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Chen M, Gerges M, Raynor WY, Park PSU, Nguyen E, Chan DH, Gholamrezanezhad A. State of the Art Imaging of Osteoporosis. Semin Nucl Med 2024; 54:415-426. [PMID: 38087745 DOI: 10.1053/j.semnuclmed.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 05/18/2024]
Abstract
Osteoporosis is a common disease, particularly prevalent in geriatric populations, which causes significant worldwide morbidity due to increased bone fragility and fracture risk. Currently, the gold-standard modality for diagnosis and evaluation of osteoporosis progression and treatment relies on dual-energy x-ray absorptiometry (DXA), which measures bone mineral density (BMD) and calculates a score based upon standard deviation of measured BMD from the mean. However, other imaging modalities can also be used to evaluate osteoporosis. Here, we review historical as well as current research into development of new imaging modalities that can provide more nuanced or opportunistic analyses of bone quality, turnover, and density that can be helpful in triaging severity and determining treatment success in osteoporosis. We discuss the use of opportunistic computed tomography (CT) scans, as well as the use of quantitative CT to help determine fracture risk and perform more detailed bone quality analysis than would be allowed by DXA . Within magnetic resonance imaging (MRI), new developments include the use of advanced MRI techniques such as quantitative susceptibility mapping (QSM), magnetic resonance spectroscopy, and chemical shift encoding-based water-fat MRI (CSE-MRI) to enable clinicians improved assessment of nonmineralized bone compartments as well as a way to longitudinally assess bone quality without the repeated exposure to ionizing radiation. Within ultrasound, development of quantitative ultrasound shows promise particularly in future low-cost, broadly available screening tools. We focus primarily on historical and recent developments within radiotracer use as applicable to osteoporosis, particularly in the use of hybrid methods such as NaF-PET/CT, wherein patients with osteoporosis show reduced uptake of radiotracers such as NaF. Use of radiotracers may provide clinicians with even earlier detection windows for osteoporosis than would traditional biomarkers. Given the metabolic nature of this disease, current investigation into the role molecular imaging can play in the prediction of this disease as well as in replacing invasive diagnostic procedures shows particular promise.
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Affiliation(s)
- Michelle Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maria Gerges
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Peter Sang Uk Park
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Edward Nguyen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David H Chan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Moore AE, Burns JE, Sally D, Milinkovic A, Krokos G, John J, Rookyard C, Borca A, Pool ER, Tostevin A, Harman A, Dulnoan DS, Gilson R, Arenas-Pinto A, Cook GJ, Saunders J, Dunn D, Blake GM, Pett SL. Bone turnover change after randomized switch from tenofovir disoproxil to tenofovir alafenamide fumarate in men with HIV. AIDS 2024; 38:521-529. [PMID: 38061030 PMCID: PMC10906193 DOI: 10.1097/qad.0000000000003811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/24/2023] [Accepted: 10/05/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Bone loss in people with HIV (PWH) is poorly understood. Switching tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) has yielded bone mineral density (BMD) increases. PETRAM (NCT#:03405012) investigated whether BMD and bone turnover changes correlate. DESIGN Open-label, randomized controlled trial. SETTING Single-site, outpatient, secondary care. PARTICIPANTS Nonosteoporotic, virologically suppressed, cis-male PWH taking TDF/emtricitabine (FTC)/rilpivirine (RPV) for more than 24 weeks. INTERVENTION Continuing TDF/FTC/RPV versus switching to TAF/FTC/RPV (1 : 1 randomization). MAIN OUTCOME MEASURES :[ 18 F]NaF-PET/CT for bone turnover (standardized uptake values, SUV mean ) and dual-energy x-ray absorptiometry for lumbar spine and total hip BMD. RESULTS Thirty-two men, median age 51 years, 76% white, median duration TDF/FTC/RPV 49 months, were randomized between 31 August 2018 and 09 March 2020. Sixteen TAF:11 TDF were analyzed. Baseline-final scan range was 23-103 (median 55) weeks. LS-SUV mean decreased for both groups (TAF -7.9% [95% confidence interval -14.4, -1.5], TDF -5.3% [-12.1,1.5], P = 0.57). TH-SUV mean showed minimal changes (TAF +0.3% [-12.2,12.8], TDF +2.9% [-11.1,16.9], P = 0.77). LS-BMD changes were slightly more favorable with TAF but failed to reach significance (TAF +1.7% [0.3,3.1], TDF -0.3 [-1.8,1.2], P = 0.06). Bone turnover markers decreased more with TAF ([CTX -35.3% [-45.7, -24.9], P1NP -17.6% [-26.2, -8.5]) than TDF (-11.6% [-28.8, +5.6] and -6.9% [-19.2, +5.4] respectively); statistical significance was only observed for CTX ( P = 0.02, P1NP, P = 0.17). CONCLUSION Contrary to our hypothesis, lumbar spine and total hip regional bone formation (SUV mean ) and BMD did not differ postswitch to TAF. However, improved LS-BMD and CTX echo other TAF-switch studies. The lack of difference in SUV mean may be due to inadequate power.
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Affiliation(s)
- Amelia E.B. Moore
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
- Osteoporosis Unit, Guy's and St Thomas’ NHS Foundation Trust
| | - James E. Burns
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Deirdre Sally
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Ana Milinkovic
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Georgios Krokos
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - Joemon John
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - Christopher Rookyard
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - Alessandro Borca
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Erica R.M. Pool
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Anna Tostevin
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
| | - Alyss Harman
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | | | - Richard Gilson
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Alejandro Arenas-Pinto
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - Gary J.R. Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital
| | - John Saunders
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
| | - David Dunn
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
| | - Glen M. Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas’ Hospital, London, UK
| | - Sarah L. Pett
- Centre for Clinical Research in HIV and Sexual Health, Institute for Global Health, University College London
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London
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Minopoulou I, Kleyer A, Yalcin-Mutlu M, Fagni F, Kemenes S, Schmidkonz C, Atzinger A, Pachowsky M, Engel K, Folle L, Roemer F, Waldner M, D'Agostino MA, Schett G, Simon D. Imaging in inflammatory arthritis: progress towards precision medicine. Nat Rev Rheumatol 2023; 19:650-665. [PMID: 37684361 DOI: 10.1038/s41584-023-01016-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/10/2023]
Abstract
Imaging techniques such as ultrasonography and MRI have gained ground in the diagnosis and management of inflammatory arthritis, as these imaging modalities allow a sensitive assessment of musculoskeletal inflammation and damage. However, these techniques cannot discriminate between disease subsets and are currently unable to deliver an accurate prediction of disease progression and therapeutic response in individual patients. This major shortcoming of today's technology hinders a targeted and personalized patient management approach. Technological advances in the areas of high-resolution imaging (for example, high-resolution peripheral quantitative computed tomography and ultra-high field MRI), functional and molecular-based imaging (such as chemical exchange saturation transfer MRI, positron emission tomography, fluorescence optical imaging, optoacoustic imaging and contrast-enhanced ultrasonography) and artificial intelligence-based data analysis could help to tackle these challenges. These new imaging approaches offer detailed anatomical delineation and an in vivo and non-invasive evaluation of the immunometabolic status of inflammatory reactions, thereby facilitating an in-depth characterization of inflammation. By means of these developments, the aim of earlier diagnosis, enhanced monitoring and, ultimately, a personalized treatment strategy looms closer.
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Affiliation(s)
- Ioanna Minopoulou
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Melek Yalcin-Mutlu
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan Kemenes
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute for Medical Engineering, University of Applied Sciences Amberg-Weiden, Weiden, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Milena Pachowsky
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Lukas Folle
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank Roemer
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Maximilian Waldner
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Maria-Antonietta D'Agostino
- Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et Inflammation, Laboratory of Excellence Inflamex, Montigny-Le-Bretonneux, France
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.
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Puri T, Frost ML, Moore AEB, Choudhury A, Vinjamuri S, Mahajan A, Fynbo C, Vrist M, Theil J, Kairemo K, Wong J, Zaidi H, Revheim ME, Werner TJ, Alavi A, Cook GJR, Blake GM. Utility of a simplified [ 18F] sodium fluoride PET imaging method to quantify bone metabolic flux for a wide range of clinical applications. Front Endocrinol (Lausanne) 2023; 14:1236881. [PMID: 37780613 PMCID: PMC10534005 DOI: 10.3389/fendo.2023.1236881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
We review the rationale, methodology, and clinical utility of quantitative [18F] sodium fluoride ([18F]NaF) positron emission tomography-computed tomography (PET-CT) imaging to measure bone metabolic flux (Ki, also known as bone plasma clearance), a measurement indicative of the local rate of bone formation at the chosen region of interest. We review the bone remodelling cycle and explain what aspects of bone remodelling are addressed by [18F]NaF PET-CT. We explain how the technique works, what measurements are involved, and what makes [18F]NaF PET-CT a useful tool for the study of bone remodelling. We discuss how these measurements can be simplified without loss of accuracy to make the technique more accessible. Finally, we briefly review some key clinical applications and discuss the potential for future developments. We hope that the simplified method described here will assist in promoting the wider use of the technique.
