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Usmani S, Ahmed N, Gnanasegaran G, Marafi F, van den Wyngaert T. Update on imaging in chronic kidney disease-mineral and bone disorder: promising role of functional imaging. Skeletal Radiol 2022; 51:905-922. [PMID: 34524489 DOI: 10.1007/s00256-021-03905-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
Disorders of mineral metabolism and bone disease are common complications in chronic kidney disease (CKD) patients and are associated with increased morbidity and mortality. Bone biopsies, bone scintigraphy, biochemical markers, and plain films have been used to assess bone disorders and bone turnover. Of these, functional imaging is less invasive than bone/marrow sampling, more specific than serum markers and is therefore ideally placed to assess total skeletal metabolism. 18F-sodium fluoride (NaF) PET/CT is an excellent bone-seeking agent superior to conventional bone scan in CKD patients due to its high bone uptake, rapid single-pass extraction, and minimal binding to serum proteins. Due to these properties, 18F-NaF can better assess the skeletal metabolism on primary diagnosis and following treatment in CKD patients. With the increased accessibility of PET scanners, it is likely that PET scanning with bone-specific tracers such as 18F-NaF will be used more regularly for clinical assessment and quantitation of bone kinetics. This article describes the pattern of scintigraphic/functional appearances secondary to musculoskeletal alterations that might occur in patients with CKD.
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Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine, Kuwait Cancer Control Centre, Kuwait City, Kuwait.
| | - Najeeb Ahmed
- Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, UK.,Cancer Research Group, Hull York Medical School, University of Hull, York, UK
| | | | - Fahad Marafi
- Jaber Al-Ahmad Molecular Imaging Center, Kuwait City, Kuwait
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Abstract
18F-Sodium fluoride (NaF) is primarily a skeletal imaging agent which can be localized in extraosseous calcified foci. Here, we describe a case of a 48-year-old man with bladder carcinoma referred for staging using 18F-NaF positron emission tomography/computed tomography (PET/CT). 18F-NaF PET/CT detected a calcified soft tissue mass in the urinary bladder. Extraosseous 18F-NaF uptake is often encountered and these non-osseous findings could possibly provide important diagnostic information. Thus, recognition of extraosseous 18F-NaF activity has implications for accurate staging and management.
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Affiliation(s)
- Sharjeel Usmani
- Kuwait Cancer Control Center, Department of Nuclear Medicine, Shuwaikh, Kuwait
| | - Najeeb Ahmed
- Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, United Kingdom
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Gutierrez-Cardo A, Lillo E, Murcia-Casas B, Carrillo-Linares JL, García-Argüello F, Sánchez-Sánchez P, Rodriguez-Morata A, Aranda IB, Sánchez-Chaparro MÁ, García-Fernández M, Valdivielso P. Skin and Arterial Wall Deposits of 18F-NaF and Severity of Disease in Patients with Pseudoxanthoma Elasticum. J Clin Med 2020; 9:E1393. [PMID: 32397252 DOI: 10.3390/jcm9051393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 01/13/2023] Open
Abstract
Pseudoxanthoma elasticum (PXE) is a genetic disease characterized by the calcification of elastin fibers. Our aim was to quantify vascular calcification in the arteries and the deposition of 18F-sodium-fluoride (18F-NaF) in the skin and vessel walls with positron emission tomography/computed tomography. This was an observational study including 18 patients with PXE. Vascular calcification was measured in Agatston units, and deposition in the skin and vessel walls was shown using target-to-background ratio (TBR). Severity of the disease was scored by Phenodex. We found higher vascular calcification in the popliteal, femoral, and aortic arch vessels compared to other vascular regions; however, the uptake of radiotracer was the highest in the aorta and femoral arteries. In the skin, the highest uptake was observed in the neck and the axillae. There was no significant association between 18F-NaF deposition in the arteries or skin and the global Phenodex score. In contrast, the Phenodex score was significantly associated in univariate analyses with the averaged vascular calcium score (p < 0.01). In the neck, patients with higher skin Phenodex scores exhibited higher radiotracer uptake. As a conclusion, because vascular calcification is physiological, our data suggested that the detection of cutaneous (neck) 18F-NaF deposits might serve to monitor the calcification process in the short-term for patients with PXE.
