Scoring systems of quantitative bone scanning in prostate cancer: historical overview, current status and future perspectives.

Whole-body bone scintigraphy using technetium-99m-methylene-diphosphonate ((99m)Tc-MDP) is the most widely used radionuclide imaging modality applied in patients with prostate cancer. With this technique, the choice of methods to estimate the extend of the metastatic disease on the skeletal system includes various different approaches, classified in two main categories: First, the quantitative measurements of tracer uptake, defined either as the percentage of the injected dose of tracer, or as the more complicated plasma clearance techniques and second, the various semi-quantitative scoring systems of the bone scan images. These scoring systems can be based either on visual counting of bone lesions, or on the estimation of a numerical index that expresses the fractional involvement of each bone by tumour, called "Bone Scan Index" (BSI); the latter can be produced either visually (manually) or by the more sophisticated techniques of fully- or semi-automated (computerized) forms. In this review, a brief chronological overview of the aforementioned methods is presented, along with the main advantages, drawbacks and the prognostic implications of each method. There remains, however, the challenge of defining, developing and validating the optimal measurement methodology in order these scoring systems to obtain a wider clinical use.