Sodium 18F-Fluoride PET/CT of Bone, Joint, and Other Disorders

doi:10.1053/j.semnuclmed.2014.07.008

Seminars in Nuclear Medicine

Volume 45, Issue 1, January 2015, Pages 58-65

https://doi.org/10.1053/j.semnuclmed.2014.07.008 Get rights and content

The use of ¹⁸F-sodium fluoride (¹⁸F-NaF) with PET/CT is increasing. This resurgence of an old tracer has been fueled by several factors including superior diagnostic performance over standard ^99mTc-based bone scintigraphy, growth in the availability of PET/CT imaging systems, increase in the number of regional commercial distribution centers for PET radiotracers, the recent concerns about potential recurring shortages with ^99mTc-based radiotracers, and the recent decision by the Centers for Medicare and Medicaid Services to reimburse for ¹⁸F-NaF PET/CT for evaluation of patients with known or suspected bone metastases through the National Oncologic PET Registry. The major goal of this article is to review the current evidence on the diagnostic utility of ¹⁸F-NaF in the imaging assessment of the bone and joint in a variety of clinical conditions.

Section snippets

Biodistribution and Radiation Dosimetry

Czernin et al⁸ summarized the mechanism of ¹⁸F-NaF uptake in the bone. From plasma, ¹⁸F-NaF is rapidly cleared in a biexponential manner, with most of the tracer retained by bone after a single pass. The tracer uptake by the bone is due to chemisorption with exchange of ¹⁸F⁻ ion for OH⁻ ion on the surface of the hydroxyapatite matrix of the bone, forming fluoroapatite, and migration of ¹⁸F⁻ ion into the crystalline matrix of the bone. There is minimal binding to serum protein and rapid renal

Pediatrics

The guidelines for clinical indications, image acquisition, image processing, and image interpretation of bone scans in children with either ^99mTc-labeled radiotracers or ¹⁸F-NaF PET have been published.¹⁹ Pediatric activity is typically weight based at 2.22 MBq/kg (0.06 mCi/kg), with a range of 18.5-185 MBq (0.5-5 mCi). The effective dose is 0.086 mSv/MBq (0.32 rem/mCi) for a 5-year-old child. The urinary bladder receives the largest radiation dose of 0.61 mGy/MBq (2.3 rad/mCi) at a voiding interval

Benign Bone, Joint, and Other Diseases

¹⁸F-NaF PET may be useful in the metabolic evaluation of benign bone, joint, and other clinical conditions. Furthermore, the CT portion of the ¹⁸F-NaF PET/CT not only provides precise information on anatomical localization but also may reveal previously unknown clinically significant extraosseous findings in approximately 11% of patients.²⁵

During evaluation of patients for osseous metastatic disease, it is often observed that there is high ¹⁸F-NaF uptake in joint degenerative and arthritic

Malignant Diseases

There is growing convincing evidence that ¹⁸F-NaF PET/CT is diagnostically superior to standard ^99mTc-based bone scintigraphy for more accurate detection and determination of the extent osseous metastatic disease in a variety of cancers.52, 53, 54, 55, 56, 57, 58, 59 A recent meta-analysis of 10 studies comparing standard bone scintigraphy with ¹⁸F-NaF PET/CT reported a patient-based pooled sensitivity of 96% and pooled specificity of 98% and a lesion-based pooled sensitivity of 97% and pooled

Conclusion

In comparison with ^99mTc-based bone scintigraphy, ¹⁸F-NaF PET/CT provides higher diagnostic performance with higher quality images within a shorter period from injection time and with relatively similar radiation dosimetry, albeit at currently higher scan cost. However, this higher cost may at least partly be mitigated by increased patient throughput, avoidance of performing additional separate CT scans, and increased availability, access, and use of PET/CT, particularly in an environment that

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^☆: This work was partly supported by grant R01-CA111613 (PI: H. Jadvar) from the National Cancer Institute, USA and National Institutes of Health, USA.