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Usmani S, Rasheed R, Al Kandari F. Textitis as Seen on 18F-NaF Imaging Using an Ultra-High-Resolution Positron Emission Mammography Scanner. J Nucl Med Technol 2020; 48:181-183. [PMID: 32111663 DOI: 10.2967/jnmt.119.235986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/11/2019] [Indexed: 11/16/2022] Open
Abstract
Textitis is a new term used to refer to the degenerative-strain osteoarthritis that comes from excessive use of a smart phone. 18F-NaF is increasingly used in diagnosing skeletal pain that is not identified on radiographs. We report a case of a 26-y-old woman with left breast cancer referred for 18F-NaF PET/CT, who was complaining of right thumb and wrist pain. Findings were negative for bone secondaries. Dedicated hands views were acquired on a positron emission mammography scanner and showed focal uptake at the first carpometacarpal and second metacarpophalangeal joints. On the basis of the strong history, the findings were likely due to active arthritic changes caused by repetitive strain injury from excessive text messaging.
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Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine, Kuwait Cancer Control Center, Shuwaikh, Kuwait; and.,Jaber Al Ahmad Al Sabah Center for Nuclear Medicine and Molecular Imaging, Kuwait City, Kuwait
| | - Rashid Rasheed
- Department of Nuclear Medicine, Kuwait Cancer Control Center, Shuwaikh, Kuwait; and
| | - Fareeda Al Kandari
- Department of Nuclear Medicine, Kuwait Cancer Control Center, Shuwaikh, Kuwait; and
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Timmermans AJ, Quak JJ, Hagen PJ, Colnot DR. 18F-NaF PET/CT imaging of bone formation induced by bioactive glass S53P4 after mastoid obliteration. Eur J Hybrid Imaging 2019; 3:18. [PMID: 34191153 PMCID: PMC8218153 DOI: 10.1186/s41824-019-0065-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/14/2019] [Indexed: 12/05/2022] Open
Abstract
Purpose Bioactive glass has been successfully used for surgical treatment of chronic infections in bone and bone cavities. Besides infection control, new bone formation is induced by the bioactive glass which is considered to have osteoconductive properties. Evaluation of postsurgical changes after bone graft surgery is generally performed with conventional radiographs or CT/MR imaging, but 18F-NaF PET/CT might be more suitable since it has a high and rapid bone uptake, accompanied by a fast blood clearance leading to a high bone to background ratio. Case Obliteration with S53P4 bioactive glass of the mastoid and middle ear was performed in a patient suffering from chronic otitis media. Control of the chronic otitis media was achieved, and follow-up imaging after 3 years with 18F-NaF PET/CT showed increased uptake in the obliterated cavity indicating new bone formation. Conclusion 18F-NaF PET/CT is able to detect new bone formation after obliteration of the mastoid with S53P4 bioactive glass.
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Affiliation(s)
- Adriana J Timmermans
- Department of Otorhinolaryngology and Head and Neck Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Jasper J Quak
- Department of Otorhinolaryngology and Head and Neck Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands
| | - Petronella J Hagen
- Department of Nuclear Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | - David R Colnot
- Department of Otorhinolaryngology and Head and Neck Surgery, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
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Uprimny C, Svirydenka A, Fritz J, Kroiss AS, Nilica B, Decristoforo C, Haubner R, von Guggenberg E, Buxbaum S, Horninger W, Virgolini IJ. Comparison of [ 68Ga]Ga-PSMA-11 PET/CT with [ 18F]NaF PET/CT in the evaluation of bone metastases in metastatic prostate cancer patients prior to radionuclide therapy. Eur J Nucl Med Mol Imaging 2018; 45:1873-1883. [PMID: 29766246 DOI: 10.1007/s00259-018-4048-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/02/2018] [Indexed: 02/07/2023]
Abstract
