In men (n = 296), the area under the curve (AUC) was 0.877 for EB, 0.912 for BN1 (p = not significant (ns) vs. EB) and 0.934 for BN2 (p = 0.007 vs. EB). In women (n = 207), the AUC was 0.831 for EB, 0.910 for BN1 (p = 0.016 vs. EB), and 0.932 for BN2 (p < 0.0001 vs. EB). The optimum sensitivity and specificity based on BN2 was 90% and 84% for men and 93% and 85% for women. In patients with prostate cancer, the AUC was equally high with EB, BN1, and BN2 (0.939, 0.949, and 0.957, p = ns). In patients with breast cancer, the AUC was improved from EB (0.847) to BN1 (0.910, p = ns) and BN2 (0.924, p = 0.039). The NRI using ANN between EB and BN1 was 17.7% (p = 0.0042), and that between EB and BN2 was 29.6% (p < 0.0001). With respect to BSI, the NRI analysis showed downward reclassification with total NRI of 31.9% (p < 0.0001). In the software for calculating BSI, the multi-institutional database significantly improved identification of bone metastasis compared with the original database, indicating the importance of a sufficient number of training databases including various types of cancers.
    Full-text · Article · Dec 2013 · EJNMMI Research

Publication Stats

3k Citations
385.24 Total Impact Points


  • 2011-2015
    • Skåne University Hospital
      Malmö, Skåne, Sweden
  • 2006-2015
    • University of Gothenburg
      • Department of Molecular and Clinical Medicine
      Goeteborg, Västra Götaland, Sweden
  • 1988-2015
    • Lund University
      • • Department of Clinical Sciences, Malmö
      • • Department of Clinical Physiology
      Lund, Skåne, Sweden
  • 2005-2012
    • Sahlgrenska University Hospital
      • Department of Cardiology
      Goeteborg, Västra Götaland, Sweden
  • 2002-2008
    • Malmö University
      Malmö, Skåne, Sweden
  • 1997
    • University of Florence
      Florens, Tuscany, Italy
  • 1994
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
  • 1992
    • Duke University Medical Center
      • Division of Cardiology
      Durham, North Carolina, United States