Prevalence of clinically significant extraosseous findings on unenhanced CT portions of ¹⁸F-fluoride PET/CT bone scans (original) (raw)
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Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2004
18F-fluoride PET/CT was performed on 44 oncologic patients to evaluate its diagnostic accuracy in assessing malignant osseous involvement and in differentiating malignant from benign bone lesions. (18)F-fluoride PET and (18)F-fluoride PET/CT were interpreted separately. Lesions showing increased (18)F-fluoride uptake were categorized as malignant, benign, or inconclusive. The final diagnosis of lesions was based on histopathology, correlation with contemporaneous diagnostic CT or MRI, or clinical follow-up of at least 6 mo (mean, 10 +/- 3 mo). Increased (18)F-fluoride uptake was detected at 212 sites, including 111 malignant lesions, 89 benign lesions, and 12 lesions for which the final diagnosis could not be determined. In a lesion-based analysis, the sensitivity of PET alone in differentiating benign from malignant bone lesions was 72% when inconclusive lesions were considered false negative and 90% when inconclusive lesions were considered true positive. On PET/CT, 94 of 111 (85%...
Determination of Skeletal Tumor Burden on 18F-FLUORIDE Pet/CT
right femur = 3.90 ± 1.57. The average normal SUV for all 543 sites was 5.32 ± 0.99. Based on these values, a threshold of SUVmax=10 was chosen to exclude normal bone from the volumetric calculations. Semiautomated measurements of total fluoride activity above an SUV of 10 (TLF10 and FTV10) exhibited high inter-observer reproducibility, within ±0.77% and ±3.62% of the inter-reader average for TLF10 and FTV10, respectively. CONCLUSIONS: Determination of skeletal tumor burden with fluoride-PET/CT is feasible and highly reproducible. Using an SUV threshold of 10 excludes nearly all normal bone activity from volumetric calculations.
Journal of nuclear medicine technology, 2016
We describe the role of (18)F-sodium fluoride ((18)F-NaF) PET/CT bone scanning in the staging of breast and prostate cancer. (18)F-NaF PET was initially utilized as a bone scanning agent in the 1960s and early 1970s, however, its use was restricted by the then-available γ-cameras. The advent of hybrid PET/CT cameras in the late 1990s has shown a resurgence of interest in its use and role. After a brief introduction, this paper describes the radiopharmaceutical properties, dosimetry, pharmacokinetics, and mechanism of uptake of (18)F-NaF. The performance of (18)F-NaF PET/CT is then compared with that of conventional bone scintigraphy using current evidence from the literature. Strengths and weaknesses of (18)F-NaF PET/CT imaging are highlighted. Clinical examples of improved accuracy of diagnosis and impact on patient management are illustrated. Limitations of (18)F-NaF PET/CT imaging are outlined.