AIM The purpose of this study was to investigate the diagnostic performance of 68Ga-PSMA-11 PET/CT in the evaluation of bone metastases in metastatic prostate cancer (PC) patients scheduled for radionuclide therapy in comparison to [18F]sodium fluoride (18F-NaF) PET/CT. METHODS Sixteen metastatic PC patients with known skeletal metastases, who underwent both 68Ga-PSMA-11 PET/CT and 18F-NaF PET/CT for assessment of metastatic burden prior to radionuclide therapy, were analysed retrospectively. The performance of both tracers was calculated on a lesion-based comparison. Intensity of tracer accumulation of pathologic bone lesions on 18F-NaF PET and 68Ga-PSMA-11 PET was measured with maximum standardized uptake values (SUVmax) and compared to background activity of normal bone. In addition, SUVmax values of PET-positive bone lesions were analysed with respect to morphologic characteristics on CT. Bone metastases were either confirmed by CT or follow-up PET scan. RESULTS In contrast to 468 PET-positive lesions suggestive of bone metastases on 18F-NaF PET, only 351 of the lesions were also judged positive on 68Ga-PSMA-11 PET (75.0%). Intensity of tracer accumulation of pathologic skeletal lesions was significantly higher on 18F-NaF PET compared to 68Ga-PSMA-11 PET, showing a median SUVmax of 27.0 and 6.0, respectively (p < 0.001). Background activity of normal bone was lower on 68Ga-PSMA-11 PET, with a median SUVmax of 1.0 in comparison to 2.7 on 18F-NaF PET; however, tumour to background ratio was significantly higher on 18F-NaF PET (9.8 versus 5.9 on 68Ga-PSMA-11 PET; p = 0.042). Based on morphologic lesion characterisation on CT, 18F-NaF PET revealed median SUVmax values of 23.6 for osteosclerotic, 35.0 for osteolytic, and 19.0 for lesions not visible on CT, whereas on 68Ga-PSMA-11 PET median SUVmax values of 5.0 in osteosclerotic, 29.5 in osteolytic, and 7.5 in lesions not seen on CT were measured. Intensity of tracer accumulation between18F-NaF PET and 68Ga-PSMA-11 PET was significantly higher in osteosclerotic (p < 0.001) and lesions not visible on CT (p = 0.012). CONCLUSION In comparison to 68Ga-PSMA-11 PET/CT, 18F-NaF PET/CT detects a higher number of pathologic bone lesions in advanced stage PC patients scheduled for radionuclide therapy. Our data suggest that 68Ga-PSMA-11 PET should be combined with 18F-NaF PET in PC patients with skeletal metastases for restaging prior to initiation or modification of therapy.
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Affiliation(s)
- Christian Uprimny
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Anna Svirydenka
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Josef Fritz
- Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alexander Stephan Kroiss
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Bernhard Nilica
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Roland Haubner
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Elisabeth von Guggenberg
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sabine Buxbaum
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Irene Johanna Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Usmani S, Sit C, Gnanasegaran G, den Wyngaert TV, Marafi F. Pictorial atlas of symptomatic accessory ossicles by 18F-Sodium Fluoride (NaF) PET-CT. Am J Nucl Med Mol Imaging 2017; 7:275-282. [PMID: 29348982 PMCID: PMC5768922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/15/2017] [Indexed: 06/07/2023]
Abstract
Accessory ossicles are developmental variants which are often asymptomatic. When incidentally picked up on imaging, they are often inconsequential and rarely a cause for concern. However, they may cause pain or discomfort due to trauma, altered stress, and over-activity. Nuclear scintigraphy may play a role in the diagnosis and localizing pain generators. 18F-Sodium Fluoride (NaF) is a PET imaging agent used in bone imaging. Although commonly used in imaging patients with cancer imaging malignancy, 18F-NaF may be useful in the evaluation of benign bone and joint conditions. In this article, we would like to present a spectrum of clinical cases and review the potential diagnostic utility of 18F-NaF in the assessment of symptomatic accessory ossicles in patients referred for staging cancers.