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Affiliation(s)
- Tanuj Puri
- Faculty of Biology, Medicine and Health, School of Medical Sciences, Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Michelle L. Frost
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), The Institute of Cancer Research, Sutton, United Kingdom
| | - Amelia E. B. Moore
- Department of Cancer Imaging, and King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Ananya Choudhury
- Faculty of Biology, Medicine and Health, School of Medical Sciences, Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sobhan Vinjamuri
- Nuclear Medicine Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Claire Fynbo
- Clinic of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark
| | - Marie Vrist
- University Clinic in Nephrology and Hypertension, Gødstrup Hospital, Herning, Denmark
| | - Jørn Theil
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kalevi Kairemo
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - James Wong
- Department of Anaesthesia, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Habib Zaidi
- Geneva University Hospital, Division of Nuclear Medicine and Molecular Imaging, Geneva, Switzerland
| | - Mona-Elisabeth Revheim
- The Intervention Centre, Oslo University Hospital, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas J. Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Gary J. R. Cook
- Department of Cancer Imaging, and King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Glen M. Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
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5
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Roy AN, Mazumdar I. Effects of Teriparatide Treatment on Bone Mineral Density in Patients With Osteoporosis: A Short-Term Dose-Response Study. Cureus 2023; 15:e45662. [PMID: 37868433 PMCID: PMC10589820 DOI: 10.7759/cureus.45662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
INTRODUCTION Osteoporosis is a chronic bone disease that develops with a decrease in bone mineral density (BMD) along with bone mass. An essential measure in the prevention of osteoporosis is the achievement of normal peak bone mass. Teriparatide (TPTD) functions as an osteoanabolic agent, exerting a dual influence on bone remodeling by modulating both osteogenesis and osteoclastogenesis. Bone mass is determined by dual-energy x-ray absorptiometry (DEXA) quantitative CT scan and has outstanding precision (within 1% to 2%) and has the ability to show the effectiveness of drug intervention. OBJECTIVE To assess the effectiveness of TPTD treatment on BMD in osteoporosis patients. MATERIALS AND METHODS The study is a retrospective, observational, multi-center study of 378 osteoporosis patients who were treated with 20 µg of subcutaneous TPTD every day for six months. DEXA scores of the hip joints of patients were measured both before and after TPTD treatment. RESULTS The DEXA scores of the total population pre and post-treatment were -2.75+0.58 and -2.15+0.95 respectively, with a p-value of <0.001, which is statistically significant. In women the pre and post-treatment scores were -2.728+0.52 and -2.276+0.49, with a significant p-value of <0.001 whereas in males, the scores were -2.756+0.72 and -2.108+1.29 respectively, with a significant p-value of <0.05. CONCLUSION The six-month treatment with TPTD significantly improved DEXA scores in osteoporosis patients. DEXA score's precision and sensitivity in quantifying impact contribute to effective osteoporosis management, guiding treatment strategies for better outcomes in the Indian population. Further research is warranted to see the long-term effect of TPTD.
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Affiliation(s)
- Amarendra Nath Roy
- Department of Orthopaedics, Murshidabad Medical College, Berhampore, IND
| | - Ipsita Mazumdar
- Department of Biochemistry, Jagannath Gupta Institute of Medical Sciences and Hospital, Kolkata, IND
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6
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Clinical Applications of PET in Evaluating the Aging Spine. PET Clin 2023; 18:39-47. [DOI: 10.1016/j.cpet.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Sheppard AJ, Paravastu SS, Wojnowski NM, Osamor CC, Farhadi F, Collins MT, Saboury B. Emerging Role of 18F-NaF PET/Computed Tomographic Imaging in Osteoporosis: A Potential Upgrade to the Osteoporosis Toolbox. PET Clin 2023; 18:1-20. [PMID: 36442958 PMCID: PMC9773817 DOI: 10.1016/j.cpet.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Osteoporosis is a metabolic bone disorder that leads to a decline in bone microarchitecture, predisposing individuals to catastrophic fractures. The current standard of care relies on detecting bone structural change; however, these methods largely miss the complex biologic forces that drive these structural changes and response to treatment. This review introduces sodium fluoride (18F-NaF) positron emission tomography/computed tomography (PET/CT) as a powerful tool to quantify bone metabolism. Here, we discuss the methods of 18F-NaF PET/CT, with a special focus on dynamic scans to quantify parameters relevant to bone health, and how these markers are relevant to osteoporosis.
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Affiliation(s)
- Aaron J. Sheppard
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Sriram S. Paravastu
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Natalia M. Wojnowski
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA;,Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611, USA
| | - Charles C. Osamor
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Faraz Farhadi
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892-4320, USA;,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Michael T. Collins
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Babak Saboury
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892-4320, USA;,Corresponding author. 10 Center Drive, Bethesda, MD 20892.
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8
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Paschalis EP, Gamsjaeger S, Klaushofer K, Shane E, Cohen A, Stepan J, Pavo I, Eriksen EF, Taylor KA, Dempster DW. Treatment of postmenopausal osteoporosis patients with teriparatide for 24 months reverts forming bone quality indices to premenopausal healthy control values. Bone 2022; 162:116478. [PMID: 35779845 DOI: 10.1016/j.bone.2022.116478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
Abstract
Postmenopausal osteoporosis (PMOP) therapies are frequently evaluated by bone mineral density (BMD) gains against patients receiving placebo (calcium and vitamin D supplementation, a mild bone turnover-suppressing intervention), which is not equivalent to either healthy or treatment-naive PMOP. The aim of the present observational study was to assess the effects of TPTD treatment in PMOP (20 μg, once daily) at 6 (TPTD 6m; n = 28, age 65 ± 7.3 years), and 24 (TPTD 24m; n = 32, age 67.4 ± 6.15 years) months on bone quality indices at actively forming trabecular surfaces (with fluorescent double labels). Data from the TPTD-treated PMOP patients were compared with those in healthy adult premenopausal women (HC; n = 62, age 40.5 ± 10.6 years), and PMOP receiving placebo (PMOP-PLC; n = 94, age 70.6 ± 4.5 years). Iliac crest biopsies were analyzed by Raman microspectroscopy at three distinct tissue ages: mid-distance between the second label and the bone surface, mid-distance between the two labels, and 1 μm behind the first label. Mineral to matrix ratio (MM), mineral maturity/crystallinity (MMC), tissue water (TW), glycosaminoglycan (GAGs), and pyridinoline (Pyd) content were determined. Outcomes were compared by ANCOVA with subject age and tissue age as covariates, and health status as a fixed factor, followed by Sidak's post-hoc testing (significance assigned to p < 0.05). Both TPTD groups increased MM compared to PMOP-PLC. While TPTD 6m had values similar to HC, TPTD 24m had higher values compared to either HC or TPTD 6m. Both TPTD groups had lower MMC values compared to PMOP-PLC and similar to HC. TPTD 6m patients had higher TW content compared to HC, while TPTD 24m had values similar to HC and lower than either PMOP-PLC or TPTD 6m. Both TPTD groups had lower GAG content compared to HC group, while TPTD 6m had higher values compared to PMOP-PLC. Finally, TPTD 6m patients had higher Pyd content compared to HC and lower compared to PMOP-PLC, while TPTD 24m had lower values compared to PMOP-PLC and TPTD 6m, and similar to HC group. The results of the present study indicate that effects of TPTD on forming trabecular bone quality indices depend on treatment duration. At the recommended length of 24 m, TPTD restores bone mineral and organic matrix quality indices (MMC, TW, Pyd content) to premenopausal healthy (HC) levels.
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Affiliation(s)
- Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
| | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Adi Cohen
- Early Onset Osteoporosis Center, Metabolic Bone Diseases Program, Division of Endocrinology, Department of Medicine, Columbia University, College of Physicians & Surgeons, New York, NY, USA
| | - Jan Stepan
- Institute of Rheumatology, Faculty of Medicine 1, Charles University, Prague, Czech Republic
| | - Imre Pavo
- Eli Lilly and Company USA, LLC, Indianapolis, IN, USA
| | - Erik F Eriksen
- Department of Endocrinology, Pilestredet Park Specialist Center, Oslo, Norway; The Faculty of Dentistry, University of Oslo, Oslo, Norway
| | | | - David W Dempster
- Regional Bone Center, Helen Hayes Hospital, New York State Department of Health, West Haverstraw, NY, USA; Department of Pathology and Cell Biology, College of Physicians and Surgeons of Columbia University, New York, NY, USA
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9
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Puri T, Frost ML, Cook GJ, Blake GM. [ 18F] Sodium Fluoride PET Kinetic Parameters in Bone Imaging. Tomography 2021; 7:843-854. [PMID: 34941643 PMCID: PMC8708178 DOI: 10.3390/tomography7040071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
This report describes the significance of the kinetic parameters (k-values) obtained from the analysis of dynamic positron emission tomography (PET) scans using the Hawkins model describing the pharmacokinetics of sodium fluoride ([18F]NaF) to understand bone physiology. Dynamic [18F]NaF PET scans may be useful as an imaging biomarker in early phase clinical trials of novel drugs in development by permitting early detection of treatment-response signals that may help avoid late-stage attrition.
