Semiquantitative Analysis of the Biodistribution of the Combined 18F-NaF and 18F-FDG Administration for PET/CT Imaging

Ryogo Minamimoto; Camila Mosci; Mehran Jamali; Amir Barkhodari; Frezghi Habte; Tatianie Jackson; Erik Mittra; Sanjiv Sam Gambhir; Andrei Iagaru

doi:10.2967/jnumed.115.153767

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FIGURE 1.
A 65-y-old man with metastatic prostate cancer. (A) ¹⁸F-NaF. (B) ¹⁸F-FDG. (C) ¹⁸F⁻/¹⁸F-FDG. SUV_max or SUV_mean of left atrium, liver, mediastinal lymph node, right rib lesion, left iliac lymph node, and left iliac bone lesion were shown for ¹⁸F-NaF, ¹⁸F-FDG, and estimated ¹⁸F⁻/¹⁸F-FDG, respectively.

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TABLE 1

Details of 3 Types of PET Scans

Parameter	¹⁸F⁻/¹⁸F-FDG	¹⁸F-FDG	¹⁸F-NaF
Injection dose (MBq)	¹⁸F⁻/¹⁸F-FDG: 625.1 ± 85.8	478.2 ± 85.0	248.7 ± 84.0
	¹⁸F-FDG: 426.9 ± 82.7
	¹⁸F-NaF: 199.7 ± 35.5
Time from injection to imaging (min)	76.6 ± 13.0	75.5 ± 13.8	75.2 ± 17.7
The difference in time of starting PET/CT with ¹⁸F⁻/¹⁸F-FDG PET/CT (min)	—	1.1 ± 13.0	1.3 ± 15.0
Time interval of PET/CT with ¹⁸F⁻/¹⁸F-FDG PET/CT (d)	—	4.1 ± 4.7	4.1 ± 4.4

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TABLE 2

Radiopharmaceutical Uptake (SUV_mean) for Studied Organs, Based on Time from Injection to Imaging

	Time from injection to imaging (min)
	¹⁸F⁻/¹⁸F-FDG			¹⁸F-FDG			¹⁸F-NaF
Organ	52–60 (n = 6)	60–90 (n = 32)	90–104 (n = 11)	43–60 (n = 8)	60–90 (n = 35)	90–111 (n = 6)	39–60 (n = 10)	60–90 (n = 29)	90–117 (n = 10)
Brain cortex (frontal lobe)	10.4 ± 2.4	9.7 ± 2.4	10.4 ± 2.5	10.0 ± 2.0	10.2 ± 2.5	11.2 ± 2.5	0.2 ± 0.1	0.3 ± 0.1	0.3 ± 0.1
Cerebellum	8.5 ± 1.8	8.2 ± 1.9	8.6 ± 2.0	8.2 ± 1.9	8.7 ± 1.9	9.2 ± 1.2	0.2 ± 0.1	0.2 ± 0.1	0.2 ± 0.1
Parotid grand	2.1 ± 0.9	1.9 ± 0.7	1.5 ± 0.4	1.6 ± 0.9	2.1 ± 1.1	1.4 ± 0.6	0.6 ± 0.2	0.5 ± 0.1	0.4 ± 0.1
Lung	0.7 ± 0.2	0.6 ± 0.2	0.7 ± 0.2	0.4 ± 0.2	0.5 ± 0.1	0.6 ± 0.1	0.3 ± 0.1	0.4 ± 0.2	0.4 ± 0.1
Myocardium	4.3 ± 2.4	4.8 ± 4.1	4.0 ± 4.0	3.7 ± 2.6	4.3 ± 3.9	7.7 ± 7.1	0.6 ± 0.3	0.7 ± 0.2	0.6 ± 0.2
Left atrium (background)	2.7 ± 0.7	2.3 ± 0.6	2.2 ± 0.6	1.8 ± 0.5	1.8 ± 0.4	1.9 ± 0.3	1.1 ± 0.4	1.2 ± 0.4	0.9 ± 0.3
Liver	2.6 ± 0.6	2.3 ± 0.5	2.5 ± 0.6	2.0 ± 0.5	2.2 ± 0.4	2.2 ± 0.3	0.4 ± 0.1	0.5 ± 0.2	0.4 ± 0.1
Spleen	2.2 ± 0.4	1.8 ± 0.6	2.3 ± 1.1	1.8 ± 0.6	1.7 ± 0.5	1.9 ± 0.3	0.6 ± 0.2	0.7 ± 0.2	0.5 ± 0.2
Pancreas	1.9 ± 0.3	1.7 ± 0.5	1.5 ± 0.6	1.4 ± 0.3	1.5 ± 0.4	1.2 ± 0.4	0.6 ± 0.2	0.6 ± 0.2	0.6 ± 0.2
Kidney	3.1 ± 0.8	2.7 ± 0.8	2.9 ± 1.1	2.4 ± 0.6	2.4 ± 0.6	2.0 ± 0.5	1.2 ± 0.5	1.7 ± 0.8	1.3 ± 0.5
Cecum	1.6 ± 0.4	1.7 ± 1.4	1.8 ± 1.8	0.9 ± 0.3	1.8 ± 2.0	1.0 ± 0.5	0.6 ± 0.2	0.7 ± 0.4	0.5 ± 0.1
Trapezius muscle	1.0 ± 0.3	1.0 ± 0.3	1.0 ± 0.3	0.6 ± 0.1	0.6 ± 0.1	0.7 ± 0.1	0.7 ± 0.2	0.8 ± 0.2	0.8 ± 0.2
Gluteus maximus muscle	1.0 ± 0.4	0.9 ± 0.3	1.1 ± 0.4	0.6 ± 0.2	0.7 ± 0.2	0.6 ± 0.1	0.7 ± 0.3	0.8 ± 0.2	0.7 ± 0.2
Fat tissue	0.3 ± 0.1	0.4 ± 0.2	0.4 ± 0.2	0.3 ± 0.1	0.3 ± 0.2	0.2 ± 0.1	0.2 ± 0.1	0.3 ± 0.1	0.2 ± 0.1
Cervical vertebrae	4.9 ± 2.6	4.5 ± 1.5	5.0 ± 2.7	1.3 ± 0.6	1.3 ± 0.3	1.7 ± 0.5	7.2 ± 3.1	6.9 ± 2.2	7.3 ± 2.5
Thoracic vertebrae	6.0 ± 2.9	5.0 ± 1.6	5.3 ± 2.5	1.8 ± 0.7	1.7 ± 0.6	1.6 ± 0.5	7.0 ± 2.5	7.6 ± 2.1	7.2 ± 2.0
Lumbar vertebrae	5.6 ± 2.4	4.8 ± 1.9	4.9 ± 3.0	1.5 ± 0.4	1.7 ± 0.6	1.5 ± 0.7	6.7 ± 1.6	7.1 ± 2.4	6.3 ± 2.4
Sacrum	4.9 ± 2.5	3.8 ± 1.5	4.2 ± 3.0	1.1 ± 0.3	1.2 ± 0.5	1.6 ± 0.1	5.8 ± 2.2	5.7 ± 2.3	5.3 ± 2.8