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Affiliation(s)
- Sharjeel Usmani
- Department of Nuclear Medicine & PET/CT Imaging, Kuwait Cancer Control CenterKhaitan, Kuwait
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Osvaldo GPF, Salvador MOS, Zael SR, Nora SM. Radium-223 IN metastatic hormone-sensitive high-grade prostate cancer: initial experience. Am J Nucl Med Mol Imaging 2017; 7:236-245. [PMID: 29181271 PMCID: PMC5698617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Our study evaluates the feasibility of compassionate exemption of Radium-223 (223Ra) treatment in metastatic hormone-sensitive high-grade prostate cancer (mHSHGPC) patients with concomitant androgen deprivation-therapy (ADT). Seven patients with mHSHGPC, were treated with six cycles of 223Ra plus ADT. All patients had undergone to 18F-NaF-PET/CT. A qualitative analyses of the 18F-NaF-PET/CT was performed in conjunction with Alkaline Phosphatase (ALP), Lactate-dehydrogenase (LDH) and Prostatic-Specific Antigen (PSA) values. The mean of SUVmax values were used as a quantitative measure of tumoral burden. Changes in PSA, ALP, LDH from baseline were evaluated, and were defined as increase or decrease of at least 30%. Clinical response was achieved if there was pain reduction using visual analogic scale. Four patients showed a significant reduction in mean SUVmax after 3 cycles of 223Ra, and one after 6 cycles. Patients who showed reductions in mean SUVmax after Ra-223 also showed reductions in PSA, ALP and LDH. Four weeks after the last cycle of 223Ra all patients had decreased total PSA, ALP and LDH values ≥ 30% also significant improvement on pain. No progress disease was documented after 14 ± 4 weeks. We found slight to moderate decreases in neutrophils and hemoglobin in two patients. We concluded that 223Ra plus ADT can be useful in mHSHGPC; the semi-quantitative 18F-NaF-PET/CT as a method effective to monitor the treatment response. Due to concomitant administration of ADT, 18F-NaF-PET/CT cannot differentiate whether the findings were due to androgen blockade or the 223Ra; nevertheless, data supporting the efficacy of 223Ra is the significant improvement on pain.
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Affiliation(s)
| | | | - Santana-Ríos Zael
- Urologic Malignances Department, Instituto Nacional de CancerologíaMexico City, Mexico
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Schwaiger BJ, Kopperdahl DL, Nardo L, Facchetti L, Gersing AS, Neumann J, Lee KJ, Keaveny TM, Link TM. Vertebral and femoral bone mineral density and bone strength in prostate cancer patients assessed in phantomless PET/CT examinations. Bone 2017; 101:62-69. [PMID: 28442297 PMCID: PMC5506071 DOI: 10.1016/j.bone.2017.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 03/23/2017] [Accepted: 04/17/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Bone fracture risk assessed ancillary to positron emission tomography with computed tomography co-registration (PET/CT) could provide substantial clinical value to oncology patients with elevated fracture risk without introducing additional radiation dose. The purpose of our study was to investigate the feasibility of obtaining valid measurements of bone mineral density (BMD) and finite element analysis-derived bone strength of the hip and spine using PET/CT examinations of prostate cancer patients by comparing against values obtained using routine multidetector-row computed tomography (MDCT) scans-as validated in previous studies-as a reference standard. MATERIALS AND METHODS Men with prostate cancer (n=82, 71.6±8.3 years) underwent Fluorine-18 NaF PET/CT and routine MDCT within three months. Femoral neck and total hip areal BMD, vertebral trabecular BMD and femur and vertebral strength based on finite element analysis were assessed in 63 paired PET/CT and MDCT examinations using phantomless calibration and Biomechanical-CT analysis. Men with osteoporosis or fragile bone strength identified at either the hip or spine (vertebral trabecular BMD ≤80mg/cm3, femoral neck or total hip T-score ≤-2.5, vertebral strength ≤6500N and femoral strength ≤3500N, respectively) were considered to be at high risk of fracture. PET/CT- versus MDCT-based BMD and strength measurements were compared using paired t-tests, linear regression and by generating Bland-Altman plots. Agreement in fracture-risk classification was assessed in a contingency table. RESULTS All measurements from PET/CT versus MDCT were strongly correlated (R2=0.93-0.97; P<0.0001 for all). Mean differences for total hip areal BMD (0.001g/cm2, 1.1%), femoral strength (-60N, 1.3%), vertebral trabecular BMD (2mg/cm3, 2.6%) and vertebral strength (150N; 1.7%) measurements were not statistically significant (P>0.05 for all), whereas the mean difference in femoral neck areal BMD measurements was small but significant (-0.018g/cm2; -2.5%; P=0.007). The agreement between PET/CT and MDCT for fracture-risk classification was 97% (0.89 kappa for repeatability). CONCLUSION Ancillary analyses of BMD, bone strength, and fracture risk agreed well between PET/CT and MDCT, suggesting that PET/CT can be used opportunistically to comprehensively assess bone integrity. In subjects with high fracture risk such as cancer patients this may serve as an additional clinical tool to guide therapy planning and prevention of fractures.
