Automatic computer-aided sacroiliac joint index analysis for bone scintigraphy

Bone scintigraphy helps to detect sacroiliitis before the radiographic changes. Nuclear medicine physicians interpret lesion on sacroiliac joint by the aid of sacroiliac joint-to-sacrum uptake ratios (sacroiliac joint index, SII). Usually, the SII is measured by manually drawing regions of interest (ROI) over the sacroiliac joints and sacrum, which is a tedious, time consuming, and highly operator dependent procedure. In this approach, we developed an automatic SII measurement program based on fuzzy sets histogram thresholding, anatomy-based image segmentation method and pelvis reference points located by morphological operations. To validate the program, the results of automatic SII measurement from 33 patients were compared with the results of manual SII measurement. For each patient, six SIIs representing the upper, middle, and low portions of the right and left SIIs were obtained. Totally, 198 SIIs were included for linear regression, bias, and precision analyses. The coefficient of determination (R²) between our approach and 2 medical experts' manual measurements are 0.923 and 0.917 respectively. The predictive performance (bias, precision) shows a good agreement result. From the result of this study, we expect that this automatic computer-aided approach may be applied to help nuclear medicine physicians in sacroiliitis interpretation.