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Increased Sensitivity in Detection of a Porcine High-Turnover Osteopenia After Total Gastrectomy by Dynamic ¹⁸F-Fluoride Ion PET and Quantitative CT

¹ Nuclear Medicine, Technical University of Munich, Germany
² Department of Abdominal and Transplantation Surgery, University of Tübingen, Germany
³ Radiopharmacy, PET-Center, University of Tübingen, Germany

High-resolution ¹⁸F-fluoride ion PET in combination with quantitative CT (QCT) allows the assessment of bone metabolism in relation to bone mass. This combined imaging approach was used to elucidate porcine bone metabolic changes after gastrectomy, which are frequently associated with osteopenia or osteomalacia. Methods: Six months after total gastrectomy (n = 7) or sham operation (n = 6), bone blood flow and bone metabolic activity (K_i, K_flux) were calculated from dynamic PET measurements from vertebral bodies and compared with corresponding QCT bone mineral density (BMD) measurements. Results: Total gastrectomy resulted in a significant reduction of the BMD (-21%; P < 0.005), whereas 1,25-(OH)₂-vitamin D, serum phosphate, and parathyroid hormone were significantly increased compared with that of sham-operated animals. Because of the significant increase of the rate constant k₃ (+325%; P < 0.05), describing chemisorption and incorporation of ¹⁸F-fluoride onto or into the bone matrix, K_i (+36%) and K_flux (+37%) were significantly elevated after total gastrectomy compared with that of control animals (P < 0.01), whereas bone blood flow was not significantly different between groups. The normalization of K_i and K_flux values by the specific bone mass (K_i/BMD; K_flux/BMD) largely increased the differences between groups (K_i/BMD, +74%; K_flux, +76%; P < 0.001). Conclusion: Dynamic ¹⁸F-fluoride ion PET revealed that porcine bone loss after total gastrectomy is related to a high-turnover bone disease without significant changes in bone blood flow. In mini pigs, the increased bone metabolism is probably related to an elevated parathyroid hormone secretion, thus maintaining serum calcium homeostasis at the expense of the bone mineral content. Normalizing bone metabolic activity by the specific bone mass increases the sensitivity in the detection of osteopenic high-turnover bone diseases. Therefore, the combination of QCT and ¹⁸F-fluoride ion PET seems to be the method of choice for the classification of metabolic bone diseases and for monitoring treatment effects quantitatively.

Key Words: ¹⁸F-fluoride ion PET • bone metabolic activity • bone mineral density • quantitative CT • postgastrectomy bone disease • total gastrectomy

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