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TABLE 3

SUV_mean Measurements from PET Scans

	SUV_mean			Comparison of ¹⁸F⁻/¹⁸F-FDG and ¹⁸F-FDG
Organ	¹⁸F⁻/¹⁸F-FDG	¹⁸F-FDG	¹⁸F-NaF	P	Correlation (r)
Brain cortex (frontal lobe)	10.0 ± 2.4	10.3 ± 2.4	0.2 ± 0.1	0.32	0.62
Cerebellum	8.4 ± 1.9	8.7 ± 1.8	0.2 ± 0.1	0.51	0.49
Parotid grand	1.8 ± 0.7	1.9 ± 1.0	0.5 ± 0.2	0.77	0.75
Lung	0.6 ± 0.2	0.5 ± 0.1	0.4 ± 0.1	<0.001	0.76
Myocardium	4.5 ± 3.8	4.6 ± 4.3	0.7 ± 0.2	0.94	0.69
Left atrium (background)	2.3 ± 0.6	1.8 ± 0.4	1.1 ± 0.4	<0.001	0.71
Liver	2.4 ± 0.5	2.2 ± 0.4	0.5 ± 0.2	<0.007	0.60
Spleen	2.0 ± 0.7	1.7 ± 0.5	0.6 ± 0.2	<0.001	0.60
Pancreas	1.7 ± 0.5	1.5 ± 0.4	0.6 ± 0.2	0.001	0.46
Kidney	2.8 ± 0.8	2.4 ± 0.6	1.5 ± 0.7	0.003	0.28
Cecum	1.7 ± 1.4	1.6 ± 1.7	0.7 ± 0.3	0.30	0.75
Trapezius muscle	1.0 ± 0.3	0.6 ± 0.1	0.8 ± 0.2	<0.001	0.50
Gluteus maximus muscle	1.0 ± 0.3	0.7 ± 0.2	0.7 ± 0.2	<0.001	0.68
Fat tissue	0.4 ± 0.2	0.3 ± 0.2	0.2 ± 0.1	<0.001	0.85
Cervical vertebrae	4.7 ± 1.9	1.4 ± 0.4	7.0 ± 2.4	<0.001	0.51
Thoracic vertebrae	5.2 ± 2.0	1.7 ± 0.6	7.4 ± 2.1	<0.001	0.65
Lumbar vertebrae	4.9 ± 2.2	1.6 ± 0.6	6.8 ± 2.2	<0.001	0.71
Sacrum	4.0 ± 2.0	1.3 ± 0.5	5.7 ± 2.3	<0.001	0.66