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Affiliation(s)
- Benedikt J Schwaiger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
| | | | - Lorenzo Nardo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States.
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
| | - Alexandra S Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
| | - Jan Neumann
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
| | - Kwang J Lee
- O.N. Diagnostics, LLC, Berkeley, CA, United States
| | - Tony M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, CA, United States.
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States.
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Beheshti M, Rezaee A, Geinitz H, Loidl W, Pirich C, Langsteger W. Evaluation of Prostate Cancer Bone Metastases with 18F-NaF and 18F-Fluorocholine PET/CT. J Nucl Med 2017; 57:55S-60S. [PMID: 27694173 DOI: 10.2967/jnumed.115.169730] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/01/2016] [Indexed: 01/09/2023] Open
Abstract
18F-fluorocholine is a specific promising agent for imaging tumor cell proliferation, particularly in prostate cancer, using PET/CT. It is a beneficial tool in the early detection of marrow-based metastases because it excludes distant metastases and evaluates the response to hormone therapy. In addition, 18F-fluorocholine has the potential to differentiate between degenerative and malignant osseous abnormalities because degenerative changes are not choline-avid; however, the agent may accumulate in recent traumatic bony lesions. On the other hand, 18F-NaF PET/CT can indicate increased bone turnover and is generally used in the assessment of primary and secondary osseous malignancies, the evaluation of response to treatment, and the clarification of abnormalities on other imaging modalities or clinical data. 18F-NaF PET/CT is a highly sensitive method in the evaluation of bone metastases from prostate cancer, but it has problematic specificity, mainly because of tracer accumulation in degenerative and inflammatory bone diseases. In summary, 18F-NaF PET/CT is a highly sensitive method, but 18F-fluorocholine PET/CT can detect early bone marrow metastases and provide greater specificity in the detection of bone metastases in patients with prostate cancer. However, the difference seems not to be significant.
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Affiliation(s)
- Mohsen Beheshti
- Department of Nuclear Medicine and Endocrinology, PET-CT Center Linz, St. Vincent's Hospital, Linz, Austria
| | - Alireza Rezaee
- Department of Nuclear Medicine and Endocrinology, PET-CT Center Linz, St. Vincent's Hospital, Linz, Austria
| | - Hans Geinitz
- Department of Radiation Oncology, St. Vincent's Hospital, Linz, Austria
| | - Wolfgang Loidl
- Department of Urology, St. Vincent's Hospital, Linz, Austria; and
| | - Christian Pirich
- Department of Nuclear Medicine, Paracelsus Private Medical University, Salzburg, Austria
| | - Werner Langsteger
- Department of Nuclear Medicine and Endocrinology, PET-CT Center Linz, St. Vincent's Hospital, Linz, Austria
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Valadares AA, Duarte PS, Carvalho G, Ono CR, Coura-Filho GB, Sado HN, Sapienza MT, Buchpiguel CA. Receiver operating characteristic (ROC) curve for classification of (18)F-NaF uptake on PET/CT. Radiol Bras 2016; 49:12-6. [PMID: 26929455 PMCID: PMC4770391 DOI: 10.1590/0100-3984.2014.0119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the cutoff values established by ROC curves to classify (18)F-NaF uptake as normal or malignant. MATERIALS AND METHODS PET/CT images were acquired 1 hour after administration of 185 MBq of (18)F-NaF. Volumes of interest (VOIs) were drawn on three regions of the skeleton as follows: proximal right humerus diaphysis (HD), proximal right femoral diaphysis (FD) and first vertebral body (VB1), in a total of 254 patients, totalling 762 VOIs. The uptake in the VOIs was classified as normal or malignant on the basis of the radiopharmaceutical distribution pattern and of the CT images. A total of 675 volumes were classified as normal and 52 were classified as malignant. Thirty-five VOIs classified as indeterminate or nonmalignant lesions were excluded from analysis. The standardized uptake value (SUV) measured on the VOIs were plotted on an ROC curve for each one of the three regions. The area under the ROC (AUC) as well as the best cutoff SUVs to classify the VOIs were calculated. The best cutoff values were established as the ones with higher result of the sum of sensitivity and specificity. RESULTS The AUCs were 0.933, 0.889 and 0.975 for UD, FD and VB1, respectively. The best SUV cutoffs were 9.0 (sensitivity: 73%; specificity: 99%), 8.4 (sensitivity: 79%; specificity: 94%) and 21.0 (sensitivity: 93%; specificity: 95%) for UD, FD and VB1, respectively. CONCLUSION The best cutoff value varies according to bone region of analysis and it is not possible to establish one value for the whole body.
