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Molecular Imaging and Biology

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01-04-2012 | Research Article

Prospective Evaluation of ^99mTc MDP Scintigraphy, ¹⁸F NaF PET/CT, and ¹⁸F FDG PET/CT for Detection of Skeletal Metastases

Authors: Andrei Iagaru, Erik Mittra, David W. Dick, Sanjiv Sam Gambhir

Published in: Molecular Imaging and Biology | Issue 2/2012

Abstract

Introduction

Technetium (Tc) methylene diphosphonate (MDP) has been the standard method for bone scintigraphy for three decades. ¹⁸F sodium fluoride (¹⁸F NaF) positron emission tomography (PET)/computed tomography (CT) has better resolution and is considered superior. The role of 2-deoxy-2-[¹⁸F]fluoro-D-glucose (¹⁸F FDG) PET/CT is proven in a variety of cancers, for which it has changed the practice of oncology. There are few prospective studies comparing these three methods of detection of skeletal metastases. Thus, we were prompted to initiate this prospective pilot trial.

Methods

This is a prospective study (Sep 2007–Dec 2010) of 52 patients with proven malignancy referred for evaluation of skeletal metastases. There were 37 men and 15 women, 19–84 years old (average, 55.6 ± 15.9). Technetium-99m (^99mTc) MDP bone scintigraphy, ¹⁸F NaF PET/CT, and ¹⁸F FDG PET/CT were subsequently performed within 1 month.

Results

Skeletal lesions were detected by ^99mTc MDP bone scintigraphy in 22 of 52 patients, by ¹⁸F NaF PET/CT in 24 of 52 patients, and by ¹⁸F FDG PET/CT in 16 of 52 patients. The image quality and evaluation of extent of disease were superior by ¹⁸F NaF PET/CT over ^99mTc MDP scintigraphy in all 22 patients with skeletal lesions on both scans and over ¹⁸F FDG PET/CT in 11 of 16 patients with skeletal metastases on ¹⁸F FDG PET/CT. In two patients, ¹⁸F NaF PET/CT showed skeletal metastases not seen on either of the other two scans. Extraskeletal lesions were identified by ¹⁸F FDG PET/CT in 28 of 52 subjects.

Conclusion

Our prospective pilot-phase trial demonstrates superior image quality and evaluation of skeletal disease extent with ¹⁸F NaF PET/CT over ^99mTc MDP scintigraphy and ¹⁸F FDG PET/CT. At the same time, ¹⁸F FDG PET detects extraskeletal disease that can significantly change disease management. As such, a combination of ¹⁸F FDG PET/CT and ¹⁸F NaF PET/CT may be necessary for cancer detection. Additional evaluation with larger cohorts is required to confirm these preliminary findings.

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Title: Prospective Evaluation of 99mTc MDP Scintigraphy, 18F NaF PET/CT, and 18F FDG PET/CT for Detection of Skeletal Metastases
Authors: Andrei Iagaru
Erik Mittra
David W. Dick
Sanjiv Sam Gambhir
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Molecular Imaging and Biology / Issue 2/2012
Print ISSN: 1536-1632
Electronic ISSN: 1860-2002
DOI: https://doi.org/10.1007/s11307-011-0486-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prospective Evaluation of ^99mTc MDP Scintigraphy, ¹⁸F NaF PET/CT, and ¹⁸F FDG PET/CT for Detection of Skeletal Metastases

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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