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TABLE 4

SUV_mean of ¹⁸F⁻/¹⁸F-FDG in Studied Organ and Differences from Estimated ¹⁸F⁻/¹⁸F-FDG Values

			Comparison of ¹⁸F⁻/¹⁸F-FDG and estimated ¹⁸F⁻/¹⁸F-FDG
Organ	¹⁸F⁻/¹⁸F-FDG	Estimated ¹⁸F⁻/¹⁸F-FDG	P	Correlation (r)
Brain cortex (frontal lobe)	10.0 ± 2.4	10.4 ± 2.4	0.17	0.62
Cerebellum	8.4 ± 1.9	8.8 ± 1.8	0.26	0.49
Parotid grand	1.8 ± 0.7	2.2 ± 1.1	<0.003	0.77
Lung	0.6 ± 0.2	0.7 ± 0.2	0.24	0.85
Myocardium	4.5 ± 3.8	5.0 ± 4.3	0.28	0.69
Left atrium (background)	2.3 ± 0.6	2.4 ± 0.6	0.16	0.80
Liver	2.4 ± 0.5	2.4 ± 0.5	0.24	0.64
Spleen	2.0 ± 0.7	2.0 ± 0.5	0.58	0.61
Pancreas	1.7 ± 0.5	1.8 ± 0.5	0.26	0.54
Kidney	2.8 ± 0.8	3.1 ± 0.8	<0.02	0.44
Cecum	1.7 ± 1.4	1.9 ± 1.9	0.58	0.76
Trapezius muscle	1.0 ± 0.3	1.0 ± 0.2	0.39	0.73
Gluteus maximus muscle	1.0 ± 0.3	1.0 ± 0.3	0.52	0.75
Fat tissue	0.4 ± 0.2	0.4 ± 0.2	0.66	0.87
Cervical vertebrae	4.7 ± 1.9	4.8 ± 1.7	0.19	0.77
Thoracic vertebrae	5.2 ± 2.0	5.3 ± 1.8	0.31	0.85
Lumbar vertebrae	4.9 ± 2.2	5.0 ± 1.9	0.47	0.85
Sacrum	4.0 ± 2.0	3.9 ± 1.6	0.94	0.80

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TABLE 5

SUV_mean and SUV_max Measured from PET Scans and Estimated ¹⁸F⁻/¹⁸F-FDG Uptake in Lesions