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Affiliation(s)
- Tanuj Puri
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK;
| | - Michelle L. Frost
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), Institute of Cancer Research, Sutton SM2 5NG, UK;
| | - Gary J. Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK;
| | - Glen M. Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK;
- Correspondence: ; Tel.: +44-7762717295
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10
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Puri T, Siddique MM, Frost ML, Moore AEB, Blake GM. A Short Dynamic Scan Method of Measuring Bone Metabolic Flux Using [ 18F]NaF PET. Tomography 2021; 7:623-635. [PMID: 34842815 PMCID: PMC8628944 DOI: 10.3390/tomography7040053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022] Open
Abstract
[18F]NaF PET measurements of bone metabolic flux (Ki) are conventionally obtained with 60-min dynamic scans analysed using the Hawkins model. However, long scan times make this method expensive and uncomfortable for subjects. Therefore, we evaluated and compared measurements of Ki with shorter scan times analysed with fixed values of the Hawkins model rate constants. The scans were acquired in a trial in 30 postmenopausal women, half treated with teriparatide (TPT) and half untreated. Sixty-minute PET-CT scans of both hips were acquired at baseline and week 12 after injection with 180 MBq [18F]NaF. Scans were analysed using the Hawkins model by fitting bone time–activity curves at seven volumes of interest (VOIs) with a semi-population arterial input function. The model was re-run with fixed rate-constants for dynamic scan times from 0–12 min increasing in 4-min steps up to 0–60 min. Using the Hawkins model with fixed rate-constants, Ki measurements with statistical power equivalent or superior to conventionally analysed 60-min dynamic scans were obtained with scan times as short as 12 min.
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Affiliation(s)
- Tanuj Puri
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, St. Thomas’ Hospital, London SE1 7EH, UK;
| | - Musib M. Siddique
- Radcliffe Department of Medicine, Level 6 West Wing, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK;
| | - Michelle L. Frost
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK;
| | - Amelia E. B. Moore
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, St. Thomas’ Hospital, London SE1 7EH, UK;
| | - Glen M. Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, St. Thomas’ Hospital, London SE1 7EH, UK;
- Correspondence: ; Tel.: +44-77-6271-7295
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11
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18F-Sodium Fluoride PET as a Diagnostic Modality for Metabolic, Autoimmune, and Osteogenic Bone Disorders: Cellular Mechanisms and Clinical Applications. Int J Mol Sci 2021; 22:ijms22126504. [PMID: 34204387 PMCID: PMC8234710 DOI: 10.3390/ijms22126504] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/13/2021] [Accepted: 06/13/2021] [Indexed: 01/31/2023] Open
Abstract
In a healthy body, homeostatic actions of osteoclasts and osteoblasts maintain the integrity of the skeletal system. When cellular activities of osteoclasts and osteoblasts become abnormal, pathological bone conditions, such as osteoporosis, can occur. Traditional imaging modalities, such as radiographs, are insensitive to the early cellular changes that precede gross pathological findings, often leading to delayed disease diagnoses and suboptimal therapeutic strategies. 18F-sodium fluoride (18F-NaF)-positron emission tomography (PET) is an emerging imaging modality with the potential for early diagnosis and monitoring of bone diseases through the detection of subtle metabolic changes. Specifically, the dissociated 18F- is incorporated into hydroxyapatite, and its uptake reflects osteoblastic activity and bone perfusion, allowing for the quantification of bone turnover. While 18F-NaF-PET has traditionally been used to detect metastatic bone disease, recent literature corroborates the use of 18F-NaF-PET in benign osseous conditions as well. In this review, we discuss the cellular mechanisms of 18F-NaF-PET and examine recent findings on its clinical application in diverse metabolic, autoimmune, and osteogenic bone disorders.
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12
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Wong JM, Puri T, Siddique MM, Frost ML, Moore AEB, Blake GM, Fogelman I. Comparison of ordered-subset expectation maximization and filtered back projection reconstruction based on quantitative outcome from dynamic [18F]NaF PET images. Nucl Med Commun 2021; 42:699-706. [PMID: 33625180 DOI: 10.1097/mnm.0000000000001393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
[18F]NaF PET imaging is a useful tool for measuring regional bone metabolism. However, due to tracer in urine, [18F]NaF PET images of the hip reconstructed using filtered back projection (FBP) frequently show streaking artifacts in slices through the bladder leading to noisy time-activity curves unsuitable for quantification. This study compares differences between quantitative outcomes at the hip derived from images reconstructed using the FBP and ordered-subset expectation maximization (OSEM) methods. Dynamic [18F]NaF PET data at the hip for four postmenopausal women were reconstructed using FBP and nine variations of the OSEM algorithm (all combinations of 1, 5, 15 iterations and 10, 15, 21 subsets). Seven volumes of interest were placed in the hip. Bone metabolism was measured using standardized uptake values, Patlak analysis (Ki-PAT) and Hawkins model Ki-4k. Percentage differences between the standardized uptake values and Ki values from FBP and OSEM images were assessed. OSEM images appeared visually smoother and without the streaking artifacts seen with FBP. However, due to loss of counts, they failed to recover the quantitative values in VOIs close to the bladder, including the femoral head and femoral neck. This was consistent for all quantification methods. Volumes of interest farther from the bladder or larger and receiving greater counts showed good convergence with 5 iterations and 21 subsets. For VOIs close to the bladder, including the femoral neck and femoral head, 15 iterations and 10, 15 or 21 subsets were not enough to obtain OSEM images suitable for measuring bone metabolism and showed no improvement compared to FBP.
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Affiliation(s)
- James M Wong
- Department of Anaesthesia, Royal Berkshire Hospitals NHS Foundation Trust, Reading
| | - Tanuj Puri
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London
| | | | - Michelle L Frost
- Clinical Trials & Statistics Unit (ICR-CTSU), Institute of Cancer Research, Sutton
| | - Amelia E B Moore
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London
| | - Glen M Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, Kings College London, St Thomas' Hospital, London
| | - Ignac Fogelman
- Osteoporosis Research Unit, Guy's & St Thomas' Hospital, King's College London, London, UK
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13
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Raynor WY, Borja AJ, Hancin EC, Werner TJ, Alavi A, Revheim ME. Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET. PET Clin 2021; 16:295-311. [PMID: 33589389 DOI: 10.1016/j.cpet.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PET imaging with 18F-sodium fluoride (NaF), combined with computed tomography or magnetic resonance, is a sensitive method of assessing bone turnover. Although NaF-PET is gaining popularity in detecting prostate cancer metastases to bone marrow, osseous changes represent secondary effects of cancer cell growth. PET tracers more appropriate for assessing prostate cancer metastases directly portray malignant activity and include 18F-fluciclovine and prostatic specific membrane antigen ligands. Recent studies investigating NaF-PET suggest utility in the assessment of benign musculoskeletal disorders. Emerging applications in assessing traumatic injuries, joint disease, back pain, orthopedic complications, and metabolic bone disease are discussed.
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Affiliation(s)
- William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Emily C Hancin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway.
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14
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Magnetic resonance imaging-based partial volume-corrected 18F-sodium fluoride positron emission tomography in the femoral neck. Nucl Med Commun 2020; 42:416-420. [PMID: 33306627 DOI: 10.1097/mnm.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 18F-sodium fluoride (NaF) is a radiotracer used in PET that reflects calcium metabolism and osteoblastic activity. In this study, we assessed the construct validity of a novel application of global assessment to measure NaF uptake in the femoral neck as a method of evaluating physiologic changes in osteoblastic metabolism with age. METHODS Whole-body NaF-PET/computed tomography (CT) images and MRI of 24 male patients with a history of nonmetastatic prostate cancer between the ages of 36 and 82 years (67.8 ± 9.6) were analyzed. A region of interest delineated the entire femoral neck on the PET/CT image to determine the mean standardized uptake value (SUVmean). Correction for the partial volume effect was performed by measuring the volume of inert yellow bone marrow by MRI segmentation. Multiple linear regression was used to assess the relationship of uptake with age and body weight. RESULTS The SUVmean with and without partial volume correction decreased with respect to age (P = 0.001 and P = 0.002, respectively). Body weight was not significantly related to any measured PET parameter. CONCLUSION Our results support the use of global NaF uptake with magnetic resonance-derived partial volume correction in the femoral neck. Because osteoblastic metabolism is known to decrease with normal aging, the observed decrease in NaF uptake constitutes evidence for convergent validity, indicating that the proposed methodology likely reflects systemic osteoblastic activity. Future studies of this methodology are warranted in other instances of varying osteoblastic activity such as in metabolic bone diseases and for the evaluation of therapy targeting osteoblastic metabolism.