Journal of Nuclear Medicine
See an invited perspective on this article on page 1776. We prospectively evaluated and compared the diagnostic performance of 99m Tc-hydroxyethylene-diphosphonate (99m Tc-HDP) planar bone scintigraphy (pBS), 99m Tc-HDP SPECT/CT, 18 F-NaF PET/CT, and 18 F-NaF PET/MRI for the detection of bone metastases. Methods: One hundred seventeen patients with histologically proven malignancy referred for clinical pBS were prospectively enrolled. pBS and whole-body SPECT/CT were performed followed by 18 F-NaF PET/CT within 9 d. 18 F-NaF PET/MRI was also performed in 46 patients. Results: Bone metastases were confirmed in 16 patients and excluded in 101, which was lower than expected. The number of equivocal scans was significantly higher for pBS than for SPECT/CT and PET/CT (18 vs. 5 and 6, respectively; P 5 0.004 and 0.01, respectively). When equivocal readings were excluded, no statistically significant difference in sensitivity, specificity, positive predictive value, negative predictive value, or overall accuracy were found when comparing the different imaging techniques. In the per-patient analysis, equivocal scans were either assumed positive for metastases ("pessimistic analysis") or assumed negative for metastases ("optimistic analysis"). The percentages of misdiagnosed patients for the pessimistic analysis were 21%, 15%, 9%, and 7% for pBS, SPECT/CT, PET/CT, and PET/MRI, respectively. Corresponding figures for the optimistic analysis were 9%, 12%, 5%, and 7%. In those patients identified as having bone metastases according to the reference standard, SPECT/CT, 18 F-NaF PET/CT, and PET/MRI detected additional lesions compared with pBS in 31%, 63%, and 71%, respectively. Conclusion: 18 F-NaF PET/CT and whole-body SPECT/CT resulted in a significant reduction of equivocal readings compared with pBS, which implies an improved diagnostic confidence. However, the clinical benefit of using, for example, 18 F-NaF PET/CT or PET/MRI as compared with SPECT/CT and pBS in this patient population with a relatively low prevalence of bone metastases (14%) is likely limited. This conclusion is influenced by the low prevalence of patients with osseous metastases. There may well be significant differences in the sensitivity of SPECT/CT, PET/CT, and PET/MRI compared with pBS, but a larger patient population or a patient population with a higher prevalence of bone metastases would have to be studied to demonstrate this.
Australasian Radiology, 2004
Accurate staging of cancer has a critical role in optimal patient management. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) is superior to CT in the detection of local and distant metastases in patients with nonsmall cell lung cancer. Although Tc-99 m methylene diphosphonate (MDP) bone scanning is well established in the evaluation of bone metastases, there are conflicting reports on the use of FDG PET in the evaluation of skeletal metastases. We report on a patient with locally advanced lung carcinoma in whom FDG PET accurately identified previously unsuspected widespread asymptomatic bone metastases (bone scan and X-rays negative, confirmed on MRI). Assessment of glucose metabolism with FDG PET might represent a more powerful tool to detect bone metastases in lung cancer compared with conventional bone scans.
18F-Fluoride PET/CT for assessing bone involvement in prostate and breast cancer
Society of Nuclear Medicine Annual Meeting Abstracts, 2008
Objective To evaluate the accuracy of 18 F-fluoride PET/computed tomography (CT) to detect bone metastases (BMs) in a breast and prostate cancer population, using magnetic resonance imaging (MRI) or thin-slice CT as a gold standard. Methods We have prospectively included 34 patients with breast (N = 24) or prostate cancer (N = 10) at high risk of BMs. Whole-body PET/CT (low-dose CT) and bone scintigraphy (BS) with single photon emission CT were obtained for all 34 patients and the results compared with a radiological gold standard. Results Out of the 386 foci detected by PET/CT, 219 (56.7%) could be verified by CT or MRI. Eighty-six additional foci were detected by BS (n = 46) or seen only by CT (n = 9), MRI (n = 23), or both CT and MRI (n = 8). The total number of verified lesions was therefore 274 (58.1%), including 119 (43.4%) benign and 155 (56.6%) BM. The sensitivity, specificity, and accuracy of 18 F-fluoride PET/CT were 76, 84.2, and 80%, respectively. For BS, they were 44.8, 79.2, and 60%, respectively. Sensitivity significantly decreased for the lytic lesions. The accuracy of PET/CT was significantly superior to BS for pelvic and lumbar lesions. PET/CT provided a correct diagnosis (M + /M0) in 32 of 33 patients (one false positive) compared with 28 of 33 with BS (four false positive, one false positive). Conclusion 18 F-fluoride PET/CT is significantly more accurate than BS for detecting BMs from breast and prostate cancers. Nucl Med Commun
World journal of nuclear medicine, 2016
The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.
