HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Even-Sapir, E. Articles by Mishani, E. Search for Related Content PubMed PubMed Citation Articles by Even-Sapir, E. Articles by Mishani, E.

Assessment of Malignant Skeletal Disease: Initial Experience with ¹⁸F-Fluoride PET/CT and Comparison Between ¹⁸F-Fluoride PET and ¹⁸F-Fluoride PET/CT

¹ Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
² Osteoradioiology Unit, Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
³ Department of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
⁴ Department of Oncology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
⁵ Cyclotron Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

¹⁸F-Fluoride PET/CT was performed on 44 oncologic patients to evaluate its diagnostic accuracy in assessing malignant osseous involvement and in differentiating malignant from benign bone lesions. Methods: ¹⁸F-Fluoride PET and ¹⁸F-fluoride PET/CT were interpreted separately. Lesions showing increased ¹⁸F-fluoride uptake were categorized as malignant, benign, or inconclusive. The final diagnosis of lesions was based on histopathology, correlation with contemporaneous diagnostic CT or MRI, or clinical follow-up of at least 6 mo (mean, 10 ± 3 mo). Results: Increased ¹⁸F-fluoride uptake was detected at 212 sites, including 111 malignant lesions, 89 benign lesions, and 12 lesions for which the final diagnosis could not be determined. In a lesion-based analysis, the sensitivity of PET alone in differentiating benign from malignant bone lesions was 72% when inconclusive lesions were considered false negative and 90% when inconclusive lesions were considered true positive. On PET/CT, 94 of 111 (85%) metastases presented as sites of increased uptake with corresponding lytic or sclerotic changes, and 16 of the 17 remaining metastases showed normal-appearing bone on CT, for an overall sensitivity of 99% for tumor detection. For only 1 metastasis was PET/CT misleading, suggesting the false diagnosis of a benign lesion. The specificity of PET/CT was significantly higher than that of PET alone (97% vs. 72%, P < 0.001). PET/CT identified benign abnormalities at the location exactly corresponding to the scintigraphic increased uptake for 85 of 89 (96%) benign lesions. In a patient-based analysis, the sensitivity of PET and PET/CT was 88% and 100%, respectively (P < 0.05) and the specificity was 56% and 88%, respectively (not statistically significant). Among the 12 patients referred for ¹⁸F-fluoride assessment because of bone pain despite negative findings on ^99mTc-methylene diphosphonate bone scintigraphy, ¹⁸F-fluoride PET/CT suggested malignant bone involvement in all 4 patients with proven skeletal metastases, a potential benign cause in 4 of 7 patients who had no evidence of metastatic disease, and a soft-tissue tumor mass invading a sacral foramen in 1 patient. Conclusion: The results indicate that ¹⁸F-fluoride PET/CT is both sensitive and specific for the detection of lytic and sclerotic malignant lesions. It accurately differentiated malignant from benign bone lesions and possibly assisted in identifying a potential cause for bone pain in oncologic patients. For most lesions, the anatomic data provided by the low-dose CT of the PET/CT study obviates the performance of full-dose diagnostic CT for correlation purposes.

Key Words: ¹⁸F-fluoride • PET/CT • bone • metastases

This article has been cited by other articles:

				J. H. Lee, E. L. Rosen, and D. A. Mankoff The Role of Radiotracer Imaging in the Diagnosis and Management of Patients with Breast Cancer: Part 1--Overview, Detection, and Staging J. Nucl. Med., April 1, 2009; 50(4): 569 - 581. [Abstract] [Full Text] [PDF]

				C. R. Walkley, R. Qudsi, V. G. Sankaran, J. A. Perry, M. Gostissa, S. I. Roth, S. J. Rodda, E. Snay, P. Dunning, F. H. Fahey, et al. Conditional mouse osteosarcoma, dependent on p53 loss and potentiated by loss of Rb, mimics the human disease Genes & Dev., June 15, 2008; 22(12): 1662 - 1676. [Abstract] [Full Text] [PDF]

				F. D. Grant, F. H. Fahey, A. B. Packard, R. T. Davis, A. Alavi, and S. T. Treves Skeletal PET with 18F-Fluoride: Applying New Technology to an Old Tracer J. Nucl. Med., January 1, 2008; 49(1): 68 - 78. [Abstract] [Full Text] [PDF]

				E. L. Rosen, W. B. Eubank, and D. A. Mankoff FDG PET, PET/CT, and Breast Cancer Imaging RadioGraphics, October 1, 2007; 27(suppl_1): S215 - S229. [Abstract] [Full Text] [PDF]

				H. Kuehl, P. Veit, S. J. Rosenbaum, A. Bockisch, and G. Antoch Can PET/CT Replace Separate Diagnostic CT for Cancer Imaging? Optimizing CT Protocols for Imaging Cancers of the Chest and Abdomen J. Nucl. Med., January 1, 2007; 48(1_suppl): 45S - 57S. [Abstract] [Full Text] [PDF]

				W. Romer, A. Nomayr, M. Uder, W. Bautz, and T. Kuwert SPECT-Guided CT for Evaluating Foci of Increased Bone Metabolism Classified as Indeterminate on SPECT in Cancer Patients J. Nucl. Med., July 1, 2006; 47(7): 1102 - 1106. [Abstract] [Full Text] [PDF]

				F.-Y. Liu, J. T. Chang, H.-M. Wang, C.-T. Liao, C.-J. Kang, S.-K. Ng, S.-C. Chan, and T.-C. Yen [18F]Fluorodeoxyglucose Positron Emission Tomography Is More Sensitive Than Skeletal Scintigraphy for Detecting Bone Metastasis in Endemic Nasopharyngeal Carcinoma at Initial Staging J. Clin. Oncol., February 1, 2006; 24(4): 599 - 604. [Abstract] [Full Text] [PDF]

				E. Even-Sapir, U. Metser, E. Mishani, G. Lievshitz, H. Lerman, and I. Leibovitch The Detection of Bone Metastases in Patients with High-Risk Prostate Cancer: 99mTc-MDP Planar Bone Scintigraphy, Single- and Multi-Field-of-View SPECT, 18F-Fluoride PET, and 18F-Fluoride PET/CT J. Nucl. Med., February 1, 2006; 47(2): 287 - 297. [Abstract] [Full Text] [PDF]

				P T Finger, M Kurli, S Reddy, L B Tena, and A C Pavlick Whole body PET/CT for initial staging of choroidal melanoma Br. J. Ophthalmol., October 1, 2005; 89(10): 1270 - 1274. [Abstract] [Full Text] [PDF]

				E. Even-Sapir Imaging of Malignant Bone Involvement by Morphologic, Scintigraphic, and Hybrid Modalities J. Nucl. Med., August 1, 2005; 46(8): 1356 - 1367. [Abstract] [Full Text] [PDF]