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15
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Hauge SC, Frost M, Hansen D. Understanding Bone Disease in Patients with Diabetic Kidney Disease: a Narrative Review. Curr Osteoporos Rep 2020; 18:727-736. [PMID: 33048275 DOI: 10.1007/s11914-020-00630-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Both diabetes and kidney disease associate with the development of bone disease and an increased risk of fragility fractures. The etiologies of bone disease in patients with diabetic kidney disease (DKD) are multiple and complex. This review explores the association between DKD and bone disease and discusses how the presence of both diabetes and kidney disease may impair bone quality and increase fracture risk. Diagnostic tools as well as future research areas are also discussed. RECENT FINDINGS Patients with DKD have an increased risk of fragility fracture, most pronounced in patients with type 1 diabetes, and in DKD a high prevalence of adynamic bone disease is found. Recent studies have demonstrated disturbances in the interplay between bone regulating factors in DKD, such as relative hypoparathyroidism and alterations of bone-derived hormones including fibroblast growth factor-23 (FGF-23), sclerostin and klotho, which lead to bone disease. This review examines the current knowledge on bone disease in patients with DKD, clinical considerations for patient care, as well as subjects for future research.
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Affiliation(s)
- Sabina Chaudhary Hauge
- Department of Nephrology, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
| | - Morten Frost
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 5000, Odense C, Denmark
| | - Ditte Hansen
- Department of Nephrology, Herlev Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
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16
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Hancin EC, Borja AJ, Nikpanah M, Raynor WY, Haldar D, Werner TJ, Morris MA, Saboury B, Alavi A, Gholamrezanezhad A. PET/MR Imaging in Musculoskeletal Precision Imaging - Third wave after X-Ray and MR. PET Clin 2020; 15:521-534. [DOI: 10.1016/j.cpet.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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17
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Kim K, Pak K, Kim IJ, Kim SJ, Sohn DH, Kim A, Lee SG. Association of Regional Bone Synthetic Activities of Vertebral Corners and Vertebral Bodies Quantified Using 18F-Fluoride Positron Emission Tomography with Bone Mineral Density on Dual Energy X-ray Absorptiometry in Patients with Ankylosing Spondylitis. J Clin Med 2020; 9:jcm9082656. [PMID: 32824431 PMCID: PMC7465964 DOI: 10.3390/jcm9082656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
We investigated whether the bone-synthetic activities of vertebral bodies or vertebral corners quantified using 18F-fluoride positron emission tomography (PET) was associated with bone mineral density (BMD) at the corresponding lumbar vertebrae in ankylosing spondylitis (AS) at each vertebra level. We analyzed 48 lumbar vertebrae in 12 AS patients who underwent 18F-fluoride PET and dual energy X-ray absorptiometry (DXA). The mean standardized uptake values (SUVmean) of the vertebral body and corners from L1 to L4 were measured using the spatially separated region of interest (ROI). The L1–L4 BMDs were calculated based on the DXA (“conventional BMD”). The BMD of the internal vertebral bodies was measured by manually drawing ROIs to represent the trabecular BMD (“alternative BMD”). After adjusting the within-patient correlation, the 18F-fluoride SUVmean of the vertebral corners but not that of vertebral bodies was significantly related with the conventional BMD of the vertebra. Otherwise, the 18F-fluoride uptake of both the vertebral and vertebral bodies was significantly related with the alternative BMD. The bone-synthetic activities of the vertebral corners may be more closely related with BMD than those of the vertebral bodies, suggesting that the effects of regional bone metabolism at the vertebral corners and bodies on BMD differ in AS.
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Affiliation(s)
- Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan 49241, Korea; (K.K.); (K.P.); (I.-J.K.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea;
| | - Kyoungjune Pak
- Department of Nuclear Medicine, Pusan National University Hospital, Busan 49241, Korea; (K.K.); (K.P.); (I.-J.K.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea;
| | - In-Joo Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan 49241, Korea; (K.K.); (K.P.); (I.-J.K.)
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea;
| | - Seong-Jang Kim
- Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Korea;
| | - Dong Hyun Sohn
- Department of Microbiology and Immunology, Pusan National University School of Medicine, Yangsan 50612, Korea;
| | - Aran Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea;
- Divsion of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan 49241, Korea
| | - Seung-Geun Lee
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea;
- Divsion of Rheumatology, Department of Internal Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan 49241, Korea
- Correspondence: ; Tel.: +82-240-7580
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18
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Prediction of Response to Tumor Necrosis Value-α Blocker Is Suggested by 18F-NaF SUV max But Not by Quantitative Pharmacokinetic Analysis in Patients With Ankylosing Spondylitis. AJR Am J Roentgenol 2020; 214:1352-1358. [PMID: 32286869 DOI: 10.2214/ajr.19.22352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE. We aimed to evaluate the pharmacokinetics and maximum standardized uptake value (SUVmax) of 18F-NaF PET/CT for assessment of disease activity and prediction of response in patients with ankylosing spondylitis (AS). MATERIALS AND METHODS. Twenty-seven patients (age, interquartile range, 30.25-49.75 years) with AS who were receiving a tumor necrosis factor-α (TNF-α) blocker were included. All patients underwent dynamic PET of the pelvis followed by whole-body PET/CT. Quantitative analysis of kinetic data of the sacroiliac joints (SIJs) was performed, and the SUVmax of the SIJs and SUVmax of the spine were calculated. Clinical indexes related to AS disease activity (serum C-reactive protein level, Bath ankylosing spondylitis disease activity index [ BASDAI], and Bath ankylosing spondylitis functional index) were evaluated. Clinical response was defined as an improvement from the initial BASDAI score of 50% or more (BASDAI 50) within 2 years after baseline 18F-NaF PET/CT. RESULTS. The BASDAI score at 18F-NaF PET/CT was significantly different between the responders and nonresponders: 18F-NaF uptake at the spine was significantly higher in the responders than in the nonresponders. Only SUVmax of the spine had a significant positive correlation with BASDAI score at PET/CT (r = 0.38, p = 0.048). The BASDAI score at PET/CT (odds ratio [OR], 35.32; 95% CI, 2.09-57.84; p = 0.014) and SUVmax of the spine (OR, 14.69; 95% CI, 0.79-27.27; p = 0.027) were significantly associated with BASDAI 50 response prediction. CONCLUSION. The results of our study suggest that the SUVmax of the spine on whole-body 18F-NaF PET/CT is a reliable and noninvasive biomarker for predicting therapeutic response to TNF-α blocker and shows better performance for predicting response than quantitative pharmacokinetic parameters. Fluorine-18-labeled NaF PET/CT showed axial bone lesions with bone formation and can be used as a monitoring tool in patients with AS receiving anti-TNF-α drugs. However, these results need to be validated in a larger cohort.
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19
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Bilinski WJ, Paradowski PT, Sypniewska G. Bone health and hyperglycemia in pediatric populations. Crit Rev Clin Lab Sci 2020; 57:444-457. [PMID: 32216595 DOI: 10.1080/10408363.2020.1739619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The impact of prediabetes and diabetes on skeletal health in the context of increased risk of fragility fractures in adults has been studied recently. However, the prevalence of diabetes, overweight, and obesity have also increased in younger subjects. Current data concerning bone metabolism based on assessment of markers for bone turnover and of bone quality in diabetes patients in diverse age groups appears to be inconsistent. This review synthesizes the current data on the assessment of bone turnover based on the use of circulating bone markers recommended by international organizations; the effects of age, gender, and other factors on the interpretation of the data; and the effects of type 1 and type 2 diabetes as well as hyperglycemia on bone quality and turnover with particular emphasis on the pediatric population. Early intervention in the pediatric population is necessary to prevent the progression of metabolic disturbances that accompany prediabetes and diabetes in the context of common low vitamin D status that may interfere with bone growth.