Skeletal PET with 18F-Fluoride: Applying New Technology to an Old Tracer
Journal of Nuclear Medicine, 2007
Although 18F-labeled NaF was the first widely used agent for skeletal scintigraphy, it quickly fell into disuse after the introduction of 99mTc-labeled bone-imaging agents. Recent comparative studies have demonstrated that 18F-fluoride PET is more accurate than 99mTc-diphosphonate SPECT for identifying both malignant and benign lesions of the skeleton. Combining 18Ffluoride PET with other imaging, such as CT, can improve the specificity and overall accuracy of skeletal 18F-fluoride PET and probably will become the routine clinical practice for 18Ffluoride PET. Although 18F-labeled NaF and 99mTc-diphosphonate have a similar patient dosimetry, 18Ffluoride PET offers shorter study times (typically less than 1 h), resulting in a more efficient workflow, improved patient convenience, and faster turnarounds of reports to the referring physicians. With the widespread availability of PET scanners and the improved logistics for the delivery of 18F radiopharmaceuticals, prior limitations to the routine use of 18F-fluoride bone imaging have largely been overcome. The favourable imaging performance and the clinical utility of 18Ffluoride PET, compared with 99mTc-diphosphonate scintigraphy, support the reconsideration of 18F-fluoride as a routine bone imaging agent.
18F-Fluoride Positron Emission Tomography and Positron Emission Tomography/Computed Tomography
Seminars in Nuclear Medicine, 2007
18 F-Fluoride is a positron-emitting bone-seeking agent, the uptake of which reflects blood flow and remodeling of bone. Assessment of 18 F-fluoride kinetics using quantitative positron emission tomography (PET) methods allows the regional characterization of lesions of metabolic bone diseases and the monitoring of their response to therapy. It also enables the assessment of bone viability and discrimination of uneventful and impaired healing processes of fractures, bone grafts and osteonecrosis. Taking advantage of the favorable pharmacokinetic properties of the tracer combined with the high performance of PET technology, static 18 F-fluoride PET is a highly sensitive imaging modality for detection of benign and malignant osseous abnormalities. Although 18 F-fluoride uptake mechanism corresponds to osteoblastic activity, it is also sensitive for detection of lytic and early marrow-based metastases, by identifying their accompanying reactive osteoblastic changes, even when minimal. The instant fusion of increased 18 F-fluoride uptake with morphological data of computed tomography (CT) using hybrid PET/CT systems improves the specificity of 18 F-fluoride PET in cancer patients by accurately differentiating between benign and malignant sites of uptake. The results of a few recent publications suggest that 18 F-fluoride PET/CT is a valuable modality in the diagnosis of pathological osseous conditions in patients also referred for nononcologic indications. 18 F-fluoride PET and PET/CT are, however, not widely used in clinical practice. The limited availability of 18 F-fluoride and of PET and PET/CT systems is a major factor. At present, there are not enough data on the cost-effectiveness of 18 F-fluoride PET/CT. However, it has been stated by some experts that 18 F-fluoride PET/CT is expected to replace 99m Tc-MDP bone scintigraphy in the future. Semin Nucl Med 37:462-469
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2014
The National Oncologic PET Registry prospectively assessed the impact of PET with (18)F-sodium fluoride (NaF PET) on intended management of Medicare patients with suspected or known osseous metastasis. We report our findings for cancers other than prostate and make selected comparisons to our previously reported prostate cancer cohort. Data were collected from both referring and interpreting physicians before and after NaF PET in patients (age ≥ 65 y) stratified for initial staging (IS; n = 570), for suspected first osseous metastasis (FOM; n = 1,814; breast, 781 [43%]; lung, 380 [21%]; and all other cancers, 653 [36%]), and for suspected progression of osseous metastasis (POM; n = 435). The dominant indication was bone pain. If NaF PET were unavailable, conventional bone scintigraphy would have been ordered in 85% of patients. In IS, 28% of patients had suspected or confirmed nonosseous metastasis. If neither conventional bone scintigraphy nor NaF PET were available, referring phys...