TY - JOUR T1 - Is Response Assessment of Breast Cancer Bone Metastases Better with Measurement of <sup>18</sup>F-Fluoride Metabolic Flux Than with Measurement of <sup>18</sup>F-Fluoride PET/CT SUV? JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 322 LP - 327 DO - 10.2967/jnumed.118.208710 VL - 60 IS - 3 AU - Gurdip K. Azad AU - Musib Siddique AU - Benjamin Taylor AU - Adrian Green AU - Jim O’Doherty AU - Joanna Gariani AU - Glen M. Blake AU - Janine Mansi AU - Vicky Goh AU - Gary J.R. Cook Y1 - 2019/03/01 UR - http://jnm.snmjournals.org/content/60/3/322.abstract N2 - Our purpose was to establish whether noninvasive measurement of changes in 18F-fluoride metabolic flux to bone mineral (Ki) by PET/CT can provide incremental value in response assessment of bone metastases in breast cancer compared with SUVmax and SUVmean. Methods: Twelve breast cancer patients starting endocrine treatment for de novo or progressive bone metastases were included. Static 18F-fluoride PET/CT scans were acquired 60 min after injection, before and 8 wk after commencing treatment. Venous blood samples were taken at 55 and 85 min after injection to measure plasma 18F-fluoride activity concentrations, and Ki in individual bone metastases was calculated using a previously validated method. Percentage changes in Ki, SUVmax, and SUVmean were calculated from the same index lesions (≤5 lesions) from each patient. Clinical response up to 24 wk, assessed in consensus by 2 experienced oncologists masked to PET imaging findings, was used as a reference standard. Results: Of the 4 patients with clinically progressive disease (PD), mean Ki significantly increased (&gt;25%) in all, SUVmax in 3, and SUVmean in 2. Of the 8 non-PD patients, Ki decreased or remained stable in 7, SUVmax in 5, and SUVmean in 6. A significant mean percentage increase from baseline for Ki, compared with SUVmax and SUVmean, occurred in the 4 patients with PD (89.7% vs. 41.8% and 43.5%, respectively; P &lt; 0.001). Conclusion: After 8 wk of endocrine treatment for bone-predominant metastatic breast cancer, Ki more reliably differentiated PD from non-PD than did SUVmax and SUVmean, probably because measurement of SUV underestimates fluoride clearance by not considering changes in input function. ER -