Sodium 18F-Fluoride PET/CT of Bone, Joint, and Other Disorders☆
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
References (87)
Musculoskeletal imaging using fluoride PET
Semin Nucl Med
(2013)- et al.
Clinical utility of 18F-fluoride PET/CT in benign and malignant bone diseases
Bone
(2012) - et al.
18Ffluoride positron emission tomography and positron emission tomography/computed tomography
Semin Nucl Med
(2007) - et al.
Quantitative studies of bone with the use of 18F-fluoride and 99Tc-methylene diphosphonate
Semin Nucl Med
(2001) - et al.
The role of [18F]fluoride positron emission tomography in the early detection of aspetic loosening of total knee arthroplasty
Int J Surg
(2007) - et al.
Coronary arterial 18F-sodium fluoride uptake: A novel marker of plaque biology
J Am Coll Cardiol
(2012) - et al.
Detection of metastatic bone lesions in breast cancer patients: Fused (18)F-Fluoride-PET/MDCT has higher accuracy than MDCT. Preliminary experience
Eur J Radiol
(2012) - et al.
Histopathological assessment of prostate cancer bone osteoblastic metastases
J Urol
(2008) - et al.
Fluorine-18: A new isotope for bone scanning
J Nucl Med
(1962) - et al.
Skeletal PET with 18F-fluoride: Applying new technology to an old tracer
J Nucl Med
(2008)
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
Nuklearmedizin
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
Clin Hemorheol Microcirc
Cited by (84)
State of the Art Imaging of Osteoporosis
2023, Seminars in Nuclear MedicinePET Imaging in Osteoarthritis
2023, PET ClinicsBiomaterials for orthopedic diagnostics and theranostics
2021, Current Opinion in Biomedical EngineeringIndications and Results of Sternal Allograft Transplantation: Learning From a Worldwide Experience
2021, Annals of Thoracic SurgeryLong-Term Metabolic Assessment of Cryopreserved Sternal Allograft: A Case Series
2021, Annals of Thoracic Surgery
- ☆
This work was partly supported by grant R01-CA111613 (PI: H. Jadvar) from the National Cancer Institute, USA and National Institutes of Health, USA.