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Affiliation(s)
| | - Przemyslaw T Paradowski
- Department of Orthopaedics and Traumatology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland.,Department of Surgical and Perioperative Sciences. Division of Orthopedics, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Grazyna Sypniewska
- Department of Laboratory Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
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20
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Nyström A, Kiritopoulos D, Ullmark G, Sörensen J, Petrén-Mallmin M, Milbrink J, Hailer NP, Mallmin H. Denosumab Prevents Early Periprosthetic Bone Loss After Uncemented Total Hip Arthroplasty: Results from a Randomized Placebo-Controlled Clinical Trial. J Bone Miner Res 2020; 35:239-247. [PMID: 31589776 DOI: 10.1002/jbmr.3883] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 08/25/2019] [Accepted: 09/11/2019] [Indexed: 11/08/2022]
Abstract
Implant loosening is the most common indication for revision surgery after total hip arthroplasty (THA). Although bone resorption around the implants plays a pivotal role in the pathophysiology of loosening, it is unknown whether potent early inhibition of osteoclasts could mitigate this process and thus reduce the need for revision surgery. We performed a randomized, double-blind, placebo-controlled phase 2 trial in 64 patients aged 35 to 65 years with unilateral osteoarthritis of the hip. They underwent surgery with an uncemented THA and were randomized to either two subcutaneous doses of denosumab (n = 32) or placebo (n = 32) given 1 to 3 days and 6 months after surgery. Patients were followed for 24 months. Primary outcome was periprosthetic bone mineral density (BMD) of the hip at 12 months as measured by dual-energy X-ray absorptiometry (DXA). In addition, [18 F] sodium fluoride positron emission tomography/CT (F-PET) was performed in half of the patients for analysis of periprosthetic standardized uptake value (SUV). Analyses were made according to intention-to-treat principles. The trial was registered at ClinicalTrials.gov 2011-001481-18, NCT01630941. Denosumab potently inhibited early periprosthetic bone loss. After 12 months, BMD in the denosumab group was 32% (95% confidence interval [CI] 22-44) higher in Gruen zone 7 and 11% (95% CI 8-15) higher in zones 1 to 7. After 24 months, the difference in BMD between groups had decreased to 15% (95% CI 4-27) in zone 7 and 4% (95% CI 0-8) in zones 1 to 7. In both groups, SUV increased after surgery, but the increase was less pronounced in the denosumab group. Biochemical markers of bone metabolism decreased in the denosumab group in the first 12 months, but a rebound effect with marker concentrations above baseline was observed after 24 months. Denosumab potently prevents early periprosthetic bone loss after uncemented THA; however, the effect diminishes after discontinuation of treatment. Further research is needed to determine whether this bone loss will prove to be of clinical importance and, if so, whether the positive effect observed in this study could be preserved by either prolonged treatment with denosumab or additional antiresorptive treatment. © 2019 American Society for Bone and Mineral Research. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Andreas Nyström
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Demostenis Kiritopoulos
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Gösta Ullmark
- Department of Orthopedics, Gävle Hospital, Gävle, Sweden
| | - Jens Sörensen
- Department of Surgical Sciences, Section of Nuclear Medicine & PET, Uppsala University, Uppsala, Sweden
| | | | - Jan Milbrink
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
| | - Hans Mallmin
- Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden
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21
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Cecelja M, Moore A, Fogelman I, Frost ML, Blake GM, Chowienczyk P. Evaluation of aortic 18F-NaF tracer uptake using PET/CT as a predictor of aortic calcification in postmenopausal women: A longitudinal study. JRSM Cardiovasc Dis 2019; 8:2048004019848870. [PMID: 31105936 PMCID: PMC6506920 DOI: 10.1177/2048004019848870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 01/22/2023] Open
Abstract
Introduction Aortic calcification as detected by computed tomography is associated with
arterial stiffening and is an important predictor of cardiovascular
morbidity and mortality. Uptake of 18F-sodium fluoride
(18F-NaF) in the aortic wall reflects metabolically active
areas of calcification. The aim of this study was to determine if
18F-NaF uptake in the aorta is associated with calcification
and progression of calcification as detected by computed tomography. Methods Twenty-one postmenopausal women (mean age 62 ± 6 years) underwent assessment
of aortic 18F-NaF uptake using positron emission
tomography/computer tomography at baseline and a repeat computed tomography
scan after a mean follow-up of 3.8 ± 1.3 years. Tracer uptake was quantified
by calculating the target-to-background (TBR) ratios at baseline and
follow-up. Calcification was assessed at baseline and follow-up using
computed tomography. Results Over the follow-up period, aortic calcium volume increased from 0.46 ± 0.62
to 0.71 ± 0.93 cm3 (P < 0.05). However, the
change in calcium volume did not correlate with baseline TBR either
unadjusted (r = 0.00, P = 1.00) or
adjusted for age and baseline calcium volume (beta coefficient = −0.18,
P = 0.42). TBR at baseline did not differ between
participants with (n = 16) compared to those without
(n = 5) progression in calcium volume (2.43 ± 0.46 vs.
2.31 ± 0.38, P = 0.58). In aortic segments identified to
have the highest tracer uptake at baseline, calcium volume did not
significantly change over the follow-up period
(P = 0.41). Conclusion In a cohort of postmenopausal women, 18F-NaF uptake as measured by
TBR in the lumbar aorta did not predict progression of aortic calcification
as detected by computed tomography over a four-year follow-up.
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Affiliation(s)
- Marina Cecelja
- King's College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, Department of Clinical Pharmacology, St Thomas' Hospital
| | - Amelia Moore
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, UK
| | - Ignac Fogelman
- Department of Nuclear Medicine, King's College London, Guy's Campus, London, UK
| | - Michelle L Frost
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Glen M Blake
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, UK
| | - Phil Chowienczyk
- King's College London British Heart Foundation Centre, School of Cardiovascular Medicine and Sciences, Department of Clinical Pharmacology, St Thomas' Hospital
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22
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Jassel IS, Siddique M, Frost ML, Moore AEB, Puri T, Blake GM. The influence of CT and dual-energy X-ray absorptiometry (DXA) bone density on quantitative [ 18F] sodium fluoride PET. Quant Imaging Med Surg 2019; 9:201-209. [PMID: 30976544 DOI: 10.21037/qims.2019.01.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background [18F] sodium fluoride PET/CT provides quantitative measures of bone metabolic activity expressed by the parameters standardised uptake value (SUV) and bone plasma clearance (K i) that correlate with measurements of bone formation rate obtained by bone biopsy with double tetracycline labelling. Both SUV and K i relate to the tracer uptake in each millilitre of tissue. In general, the bone region of interest (ROI) includes both mineralised bone {generally with a high concentration of [18F]NaF} and bone marrow (with a much lower concentration), suggesting that correcting SUV and K i for volumetric bone mineral density (vBMD) and measuring them with respect to the tracer uptake in each gram of bone mineral might improve the correlation with the findings of bone biopsy. As a first test of this hypothesis, we looked for positive correlations between SUV and K i values with CT and DXA bone mineral density (BMD) parameters measured in the same ROI. Methods A retrospective reanalysis was performed of 63 lumbar spine [18F]NaF PET/CT scans acquired in four earlier studies. The quantitative PET parameters SUV and K i were measured in L1-L4 and Hounsfield units (HU) measured on the CT scans in the same ROI. Spine BMD data was also obtained from DXA scans in the form of areal BMD and used to derive the bone mineral apparent density (BMAD, an estimate of vBMD). Scatter plots were drawn of SUV and K i against HU, BMAD and areal BMD and the Spearman rank correlation coefficients derived for each plot. Results All correlations were positive and statistically significant. Correlations were highest for HU (SUV: RS =0.513, P<0.0001; K i: RS =0.429, P=0.0005) and lowest for areal BMD (SUV: RS =0.353, P=0.005; K i: RS =0.274, P=0.03). Conclusions The results demonstrate significant positive correlations between SUV and K i and vBMD measurements in the form of HU from CT or BMAD and areal BMD from DXA. These findings justify further exploration of the relationship between SUV and K i [18F]NaF PET/CT measurements and CT or DXA measurements of vBMD to examine whether normalization for bone density might improve their correlation with bone metabolic activity as measured by bone biopsy.
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Affiliation(s)
- Inderbir S Jassel
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Musib Siddique
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Michelle L Frost
- Osteoporosis Research Unit, King's College London, Guy's Hospital, London, UK
| | - Amelia E B Moore
- Osteoporosis Research Unit, King's College London, Guy's Hospital, London, UK
| | - Tanuj Puri
- Osteoporosis Research Unit, King's College London, Guy's Hospital, London, UK
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
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23
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Tsuchimochi M, Kurabayashi T. Symposium: Imaging modalities for drug-related osteonecrosis of the jaw (1), role of imaging in drug-related osteonecrosis of the jaw: An up-to-date review (secondary publication). JAPANESE DENTAL SCIENCE REVIEW 2019; 55:1-4. [PMID: 30705708 PMCID: PMC6348294 DOI: 10.1016/j.jdsr.2018.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022] Open
Abstract
MRONJ/ARONJ is a serious adverse effect of medication, although the incidence of the disease is rare, and there are still controversial issues regarding the pathogenesis of MRONJ/ARONJ. Medications that can lead to MRONJ/ARONJ are commonly used to treat osteoporosis and to prevent bone fractures caused by bone metastasis of malignancies. The long-standing disease state of ONJ deteriorates the quality of life of affected patients. Early detection and prevention of the disease are key to alleviating pain and discomfort. To date, several imaging modalities have been introduced to depict the lesions. Imaging modalities, radiography, CT, MRI and nuclear medicine provide important information for managing this challenging disease.
