Development and Initial Validation of a Statistical Image Analysis Framework for Quantitative Bone SPECT/CT in Patients with Prostate Cancer

Background/Objectives: Quantitative bone single-photon emission computed tomography/computed tomography (SPECT/CT) enables standardized uptake value (SUV)-based assessment of skeletal tracer uptake; however, SUV does not directly indicate the degree of deviation from the physiological distribution at the corresponding anatomical location. This study aimed to develop a statistical image analysis software framework for quantitative bone SPECT/CT and perform its initial validation.

Methods

Eighty-one male patients who underwent quantitative bone SPECT/CT for suspected bone metastases from prostate cancer were retrospectively analyzed, including 49 without and 32 with bone metastases. The developed software integrated CT-based anatomical standardization, construction of a bone-specific normal database (NDB), and voxel-wise Z-score mapping. Thirty successfully standardized subjects without bone metastases were used to construct the NDB. Preliminary clinical validation included 75 reference skeletal regions of interest (ROIs) in the lumbar vertebrae and iliac bones from three independent subjects and 74 metastatic lesions from 19 patients.