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Affiliation(s)
- Agnes Araujo Valadares
- Nuclear Physician, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Paulo Schiavom Duarte
- PhD, Physician Assistant, Service of Nuclear Medicine - Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP Brazil
| | - Giovanna Carvalho
- Physician Assistant, Service of Nuclear Medicine - Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP Brazil
| | - Carla Rachel Ono
- PhD, Physician Assistant, Service of Nuclear Medicine - Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP Brazil
| | - George Barberio Coura-Filho
- PhD, Physician Assistant, Service of Nuclear Medicine - Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP Brazil
| | - Heitor Naoki Sado
- PhD, Physician Assistant, Service of Nuclear Medicine - Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP Brazil
| | - Marcelo Tatit Sapienza
- Private Docent, Professor, Department of Radiology and Oncology - Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP Brazil
| | - Carlos Alberto Buchpiguel
- Private Docent, Full Professor, Department of Radiology and Oncology - Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP Brazil
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Gerety EL, Lawrence EM, Wason J, Yan H, Hilborne S, Buscombe J, Cheow HK, Shaw AS, Bird N, Fife K, Heard S, Lomas DJ, Matakidou A, Soloviev D, Eisen T, Gallagher FA. Prospective study evaluating the relative sensitivity of 18F-NaF PET/CT for detecting skeletal metastases from renal cell carcinoma in comparison to multidetector CT and 99mTc-MDP bone scintigraphy, using an adaptive trial design. Ann Oncol 2015; 26:2113-8. [PMID: 26202597 PMCID: PMC4576907 DOI: 10.1093/annonc/mdv289] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/15/2015] [Accepted: 07/01/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The detection of occult bone metastases is a key factor in determining the management of patients with renal cell carcinoma (RCC), especially when curative surgery is considered. This prospective study assessed the sensitivity of (18)F-labelled sodium fluoride in conjunction with positron emission tomography/computed tomography ((18)F-NaF PET/CT) for detecting RCC bone metastases, compared with conventional imaging by bone scintigraphy or CT. PATIENTS AND METHODS An adaptive two-stage trial design was utilized, which was stopped after the first stage due to statistical efficacy. Ten patients with stage IV RCC and bone metastases were imaged with (18)F-NaF PET/CT and (99m)Tc-labelled methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy including pelvic single photon emission computed tomography (SPECT). Images were reported independently by experienced radiologists and nuclear medicine physicians using a 5-point scoring system. RESULTS Seventy-seven lesions were diagnosed as malignant: 100% were identified by (18)F-NaF PET/CT, 46% by CT and 29% by bone scintigraphy/SPECT. Standard-of-care imaging with CT and bone scintigraphy identified 65% of the metastases reported by (18)F-NaF PET/CT. On an individual patient basis, (18)F-NaF PET/CT detected more RCC metastases than (99m)Tc-MDP bone scintigraphy/SPECT or CT alone (P = 0.007). The metabolic volumes, mean and maximum standardized uptake values (SUV mean and SUV max) of the malignant lesions were significantly greater than those of the benign lesions (P < 0.001). CONCLUSIONS (18)F-NaF PET/CT is significantly more sensitive at detecting RCC skeletal metastases than conventional bone scintigraphy or CT. The detection of occult bone metastases could greatly alter patient management, particularly in the context when standard-of-care imaging is negative for skeletal metastases.
