18F-Fluoride Positron Emission Tomography and Positron Emission Tomography/Computed Tomography

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18F-Fluoride is a positron-emitting bone-seeking agent, the uptake of which reflects blood flow and remodeling of bone. Assessment of 18F-fluoride kinetics using quantitative positron emission tomography (PET) methods allows the regional characterization of lesions of metabolic bone diseases and the monitoring of their response to therapy. It also enables the assessment of bone viability and discrimination of uneventful and impaired healing processes of fractures, bone grafts and osteonecrosis. Taking advantage of the favorable pharmacokinetic properties of the tracer combined with the high performance of PET technology, static 18F-fluoride PET is a highly sensitive imaging modality for detection of benign and malignant osseous abnormalities. Although 18F-fluoride uptake mechanism corresponds to osteoblastic activity, it is also sensitive for detection of lytic and early marrow-based metastases, by identifying their accompanying reactive osteoblastic changes, even when minimal. The instant fusion of increased 18F-fluoride uptake with morphological data of computed tomography (CT) using hybrid PET/CT systems improves the specificity of 18F-fluoride PET in cancer patients by accurately differentiating between benign and malignant sites of uptake. The results of a few recent publications suggest that 18F-fluoride PET/CT is a valuable modality in the diagnosis of pathological osseous conditions in patients also referred for nononcologic indications. 18F-fluoride PET and PET/CT are, however, not widely used in clinical practice. The limited availability of 18F-fluoride and of PET and PET/CT systems is a major factor. At present, there are not enough data on the cost-effectiveness of 18F-fluoride PET/CT. However, it has been stated by some experts that 18F-fluoride PET/CT is expected to replace 99mTc-MDP bone scintigraphy in the future.

Section snippets

18F-Fluoride Preparation

18F-Fluoride was produced by the 18O(p,n)18F nuclear reaction in 2 mL of enriched 18O water as a target and then transferred into a fluorination module by a flow of argon. After trapping, it was loaded on an anion exchange column, dried, eluted with 1 mL of K2CO3 solution (5 mg/mL), and transferred to the reactor. After the addition of 1 mL of sterile water, the solution was heated to 120°C (2 minutes), followed by evaporation under reduced pressure. After the temperature of the solution was

Assessment of Metabolic Bone Diseases and Other Pathological Bone Conditions Using Quantitative 18F-Fluoride Imaging

In vivo assessment of 18F-fluoride kinetics allows characterization of bone disease as well as monitoring response to therapy. Specific regions in the skeleton can be individually assessed. This section will address the clinical role of quantitative 18F-fluoride PET.

Metabolic Bone Disease: Paget, Osteoporosis, and Renal Osteodystrophy

Several groups have investigated the kinetics of 18F-fluoride in Paget’s disease.19, 24 In Pagetic bones, Ki values were increased more than 3-fold increased and k1 values were increased more than 2-fold, reflecting increased

Detection of Malignant and Benign Lesions by Static 18F-Fluoride PET and PET/CT

18F-fluoride PET is the most sensitive imaging modality for detection of malignant bone involvement.27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 The regional clearance of 18F fluoride from plasma to bone is 3-fold or greater in metastatic lesions than in normal bone.3 Schirrmeister and coworkers have shown, in several reports, the superiority of 18F-fluoride–PET for the detection of metastatic skeletal involvement compared with 99mTc-MDP bone scintigraphy (BS).29, 30, 32, 35

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