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Affiliation(s)
- Makoto Tsuchimochi
- The Nippon Dental University (Emeritus Professor), Formerly, Oral and Maxillofacial Radiology, The Nippon Dental University School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata 951-8580, Japan
| | - Tohru Kurabayashi
- Department of Oral and Maxillofacial Radiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan
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24
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Deidda D, Karakatsanis NA, Robson PM, Calcagno C, Senders ML, Mulder WJM, Fayad ZA, Aykroyd RG, Tsoumpas C. Hybrid PET/MR Kernelised Expectation Maximisation Reconstruction for Improved Image-Derived Estimation of the Input Function from the Aorta of Rabbits. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:3438093. [PMID: 30800014 PMCID: PMC6360049 DOI: 10.1155/2019/3438093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 11/30/2022]
Abstract
Positron emission tomography (PET) provides simple noninvasive imaging biomarkers for multiple human diseases which can be used to produce quantitative information from single static images or to monitor dynamic processes. Such kinetic studies often require the tracer input function (IF) to be measured but, in contrast to direct blood sampling, the image-derived input function (IDIF) provides a noninvasive alternative technique to estimate the IF. Accurate estimation can, in general, be challenging due to the partial volume effect (PVE), which is particularly important in preclinical work on small animals. The recently proposed hybrid kernelised ordered subsets expectation maximisation (HKEM) method has been shown to improve accuracy and contrast across a range of different datasets and count levels and can be used on PET/MR or PET/CT data. In this work, we apply the method with the purpose of providing accurate estimates of the aorta IDIF for rabbit PET studies. In addition, we proposed a method for the extraction of the aorta region of interest (ROI) using the MR and the HKEM image, to minimise the PVE within the rabbit aortic region-a method which can be directly transferred to the clinical setting. A realistic simulation study was performed with ten independent noise realisations while two, real data, rabbit datasets, acquired with the Biograph Siemens mMR PET/MR scanner, were also considered. For reference and comparison, the data were reconstructed using OSEM, OSEM with Gaussian postfilter and KEM, as well as HKEM. The results across the simulated datasets and different time frames show reduced PVE and accurate IDIF values for the proposed method, with 5% average bias (0.8% minimum and 16% maximum bias). Consistent results were obtained with the real datasets. The results of this study demonstrate that HKEM can be used to accurately estimate the IDIF in preclinical PET/MR studies, such as rabbit mMR data, as well as in clinical human studies. The proposed algorithm is made available as part of an open software library, and it can be used equally successfully on human or animal data acquired from a variety of PET/MR or PET/CT scanners.
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Affiliation(s)
- Daniel Deidda
- Biomedical Imaging Science Department, University of Leeds, Leeds, UK
- Department of Statistics, University of Leeds, Leeds, UK
| | - Nicolas A. Karakatsanis
- Translational and Molecular Imaging Institute (TMII), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Philip M. Robson
- Translational and Molecular Imaging Institute (TMII), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia Calcagno
- Translational and Molecular Imaging Institute (TMII), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Max L. Senders
- Translational and Molecular Imaging Institute (TMII), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Willem J. M. Mulder
- Translational and Molecular Imaging Institute (TMII), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A. Fayad
- Translational and Molecular Imaging Institute (TMII), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Charalampos Tsoumpas
- Biomedical Imaging Science Department, University of Leeds, Leeds, UK
- Translational and Molecular Imaging Institute (TMII), Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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25
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Austin AG, Raynor WY, Reilly CC, Zadeh MZ, Werner TJ, Zhuang H, Alavi A, Rajapakse CS. Evolving Role of MR Imaging and PET in Assessing Osteoporosis. PET Clin 2019; 14:31-41. [DOI: 10.1016/j.cpet.2018.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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26
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Paschalis EP, Krege JH, Gamsjaeger S, Eriksen EF, Burr DB, Disch DP, Stepan JJ, Fahrleitner-Pammer A, Klaushofer K, Marin F, Pavo I. Teriparatide Treatment Increases Mineral Content and Volume in Cortical and Trabecular Bone of Iliac Crest: A Comparison of Infrared Imaging With X-Ray-Based Bone Assessment Techniques. J Bone Miner Res 2018; 33:2230-2235. [PMID: 30102789 DOI: 10.1002/jbmr.3565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 07/25/2018] [Accepted: 08/05/2018] [Indexed: 11/11/2022]
Abstract
Teriparatide increases bone mass primarily through remodeling of older or damaged bone and abundant replacement with new mineralizing bone. This post hoc analysis investigated whether dual-energy X-ray absorptiometric (DXA) areal bone mineral density (aBMD) measurement adequately reflects changes of mineral and organic matrix content in cortical and trabecular bone. Paired biopsies and aBMD measurements were obtained before and at end of 2 years of teriparatide treatment from postmenopausal women with osteoporosis who were either alendronate pretreated (mean, 57.5 months) or osteoporosis-treatment naive. Biopsies were assessed by micro-computed tomography (μCT) to calculate mean cortical width (Ct.Wi), cortical area (Ct.Ar), and trabecular bone volume fraction (BV/TV). Fourier transformed infrared imaging (pixel size ∼6.3 × 6.3 μm2 ) was utilized to calculate mineral and organic matrix density (mean absorption/pixel), as well as total mineral and organic contents of cortical and cancellous compartments (sum of all pixels in the compartment). Effect of pretreatment over time was analyzed using mixed model repeated measures. μCT derived Ct.Wi and BV/TV increased, accompanied by similar increases in the overall mineral contents of their respective bone compartments. Mineral density did not change. Marked increases in the total content of both mineral and organic matrix associated with volumetric growth in both compartments consistently exceeded those of aBMD. Increases in organic matrix exceeded increases in mineral content in both cortical and trabecular compartments. For percent changes, only change in Ct.Wi correlated to change in femoral neck aBMD (r = .38, p = 0.043), whereas no other significant correlations of Ct.Wi or BV/TV with lumbar spine, total hip, or femoral neck aBMD were demonstrable. These data indicate that 2 years of teriparatide treatment leads to an increased bone organic matrix and mineral content in the iliac crest. The magnitude of these increases in the iliac crest were not detected with conventional aBMD measurements at other skeletal sites. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of Wiener Gebietskrankenkasse (WGKK), Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of Wiener Gebietskrankenkasse (WGKK), Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Erik F Eriksen
- Department of Clinical Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Insititute of Clinical Medicine, Oslo University, Oslo, Norway
| | - David B Burr
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Jan J Stepan
- Institute of Rheumatology and Faculty of Medicine 1, Charles University, Prague, Czech Republic
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Diabetes, Medical University of Graz, Graz, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of Wiener Gebietskrankenkasse (WGKK), Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Imre Pavo
- Eli Lilly and Company, Indianapolis, IN, USA
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27
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Al-Zaghal A, Raynor W, Khosravi M, Guermazi A, Werner TJ, Alavi A. Applications of PET Imaging in the Evaluation of Musculoskeletal Diseases Among the Geriatric Population. Semin Nucl Med 2018; 48:525-534. [DOI: 10.1053/j.semnuclmed.2018.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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28
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29
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Reilly CC, Raynor WY, Hong AL, Kargilis DC, Lee JS, Alecxih AG, Gupta N, Lim MK, Al-Zaghal A, Werner TJ, Rhodes SS, Alavi A, Rajapakse CS. Diagnosis and Monitoring of Osteoporosis With 18F-Sodium Fluoride PET: An Unavoidable Path for the Foreseeable Future. Semin Nucl Med 2018; 48:535-540. [PMID: 30322479 DOI: 10.1053/j.semnuclmed.2018.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The prevalence of metabolic bone diseases particularly osteoporosis and its precursor, osteopenia, continue to grow as serious global health issues today. On a worldwide perspective, 200million people suffer from osteoporosis and in 2005, over 2million fracture incidents were estimated due to osteoporosis in the United States. Currently, osteoporosis and other metabolic bone diseases are evaluated primarily through dual energy X-ray absorptiometry, and rarely by bone biopsy with tetracycline labeling or Technetium-99m (99mTc) based bone scintigraphy. Deficiencies in these methods have prompted the use of more precise methods of assessment. This review highlights the use of 18F-sodium fluoride (NaF) with PET (NaF-PET), NaF-PET/CT, or NaF-PET/MRI in the evaluation of osteoporosis and osteopenia in the lumbar spine and hip. This imaging modality provides a molecular perspective with respect to the underlying metabolic alterations that lead to osseous disorders by measuring bone turnover through standardized uptake values. Its sensitivity and ability to examine the entire skeletal system make it a more superior imaging modality compared to standard structural imaging techniques. Further research is needed to determine its accuracy in reflecting the efficacy of therapeutic interventions in metabolic bone diseases.