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Sodium 18F-Fluoride PET/CT of Bone, Joint, and Other Disorders☆

Section snippets

Biodistribution and Radiation Dosimetry

Pediatrics

Benign Bone, Joint, and Other Diseases

Malignant Diseases

Conclusion

Semin Nucl Med

Bone

Semin Nucl Med

Semin Nucl Med

Int J Surg

J Am Coll Cardiol

Eur J Radiol

J Urol

Fluorine-18: A new isotope for bone scanning

J Nucl Med

Skeletal PET with 18F-fluoride: Applying new technology to an old tracer

J Nucl Med

Whole body skeletal imaging with [18F]fluoride ion and PET

J Comput Assist Tomogr

Atlas of sodium fluoride PET bone scans

Clin Nucl Med

Molecular mechanisms of bone 18F-NaF deposition

J Nucl Med

Uptake of bone-seekers is solely associated with mineralization. A study with 99mTc-MDP, 153Sm-EDTMP and 18F-fluoride on osteoblasts

Eur J Nucl Med Mol Imaging

Evaluation of the skeletal kinetics of fluorine-18-fluoride ion with PET

J Nucl Med

Fluoride kinetics of the axial skeleton measured in vivo with fluorine-18 fluoride PET

J Nucl Med

Measurement of skeletal flow with positron emission tomography and 18F-fluoride in femoral head osteonecrosis

Arch Orthop Trauma Surg

Evaluation of the incorporation of bone grafts used in maxillofacial surgery with [18F]fluoride ion and dynamic positron emission tomography

Eur J Nucl Med

The kinetics and reproducibility of 18F-sodium fluoride for oncology using current PET camera technology

J Nucl Med

SNM practice guideline for sodium 18F-fluoride PET/CT bone scan 1.0

J Nucl Med

Can we achieve a radionuclide radiation dose equal to or less than that of 99mTc-hydroxymethane diphosphonate bone scintigraphy with a low dose 18F-sodium fluoride time-of-flight PET of diagnostic quality

Nucl Med Commun

Guidelines for pediatric bone scanning with 99mTc-labelled radiopharmaceuticals and 18F-fluoride

Eur J Nucl Med Mol Imaging

Skeletal scintigraphy with 18F-NaF PET for the evaluation of bone pain in children

Am J Roentgenol

Fluorine-18 NaF PET imaging of child abuse

Pediatr Radiol

Skeletal trauma in child abuse: Detection with 18F-NaF PET

Radiology

Back pain in adolescents: Assessment with integrated 18F-fluoride positron-emission tomography-computed tomography

J Pediatr Orthop

Early experience with fluorine-18 sodium fluoride bone PET in young patients with back pain

J Pediatr Orthop

Prevalence of clinically significant extraosseous findings on unenhanced CT portions of 18F-fluoride PET/CT bone scans

ScientificWorldJournal

Use of F-18 fluoride PET to differentiate septic from aseptic loosening in total hip arthroplasty patients

Clin Nucl Med

New application of 18F-fluoride PET for the detection of bone remodeling in early stage osteoarthritis of the hip

Clin Nucl Med

Analysis of bone mineralization on uncemented femoral stems by [18F]-fluoride-PET: A randomized clinical study of 16 hips in 8 patients

Acta Orthop

Clinical utility of fluoride-18 positron emission tomography/CT in temporomandibular disorder with osteoarthritis: Comparisons with 99mTc-MDP bone scan

Dentomaxillofac Radiol

18F-fluoride PET as a noninvasive imaging biomarker for determining treatment efficacy of bone active agents at the hip: A prospective, randomized, controlled clinical study

J Bone Miner Res

High bone turnover assessed by 18F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: Comparison with inflammatory lesions detected by whole body MRI

EJNMMI Res

18F-fluoride PET/CT for detection of sacroiliitis of ankylosing spondylitis

Eur J Nucl Med Mol Imaging

Comparison of MRI and 18F-NaF PET/CT in patients with patellofemoral pain

J Magn Reson Imaging

Effects of alendronate on bone metabolism in glucocorticoid-induced osteoporosis measured by 18F-fluoride PET

