Dynamic Bone Imaging with 99mTc-Labeled Diphosphonates and 18F-NaF: Mechanisms and Applications

Ka Kit Wong; Morand Piert

doi:10.2967/jnumed.112.114298

Abstract

Dynamic bone scanning with ^99mTc-labeled diphosphonates and ¹⁸F-labeled sodium fluoride provides functional information sensitive for subtle changes in bone turnover and perfusion, which assists the clinical management of numerous osseous pathologies. This article reviews the mechanisms of uptake of ^99mTc-labeled diphosphonates and ¹⁸F-sodium fluoride and discusses and compares the performance of these bone-seeking radiotracers for clinical and research applications, using dynamic and multiple-time-point imaging protocols and quantitative techniques.

Footnotes

Published online Mar. 12, 2013.
Learning Objectives: On successful completion of this activity, participants should be able to (1) appreciate the physiologic mechanisms underlying uptake of bone-seeking radiopharmaceuticals used to assess bone perfusion and turnover and note the differences between ¹⁸F-NaF and ^99mTc-labeled diphosphonates; (2) discuss the use of bone scintigraphy for evaluation of bone viability and metabolic bone disorders and appreciate the potential role of quantitative dynamic ¹⁸F-NaF PET for evaluation of response to therapy; and (3) discuss indications for ^99mTc-labeled diphosphonate bone scans and ¹⁸F-NaF PET/CT for oncologic staging and appreciate quantitative methods on static and dynamic bone imaging as imaging biomarkers of treatment response using novel systemic therapies for metastatic castrate-resistant prostate cancer as a model.
Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest.
CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, participants can access this activity through the SNMMI Web site (http://www.snmmi.org/ce_online) through April 2016.