Molecular Mechanisms of Bone 18F-NaF Deposition | Journal of Nuclear Medicine

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FIGURE 1.
Maximum-intensity-projection PET image (A) and selected axial PET/CT (B, D, F, H) and CT (C, E, G, I) images of ¹⁸F-NaF PET/CT scan of 63-y-old man with prostate cancer. Increased ¹⁸F-NaF uptake can be seen in benign changes of right cervical facet joint (green arrow in A, B, and C), healing rib fracture (yellow arrow in A, D, and E), benign lumbar vertebral bone cyst (blue arrow in A, F, and G), and blastic metastasis in sacrum (red arrow in A, H, and I). Additional value of CT to characterize focally increased tracer uptake is evident.
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FIGURE 2.
¹⁸F-NaF kinetic model with 3 compartments: vascular (1), extravascular (2), and bone (3). Plasma clearance of ¹⁸F-NaF is measured in left ventricle or aorta with PET scanner or from arterial blood draw; k₁–k₄ are rate constants; k₁ and k₂ represent forward and reverse transport from plasma, and k₃ and k₄ represent uptake and release from bone. If extraction fraction equals 1, then k₁ represents local bone blood flow. Influx rate K_i = k₁ · k₃ · (k₂ + k₃)⁻¹ is related to Ca²⁺ influx and bone apposition rate and, presumably, represents bone remodeling rate. Ki is determined by both bone blood flow and bone turnover. Therefore, measurements have to be interpreted in context of each individual study. Respective concentrations of fluoride are denoted as C_p (in plasma), C_e (in extravascular space), and C_b (in bone compartment). RBC = red blood cells
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FIGURE 3.
Radiographs (left), ¹⁸F-NaF PET/CT scans (middle), and photomicrographs of histologic specimen (right). PET/CT images reveal osteoblastic lesion earlier (4 wk) than radiography (arrows denote bone lesions). Increasing ¹⁸F-NaF uptake over time corresponds to increased bone formation seen on histology (asterisks). (Reprinted from (36).)