J Nucl Med

Evaluation of lesion in a spontaneous osteonecrosis of the knee using 18F-fluoride positron emission tomography

Knee Surg Sports Traumatol Arthrosc

Use of 18F-flluoride PET to determine the appropriate tissue sampling region for improved sensitivity of tissue examinations in cases of suspected periprosthetic infection after total hip arthroplasty

Acta Orthop

Allogenic bone graft viability after hip revision arthroplasty assessed by dynamic [18F]fluoride ion positron emission tomography

Eur J Nucl Med

Periacetabular bone metabolism following hip revision surgery. PET-based evaluation of allograft osteointegration

Sodium ¹⁸F-Fluoride PET/CT of Bone, Joint, and Other Disorders☆

Skeletal PET with ¹⁸F-fluoride: Applying new technology to an old tracer

Whole body skeletal imaging with [¹⁸F]fluoride ion and PET

Molecular mechanisms of bone ¹⁸F-NaF deposition

Uptake of bone-seekers is solely associated with mineralization. A study with ^99mTc-MDP, ¹⁵³Sm-EDTMP and ¹⁸F-fluoride on osteoblasts

Measurement of skeletal flow with positron emission tomography and ¹⁸F-fluoride in femoral head osteonecrosis

Evaluation of the incorporation of bone grafts used in maxillofacial surgery with [¹⁸F]fluoride ion and dynamic positron emission tomography

The kinetics and reproducibility of ¹⁸F-sodium fluoride for oncology using current PET camera technology

SNM practice guideline for sodium ¹⁸F-fluoride PET/CT bone scan 1.0

Can we achieve a radionuclide radiation dose equal to or less than that of ^99mTc-hydroxymethane diphosphonate bone scintigraphy with a low dose ¹⁸F-sodium fluoride time-of-flight PET of diagnostic quality

Guidelines for pediatric bone scanning with ^99mTc-labelled radiopharmaceuticals and ¹⁸F-fluoride

Skeletal scintigraphy with ¹⁸F-NaF PET for the evaluation of bone pain in children

Skeletal trauma in child abuse: Detection with ¹⁸F-NaF PET

Back pain in adolescents: Assessment with integrated ¹⁸F-fluoride positron-emission tomography-computed tomography

Prevalence of clinically significant extraosseous findings on unenhanced CT portions of ¹⁸F-fluoride PET/CT bone scans

New application of ¹⁸F-fluoride PET for the detection of bone remodeling in early stage osteoarthritis of the hip

Analysis of bone mineralization on uncemented femoral stems by [¹⁸F]-fluoride-PET: A randomized clinical study of 16 hips in 8 patients

Clinical utility of fluoride-18 positron emission tomography/CT in temporomandibular disorder with osteoarthritis: Comparisons with ^99mTc-MDP bone scan

¹⁸F-fluoride PET as a noninvasive imaging biomarker for determining treatment efficacy of bone active agents at the hip: A prospective, randomized, controlled clinical study

High bone turnover assessed by ¹⁸F-fluoride PET/CT in the spine and sacroiliac joints of patients with ankylosing spondylitis: Comparison with inflammatory lesions detected by whole body MRI

¹⁸F-fluoride PET/CT for detection of sacroiliitis of ankylosing spondylitis

Comparison of MRI and ¹⁸F-NaF PET/CT in patients with patellofemoral pain

Effects of alendronate on bone metabolism in glucocorticoid-induced osteoporosis measured by ¹⁸F-fluoride PET

Evaluation of lesion in a spontaneous osteonecrosis of the knee using ¹⁸F-fluoride positron emission tomography

Use of ¹⁸F-flluoride PET to determine the appropriate tissue sampling region for improved sensitivity of tissue examinations in cases of suspected periprosthetic infection after total hip arthroplasty

Allogenic bone graft viability after hip revision arthroplasty assessed by dynamic [¹⁸F]fluoride ion positron emission tomography

Assessment of bone microcirculation by contrast-enhanced ultrasound (CEUS) and ¹⁸F-positron emission tomography/computed tomography in free osseous and osseocutaneus flaps for mandibular reconstruction: Preliminary results