						P		Correlation (r)
Value	Lesion	¹⁸F⁻/¹⁸F-FDG	¹⁸F-FDG	¹⁸F-NaF	Estimated ¹⁸F⁻/¹⁸F-FDG	¹⁸F⁻/¹⁸F-FDG and ¹⁸F-FDG	¹⁸F⁻/¹⁸F-FDG and estimated ¹⁸F⁻/¹⁸F-FDG	¹⁸F⁻/¹⁸F-FDG and ¹⁸F-FDG	¹⁸F⁻/¹⁸F-FDG and ¹⁸F-NaF	¹⁸F⁻/¹⁸F-FDG and estimated ¹⁸F⁻/¹⁸F-FDG
SUV_mean	All lesions^*	7.3 ± 4.6	2.2 ± 1.7	10.0 ± 10.0	6.8 ± 4.2	<0.001	<0.007	0.10	0.84	0.88
	Extraskeletal lesions	4.3 ± 2.4	3.7 ± 2.1	0.9 ± 0.4	4.1 ± 2.1	0.30	0.25	0.90	0.35	0.88
	Skeletal lesions	8.3 ± 4.7	1.7 ± 1.0	12.6 ± 9.9	7.4 ± 4.3	<0.001	<0.001	0.50	0.86	0.92
	Skeletal lesions, PC patient	7.3 ± 4.0	1.5 ± 0.8	10.2 ± 6.7	6.5 ± 3.5	<0.001	<0.003	0.23	0.83	0.85
	Skeletal lesions, non–PC patient	10.5 ± 5.5	2.3 ± 1.2	18.7 ± 13.4	9.6 ± 5.2	<0.001	<0.001	0.69	0.88	0.98
	Osteolytic lesions	10.9 ± 5.5	3.0 ± 1.0	14.5 ± 8.6	9.8 ± 5.1	<0.001	<0.02	0.51	0.88	0.96
	Osteoblastic lesions	7.8 ± 4.4	1.5 ± 0.8	12.3 ± 10.0	7.0 ± 4.0	<0.001	<0.001	0.45	0.86	0.90
	Background^†	2.3 ± 0.6	1.8 ± 0.4	1.1 ± 0.4	2.4 ± 0.6	<0.001	0.48	0.70	0.72	0.81
SUV_max	All lesions^*	15.4 ± 11.4	4.7 ± 4.7	27.4 ± 28.8	16.9 ± 12.4	<0.001	<0.001	0.29	0.82	0.91
	Extraskeletal lesions	9.5 ± 9.4	8.4 ± 6.3	2.2 ± 1.6	9.4 ± 6.7	0.61	0.87	0.94	0.91	0.94
	Skeletal lesions	17.3 ± 11.3	3.4 ± 2.8	34.5 ± 28.9	19.1 ± 12.8	<0.001	<0.002	0.51	0.89	0.91
	Skeletal lesions, PC patient	15.0 ± 9.6	2.7 ± 2.4	29.2 ± 23.9	17.3 ± 12.4	<0.001	<0.001	0.27	0.85	0.88
	Skeletal lesions, non–PC patient	23.0 ± 13.5	5.2 ± 3.0	48.0 ± 35.8	23.8 ± 12.7	<0.001	0.19	0.69	0.91	0.98
	Osteolytic lesions	21.6 ± 9.9	6.8 ± 2.3	36.8 ± 17.7	23.4 ± 8.5	<0.001	0.06	0.34	0.82	0.96
	Osteoblastic lesions	16.6 ± 11.5	2.9 ± 2.5	34.2 ± 30.3	18.4 ± 13.2	<0.001	<0.001	0.52	0.90	0.90
	Background^†	3.3 ± 0.8	2.7 ± 0.7	1.8 ± 0.5	3.8 ± 0.9	<0.002	<0.02	0.52	0.52	0.67

↵* All lesions: both extraskeletal lesions and skeletal lesions.
↵† Background: uptake at left atrium for patient with malignant lesions.
PC = prostate cancer.

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TABLE 6

T/B Ratios from PET Scans and Estimated ¹⁸F⁻/¹⁸F-FDG Measurements

Value	Lesion	¹⁸F⁻/¹⁸F-FDG	¹⁸F-FDG	¹⁸F-NaF	Estimated ¹⁸F⁻/¹⁸F-FDG	P
T/B ratio by SUV_mean	All lesions^*	3.3 ± 2.2	1.2 ± 1.1	9.3 ± 9.7	2.8 ± 1.7	<0.001
	Extraskeletal lesions	2.1 ± 1.8	2.1 ± 1.8	0.9 ± 0.4	1.9 ± 1.2	0.21
	Skeletal lesions	3.6 ± 2.2	1.0 ± 0.8	11.7 ± 9.7	3.0 ± 1.8	0.006
	Skeletal lesions, prostatecancer patient	3.3 ± 2.0	0.9 ± 0.9	9.4 ± 6.7	2.7 ± 1.5	<0.001
	Skeletal lesions, non–prostate cancer patient	4.4 ± 2.3	1.2 ± 0.6	17.6 ± 13.2	4.0 ± 2.2	<0.005
	Osteolytic lesions	4.6 ± 1.7	1.7 ± 0.6	13.9 ± 6.6	4.3 ± 2.0	0.28
	Osteoblastic lesions	3.4 ± 2.2	0.9 ± 0.8	11.4 ± 10.1	2.8 ± 1.7	<0.001
T/B ratio by SUV_max	All lesions^*	4.8 ± 3.6	1.7 ± 1.7	14.6 ± 14.0	4.3 ± 3.0	<0.007
	Extraskeletal lesions	3.3 ± 4.2	3.1 ± 2.4	1.4 ± 1.1	2.5 ± 1.9	0.09
	Skeletal lesions	5.2 ± 3.3	1.2 ± 1.2	18.3 ± 13.7	4.8 ± 3.1	<0.03
	Skeletal lesions, prostate cancer patient	4.7 ± 3.1	1.1 ± 1.2	16.0 ± 12.2	4.6 ± 3.1	0.61
	Skeletal lesions, non–prostate cancer patient	6.2 ± 3.6	1.6 ± 1.1	24.2 ± 15.7	5.1 ± 3.1	<0.003
	Osteolytic lesions	6.5 ± 3.0	2.4 ± 1.2	22.9 ± 9.8	6.4 ± 3.3	0.62
	Osteoblastic lesions	5.0 ± 3.3	1.1 ± 1.1	17.6 ± 14.2	4.5 ± 3.0	0.011