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¹⁸F-Fluoride PET for Monitoring Therapeutic Response in Paget’s Disease of Bone

¹ Department of Molecular Imaging and Experimental Radiotherapy, Catholic University of Louvain, Brussels, Belgium
² Department of Rheumatology, Catholic University of Louvain, Brussels, Belgium

A prospective study was undertaken to evaluate PET with ¹⁸F-fluoride for monitoring the response to bisphosphonates in Paget’s disease of bones. Methods: Fourteen patients with a monostotic (n = 9) or a polyostotic form (n = 5) of Paget’s disease were scanned at baseline and at 1 and 6 mo after the beginning of treatment. Dynamic acquisition and arterial blood sampling were used to calculate the influx constant Ki (by both the Patlak [Ki-PAT] method and the nonlinear regression [Ki-NLR] method). Kinetic modeling was compared with maximal standardized uptake values (SUV_max) and biochemical markers of bone remodeling. Results: Baseline uptake of ¹⁸F-fluoride by pagetic bones was significantly higher than in normal bones (P < 0.05). One month after the start of treatment, SUV_max, Ki-PAT, Ki-NLR, and K₁ (the unidirectional clearance of fluoride from plasma to the whole of the bone tissue) decreased significantly by 27.8%, 27.9%, 27.5%, and 23.6%, respectively. Biochemical markers were already normalized in 6 of 9 patients with monostotic disease, although all had high ¹⁸F-fluoride uptake values. Six months after the start of treatment, ¹⁸F-fluoride uptake further diminished by 22.3%–25.6%. Biochemical markers were normal in all but 2 patients, although 10 of 14 patients still showed high ¹⁸F-fluoride uptake. One patient did not respond to treatment and maintained high uptake of ¹⁸F-fluoride throughout the study. SUV_max correlated with both Ki-PAT and Ki-NLR at baseline, 1 mo, and 6 mo (P < 0.05). Moreover, the change of SUV_max between baseline and 1 mo, as well as between baseline and 6 mo, also correlated with the change of Ki-PAT and Ki-NLR (P < 0.05). Conclusion: Our results show that ¹⁸F-fluoride PET can be used to noninvasively and accurately monitor the efficacy of treatment with bisphosphonates in Paget’s disease of bones. SUV_max correlates with Ki-PAT and Ki-NLR and, interestingly, varies in the same manner as kinetic indices. Therefore, the use of SUV_max could avoid the need for dynamic acquisition and arterial blood sampling and would facilitate the use of whole-body PET in a clinical setting.

Key Words: PET • ¹⁸F-fluoride • therapeut[b]ic response • Paget’s disease • kinetic modeling

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