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Affiliation(s)
| | | | | | | | - Jae S Lee
- University of Pennsylvania, Philadelphia, PA
| | | | | | - Marie K Lim
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Abass Alavi
- University of Pennsylvania, Philadelphia, PA
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30
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Blake GM, Puri T, Siddique M, Frost ML, Moore AEB, Fogelman I. Site specific measurements of bone formation using [ 18F] sodium fluoride PET/CT. Quant Imaging Med Surg 2018. [PMID: 29541623 DOI: 10.21037/qims.2018.01.02] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dynamic positron emission tomography (PET) imaging with fluorine-18 labelled sodium fluoride ([18F]NaF) allows the quantitative assessment of regional bone formation by measuring the plasma clearance of fluoride to bone at any site in the skeleton. Today, hybrid PET and computed tomography (CT) dual-modality systems (PET/CT) are widely available, and [18F]NaF PET/CT offers a convenient non-invasive method of studying bone formation at the important osteoporotic fracture sites at the hip and spine, as well as sites of pure cortical or trabecular bone. The technique complements conventional measurements of bone turnover using biochemical markers or bone biopsy as a tool to investigate new therapies for osteoporosis, and has a potential role as an early biomarker of treatment efficacy in clinical trials. This article reviews methods of acquiring and analyzing dynamic [18F]NaF PET/CT scan data, and outlines a simplified approach combining venous blood sampling with a series of short (3- to 5-minute) static PET/CT scans acquired at different bed positions to estimate [18F]NaF plasma clearance at multiple sites in the skeleton with just a single injection of tracer.
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Affiliation(s)
- Glen M Blake
- Biomedical Engineering Department, King's College London, Strand, LondonUK
| | - Tanuj Puri
- Biomedical Engineering Department, King's College London, Strand, LondonUK
| | - Musib Siddique
- Biomedical Engineering Department, King's College London, Strand, LondonUK
| | - Michelle L Frost
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Amelia E B Moore
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, UK
| | - Ignac Fogelman
- Nuclear Medicine Department, King's College London, Guy's Campus, London, UK
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31
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Abstract
PURPOSE OF REVIEW Vertebral fractures are the most common osteoporotic fracture and result in functional decline and excess mortality. Dual-energy x-ray absorptiometry (DXA) is the gold standard for the diagnosis of osteoporosis to identify patients at risk for fragility fractures; however, advances in imaging have expanded the role of computed tomography (CT) and magnetic resonance imaging (MRI) in evaluating bone health. RECENT FINDINGS The utility of CT and MRI in the assessment of bone density is starting to gain traction, particularly when used opportunistically. DXA, conventional radiography, CT, and MRI can all be used to assess for vertebral fractures, and MRI can determine the acuity of fractures. Finally, advances in imaging allow for non-invasive assessment of measures of bone quality, including microarchitecture, bone strength, and bone turnover, to help identify and treat at-risk patients prior to sustaining a vertebral fracture. CT and MRI techniques remain primarily research tools to assess metabolic bone dysfunction, while use of DXA can be clinically expanded beyond measurement of bone density to assess for vertebral fractures and bone architecture to improve fracture risk assessment and guide treatment.
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Affiliation(s)
- Sharon H Chou
- Harvard Medical School, Boston, MA, 02115, USA
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA
| | - Meryl S LeBoff
- Harvard Medical School, Boston, MA, 02115, USA.
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
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32
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Eastell R, Szulc P. Use of bone turnover markers in postmenopausal osteoporosis. Lancet Diabetes Endocrinol 2017; 5:908-923. [PMID: 28689768 DOI: 10.1016/s2213-8587(17)30184-5] [Citation(s) in RCA: 268] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 12/30/2022]
Abstract
Bone turnover comprises two processes: the removal of old bone (resorption) and the laying down of new bone (formation). N-terminal propeptide of type I procollagen (PINP) and C-telopeptide of type I collagen (CTX-I) are markers of bone formation and resorption, respectively, that are recommended for clinical use. Bone turnover markers can be measured on several occasions in one individual with good precision. However, these markers are subject to several sources of variability, including feeding (resorption decreases) and recent fracture (all markers increase for several months). Bone turnover markers are not used for diagnosis of osteoporosis and do not improve prediction of bone loss or fracture within an individual. In untreated women, very high bone turnover marker concentrations suggest secondary causes of high bone turnover (eg, bone metastases or multiple myeloma). In people with osteoporosis, bone turnover markers might be useful to assess the response to anabolic and antiresorptive therapies, to assess compliance to therapy, or to indicate possible secondary osteoporosis. Much remains to be learnt about how bone turnover markers can be used to monitor the effect of stopping bisphosphonate therapy (eg, to identify a threshold above which restarting therapy should be considered). More studies are needed to investigate the use of bone turnover markers for assessment of the bone safety of new medications.
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Affiliation(s)
- Richard Eastell
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK.
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
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Spriet M, Espinosa P, Kyme AZ, Phillips KL, Katzman SA, Galuppo LD, Stepanov P, Beylin D. 18
F-sodium fluoride positron emission tomography of the equine distal limb: Exploratory study in three horses. Equine Vet J 2017; 50:125-132. [DOI: 10.1111/evj.12719] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 07/09/2017] [Indexed: 01/03/2023]
Affiliation(s)
- M. Spriet
- University of California; Davis California USA
| | - P. Espinosa
- University of California; Davis California USA
| | - A. Z. Kyme
- University of California; Davis California USA
| | | | | | | | - P. Stepanov
- Brain Biosciences, Inc.; Rockville Maryland USA
| | - D. Beylin
- Brain Biosciences, Inc.; Rockville Maryland USA
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34
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Chang G, Boone S, Martel D, Rajapakse CS, Hallyburton RS, Valko M, Honig S, Regatte RR. MRI assessment of bone structure and microarchitecture. J Magn Reson Imaging 2017; 46:323-337. [PMID: 28165650 PMCID: PMC5690546 DOI: 10.1002/jmri.25647] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/21/2016] [Indexed: 12/12/2022] Open
Abstract
Osteoporosis is a disease of weak bone and increased fracture risk caused by low bone mass and microarchitectural deterioration of bone tissue. The standard-of-care test used to diagnose osteoporosis, dual-energy x-ray absorptiometry (DXA) estimation of areal bone mineral density (BMD), has limitations as a tool to identify patients at risk for fracture and as a tool to monitor therapy response. Magnetic resonance imaging (MRI) assessment of bone structure and microarchitecture has been proposed as another method to assess bone quality and fracture risk in vivo. MRI is advantageous because it is noninvasive, does not require ionizing radiation, and can evaluate both cortical and trabecular bone. In this review article, we summarize and discuss research progress on MRI of bone structure and microarchitecture over the last decade, focusing on in vivo translational studies. Single-center, in vivo studies have provided some evidence for the added value of MRI as a biomarker of fracture risk or treatment response. Larger, prospective, multicenter studies are needed in the future to validate the results of these initial translational studies. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. MAGN. RESON. IMAGING 2017;46:323-337.
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Affiliation(s)
- Gregory Chang
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Sean Boone
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Dimitri Martel
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Chamith S Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert S Hallyburton
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Mitch Valko
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
| | - Stephen Honig
- Osteoporosis Center, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York, USA
| | - Ravinder R Regatte
- Department of Radiology, Center for Biomedical Imaging, NYU Langone Medical Center, New York, New York, USA
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35
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Raynor W, Houshmand S, Gholami S, Emamzadehfard S, Rajapakse CS, Blomberg BA, Werner TJ, Høilund-Carlsen PF, Baker JF, Alavi A. Evolving Role of Molecular Imaging with (18)F-Sodium Fluoride PET as a Biomarker for Calcium Metabolism. Curr Osteoporos Rep 2016; 14:115-25. [PMID: 27301549 DOI: 10.1007/s11914-016-0312-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
(18)F-sodium fluoride (NaF) as an imaging tracer portrays calcium metabolic activity either in the osseous structures or in soft tissue. Currently, clinical use of NaF-PET is confined to detecting metastasis to the bone, but this approach reveals indirect evidence for disease activity and will have limited use in the future in favor of more direct approaches that visualize cancer cells in the read marrow where they reside. This has proven to be the case with FDG-PET imaging in most cancers. However, a variety of studies support the application of NaF-PET to assess benign osseous diseases. In particular, bone turnover can be measured from NaF uptake to diagnose osteoporosis. Several studies have evaluated the efficacy of bisphosphonates and their lasting effects as treatment for osteoporosis using bone turnover measured by NaF-PET. Additionally, NaF uptake in vessels tracks calcification in the plaques at the molecular level, which is relevant to coronary artery disease. Also, NaF-PET imaging of diseased joints is able to project disease progression in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. Further studies suggest potential use of NaF-PET in domains such as back pain, osteosarcoma, stress-related fracture, and bisphosphonate-induced osteonecrosis of the jaw. The critical role of NaF-PET in disease detection and characterization of many musculoskeletal disorders has been clearly demonstrated in the literature, and these methods will become more widespread in the future. The data from PET imaging are quantitative in nature, and as such, it adds a major dimension to assessing disease activity.