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Affiliation(s)
- E L Gerety
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge
| | - E M Lawrence
- Department of Radiology, University of Cambridge, Cambridge
| | - J Wason
- MRC Biostatistics Unit Hub for Trials Methodology, Cambridge
| | - H Yan
- Department of Radiology, University of Cambridge, Cambridge
| | - S Hilborne
- Department of Radiology, University of Cambridge, Cambridge
| | - J Buscombe
- Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge
| | - H K Cheow
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge
| | - A S Shaw
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge
| | - N Bird
- East Anglian Regional Radiation Protection Service, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge
| | - K Fife
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge
| | - S Heard
- Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge
| | - D J Lomas
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge Department of Radiology, University of Cambridge, Cambridge
| | - A Matakidou
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge
| | - D Soloviev
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge
| | - T Eisen
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge Department of Oncology, University of Cambridge, Cambridge, UK
| | - F A Gallagher
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust and Cambridge University Health Partners, Cambridge Department of Radiology, University of Cambridge, Cambridge
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Valadares AA, Duarte PS, Woellner EB, Coura-Filho GB, Sapienza MT, Buchpiguel CA. Comparison of standardized uptake values measured on F-NaF PET/CT scans using three different tube current intensities. Radiol Bras 2015; 48:17-20. [PMID: 25798003 PMCID: PMC4366024 DOI: 10.1590/0100-3984.2014.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/08/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze standardized uptake values (SUVs) using three different tube current intensities for attenuation correction on (18)FNaF PET/CT scans. MATERIALS AND METHODS A total of 254 (18)F-NaF PET/CT studies were analyzed using 10, 20 and 30 mAs. The SUVs were calculated in volumes of interest (VOIs) drawn on three skeletal regions, namely, right proximal humeral diaphysis (RH), right proximal femoral diaphysis (RF), and first lumbar vertebra (LV1) in a total of 712 VOIs. The analyses covered 675 regions classified as normal (236 RH, 232 RF, and 207 LV1). RESULTS Mean SUV for each skeletal region was 3.8, 5.4 and 14.4 for RH, RF, and LV1, respectively. As the studies were grouped according to mAs value, the mean SUV values were 3.8, 3.9 and 3.7 for 10, 20 and 30 mAs, respectively, in the RH region; 5.4, 5.5 and 5.4 for 10, 20 and 30 mAs, respectively, in the RF region; 13.8, 14.9 and 14.5 for 10, 20 and 30 mAs, respectively, in the LV1 region. CONCLUSION The three tube current values yielded similar results for SUV calculation.
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Affiliation(s)
- Agnes Araujo Valadares
- Nuclear Physicians, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Paulo Schiavom Duarte
- PhDs, Physicians Assistants, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Eduardo Bechtloff Woellner
- Nuclear Physicians, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - George Barberio Coura-Filho
- PhDs, Physicians Assistants, Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Marcelo Tatit Sapienza
- Private Docent, Professor, Department of Radiology and Oncology - Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- Private Docent, Full Professor, Department of Radiology and Oncology - Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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14
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Kuyumcu S, Adalet I, Isik EG, Unal SN. Impact of Nonosseous Findings on (18)F-NaF PET/CT in a Patient with Ductal Breast Carcinoma. Nucl Med Mol Imaging 2013; 48:72-4. [PMID: 24900141 DOI: 10.1007/s13139-013-0235-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/20/2013] [Accepted: 08/27/2013] [Indexed: 11/25/2022] Open
Abstract
(18)F-NaF was used as a bone-seeking PET tracer for skeletal imaging until the introduction of the widely available (99m)Tc-labeled bone agents. However, there is renewed clinical interest in (18)F-NaF since prior technical and logistic limitations to its routine use are no longer present, and, as a consequence, it is likely that uptake unrelated to bone and non-osseous findings will be encountered more frequently. As a result of tumoral necrosis, soft tissue metastases may demonstrate (18)F-NaF avidity due to dystrophic calcification. On the other hand, all non-osseous findings, whether (18)F-NaF avid or not, may provide important diagnostic information that may alter the course of the disease, including treatment options. Herein we present a patient with ductal carcinoma of the breast in whom findings unrelated to the skeletal system in (18)F-NaF PET/CT altered the treatment strategy.
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Affiliation(s)
- Serkan Kuyumcu
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul Turkey
| | - Isik Adalet
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul Turkey
| | - Emine Goknur Isik
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul Turkey
| | - Seher Nilgun Unal
- Istanbul Medical Faculty, Department of Nuclear Medicine, Istanbul University, 34093 Fatih, Istanbul Turkey
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