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Novel Strategy for a Cocktail ¹⁸F-Fluoride and ¹⁸F-FDG PET/CT Scan for Evaluation of Malignancy: Results of the Pilot-Phase Study

¹ Division of Nuclear Medicine, Stanford University Medical Center, Stanford, California; ² Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, California; and ³ Departments of Radiology and Bioengineering, Molecular Imaging Program at Stanford (MIPS), Stanford University Medical Center, Stanford, California

Correspondence: For correspondence or reprints contact: Sanjiv S. Gambhir, James H. Clark Center, 318 Campus Dr., 150 E. Wing, 1st Floor, Stanford, CA 94305–5427. E-mail: sgambhir{at}stanford.edu

¹⁸F-FDG PET/CT is used for detecting cancer and monitoring cancer response to therapy. However, because of the variable rates of glucose metabolism, not all cancers are identified reliably. Sodium ¹⁸F was previously used for bone imaging and can be used as a PET/CT skeletal tracer. The combined administration of ¹⁸F and ¹⁸F-FDG in a single PET/CT study for cancer detection has not been reported to date. Methods: This is a prospective pilot study (November 2007–November 2008) of 14 patients with proven malignancy (6 sarcoma, 3 prostate cancer, 2 breast cancer, 1 colon cancer, 1 lung cancer, and 1 malignant paraganglioma) who underwent separate ¹⁸F PET/CT and ¹⁸F-FDG PET/CT and combined ¹⁸F/¹⁸F-FDG PET/CT scans for the evaluation of malignancy (a total of 3 scans each). There were 11 men and 3 women (age range, 19–75 y; average, 50.4 y). Results: Interpretation of the combined ¹⁸F/¹⁸F-FDG PET/CT scans compared favorably with that of the ¹⁸F-FDG PET/CT (no lesions missed) and the ¹⁸F PET/CT scans (only 1 skull lesion seen on an ¹⁸F PET/CT scan was missed on the corresponding combined scan). Through image processing, the combined ¹⁸F/¹⁸F-FDG scan yielded results for bone radiotracer uptake comparable to those of the ¹⁸F PET/CT scan performed separately. Conclusion: Our pilot-phase prospective trial demonstrates that the combined ¹⁸F/¹⁸F-FDG administration followed by a single PET/CT scan is feasible for cancer detection. This combined method opens the possibility for improved patient care and reduction in health care costs.

Key Words: ¹⁸F • ¹⁸F-FDG • PET/CT • malignancy

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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