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Affiliation(s)
- William Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sina Houshmand
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Saeid Gholami
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sahra Emamzadehfard
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Chamith S Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Björn Alexander Blomberg
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | | | - Joshua F Baker
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- Division of Rheumatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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36
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Andersson M, Johansson L, Mattsson S, Minarik D, Leide-Svegborn S. ORGAN DOSES AND EFFECTIVE DOSE FOR FIVE PET RADIOPHARMACEUTICALS. RADIATION PROTECTION DOSIMETRY 2016; 169:253-258. [PMID: 26977075 DOI: 10.1093/rpd/ncw033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Diagnostic investigations with positron-emitting radiopharmaceuticals are dominated by (18)F-fluorodeoxyglucose ((18)F-FDG), but other radiopharmaceuticals are also commercially available or under development. Five of them, which are all clinically important, are (18)F-fluoride, (18)F-fluoroethyltyrosine ((18)F-FET), (18)F-deoxyfluorothymidine ((18)F-FLT), (18)F-fluorocholine ((18)F-choline) and (11)C-raclopride. To estimate the potential risk of stochastic effects (mainly lethal cancer) to a population, organ doses and effective dose values were updated for all five radiopharmaceuticals. Dose calculations were performed using the computer program IDAC2.0, which bases its calculations on the ICRP/ICRU adult reference voxel phantoms and the tissue weighting factors from ICRP publication 103. The biokinetic models were taken from ICRP publication 128. For organ doses, there are substantial changes. The only significant change in effective dose compared with previous estimations was a 46 % reduction for (18)F-fluoride. The estimated effective dose in mSv MBq(-1) was 1.5E-02 for (18)F-FET, 1.5E-02 for (18)F-FLT, 2.0E-02 for (18)F-choline, 9.0E-03 for (18)F-fluoride and 4.4E-03 for (11)C-raclopride.
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Affiliation(s)
- Martin Andersson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Lennart Johansson
- Radiation Physics, Department of Radiation Sciences, Umeå University, SE-901 87 Umeå, Sweden
| | - Sören Mattsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - David Minarik
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Sigrid Leide-Svegborn
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
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Abstract
The use of (18)F-sodium fluoride ((18)F-NaF) with PET/CT is increasing. This resurgence of an old tracer has been fueled by several factors including superior diagnostic performance over standard (99m)Tc-based bone scintigraphy, growth in the availability of PET/CT imaging systems, increase in the number of regional commercial distribution centers for PET radiotracers, the recent concerns about potential recurring shortages with (99m)Tc-based radiotracers, and the recent decision by the Centers for Medicare and Medicaid Services to reimburse for (18)F-NaF PET/CT for evaluation of patients with known or suspected bone metastases through the National Oncologic PET Registry. The major goal of this article is to review the current evidence on the diagnostic utility of (18)F-NaF in the imaging assessment of the bone and joint in a variety of clinical conditions.
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Affiliation(s)
- Hossein Jadvar
- PET/CT Imaging Science Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Bhushan Desai
- PET/CT Imaging Science Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Peter S Conti
- PET/CT Imaging Science Center, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Blake GM, Siddique M, Frost ML, Moore AEB, Fogelman I. Imaging of site specific bone turnover in osteoporosis using positron emission tomography. Curr Osteoporos Rep 2014; 12:475-85. [PMID: 25168931 DOI: 10.1007/s11914-014-0231-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The functional imaging technique of dynamic fluorine-18 labeled sodium fluoride positron emission tomography ((18)F-NaF PET) allows the quantitative assessment of regional bone formation by measuring the plasma clearance of fluoride to bone at any site in the skeleton. (18)F-NaF PET provides a novel and noninvasive method of studying site-specific bone formation at the hip and spine, as well as areas of pure cortical or trabecular bone. The technique complements conventional measurements of bone turnover using biochemical markers and bone biopsy as a tool to investigate new treatments for osteoporosis, and holds promise of a future role as an early biomarker of treatment efficacy in clinical trials. This article reviews methods of acquiring and analyzing (18)F-NaF PET scan data, and outlines a simplified approach that uses 5-minute static PET scan images combined with venous blood samples to estimate (18)F-NaF plasma clearance at multiple sites in the skeleton with a single injection of tracer.
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Affiliation(s)
- Glen M Blake
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, SE1 9RT, UK,
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39
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Eriksen EF, Keaveny TM, Gallagher ER, Krege JH. Literature review: The effects of teriparatide therapy at the hip in patients with osteoporosis. Bone 2014; 67:246-56. [PMID: 25053463 DOI: 10.1016/j.bone.2014.07.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 06/19/2014] [Accepted: 07/08/2014] [Indexed: 01/24/2023]
Abstract
Teriparatide is a skeletal anabolic treatment for patients with osteoporosis at high risk for fracture. Because adequate clinical trials have not yet been conducted to assess the efficacy of teriparatide for reducing the risk of hip fracture, we review here the literature regarding how treatment with teriparatide affects the hip in patients with osteoporosis. Teriparatide increases cancellous bone volume, improves bone architecture, and - uniquely among osteoporosis treatments - increases cortical thickness and cortical porosity. By bone scan and positron emission tomography, teriparatide increases bone formation throughout the skeleton, including the hip. Consistent with these findings, studies using dual-energy X-ray absorptiometry and quantitative computed tomography for longitudinal assessment of changes at the hip have consistently shown increases in areal and volumetric bone mineral density, cortical thickness, and finite element-estimated hip strength in patients treated with teriparatide. Finally, in clinical fracture-outcome trials, treatment with teriparatide has been shown to reduce the risk of nonvertebral fracture, a composite endpoint that includes hip fracture. Taken together, this body of evidence suggests that teriparatide positively affects the hip in patients with osteoporosis.
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Affiliation(s)
- Erik F Eriksen
- Department of Endocrinology, Oslo University Hospital, Pb 49596 Nydalen, N-0424 Oslo, Norway.
| | - Tony M Keaveny
- University of California, Berkeley, Departments of Mechanical Engineering and Bioengineering, 6175 Etcheverry Hall, MC 1740, Berkeley, CA 94720, USA.
| | - Eileen R Gallagher
- inVentiv Health Clinical, 504 Carnegie Center, Princeton, NJ 08540, USA.
| | - John H Krege
- Lilly USA, LLC, Lilly Technology Center South, Drop Code 5028 Indianapolis, IN 46221, USA.
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40
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Frost ML, Compston JE, Goldsmith D, Moore AE, Blake GM, Siddique M, Skingle L, Fogelman I. (18)F-fluoride positron emission tomography measurements of regional bone formation in hemodialysis patients with suspected adynamic bone disease. Calcif Tissue Int 2013; 93:436-47. [PMID: 23995764 PMCID: PMC3824308 DOI: 10.1007/s00223-013-9778-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/25/2013] [Indexed: 01/10/2023]
Abstract
(18)F-fluoride positron emission tomography ((18)F-PET) allows the assessment of regional bone formation and could have a role in the diagnosis of adynamic bone disease (ABD) in patients with chronic kidney disease (CKD). The purpose of this study was to examine bone formation at multiple sites of the skeleton in hemodialysis patients (CKD5D) and assess the correlation with bone biopsy. Seven CKD5D patients with suspected ABD and 12 osteoporotic postmenopausal women underwent an (18)F-PET scan, and bone plasma clearance, K i, was measured at ten skeletal regions of interest (ROI). Fifteen subjects had a transiliac bone biopsy following double tetracycline labeling. Two CKD5D patients had ABD confirmed by biopsy. There was significant heterogeneity in K i between skeletal sites, ranging from 0.008 at the forearm to 0.028 mL/min/mL at the spine in the CKD5D group. There were no significant differences in K i between the two study groups or between the two subjects with ABD and the other CKD5D subjects at any skeletal ROI. Five biopsies from the CKD5D patients had single tetracycline labels only, including the two with ABD. Using an imputed value of 0.3 μm/day for mineral apposition rate (MAR) for biopsies with single labels, no significant correlations were observed between lumbar spine K i corrected for BMAD (K i/BMAD) and bone formation rate (BFR/BS), or MAR. When biopsies with single labels were excluded, a significant correlation was observed between K i/BMAD and MAR (r = 0.81, p = 0.008) but not BFR/BS. Further studies are required to establish the sensitivity of (18)F-PET as a diagnostic tool for identifying CKD patients with ABD.
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Affiliation(s)
- Michelle L Frost
- Osteoporosis Unit, Division of Imaging Sciences and Biomedical Engineering, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK,
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