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Published in: Annals of Nuclear Medicine 4/2022

01-04-2022 | Metastasis | Review Article

Therapy-induced bone changes in oncology imaging with 18F-sodium fluoride (NaF) PET–CT

Authors: Najeeb Ahmed, Alyaa Sadeq, Fahad Marafi, Gopinath Gnanasegaran, Sharjeel Usmani

Published in: Annals of Nuclear Medicine | Issue 4/2022

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Abstract

18F-Sodium fluoride (18F-NaF) is a PET tracer that is mostly used in the evaluation of bone metastasis in oncology cases. Recently, 18F-NaF PET/CT is gaining wide popularity owing to its higher sensitivity over the other conventional bone tracer with higher and rapid single-pass extraction, negligible plasma protein binding, rapid blood, and renal clearance. In the era of constant evolution of cancer therapy regimens, considerable bone health impact is seen in the form of avascular necrosis, insufficiency fractures, among others. A significant number of these therapy-induced changes show high bone turnover and thereby 18F-NaF accumulation, mimicking metastatic lesions. This article summarizes and illustrates the pattern and morphological features of 18F-NaF PET/CT findings in these changes in the context of clinical and therapeutic history.
Literature
1.
go back to reference Czernin J, Satyamurthy N, Schiepers C. Molecular mechanisms of bone 18F-NaF deposition. J Nucl Med. 2010;51:1826–9.PubMed Czernin J, Satyamurthy N, Schiepers C. Molecular mechanisms of bone 18F-NaF deposition. J Nucl Med. 2010;51:1826–9.PubMed
2.
go back to reference Laverick S, Bounds G, Wong WL. [18F]-Fluoride positron emission tomography for imaging condylar hyperplasia. Br J Oral Maxillofac Surg. 2009;47:196–9.PubMed Laverick S, Bounds G, Wong WL. [18F]-Fluoride positron emission tomography for imaging condylar hyperplasia. Br J Oral Maxillofac Surg. 2009;47:196–9.PubMed
3.
go back to reference Sachpekidis C, Hillengass J, Goldschmidt H, et al. Quantitative analysis of 18F-NaF dynamic PET/CT cannot differentiate malignant from benign lesions in multiple myeloma. Am J Nucl Med Mol Imaging. 2017;7:148–56.PubMedPubMedCentral Sachpekidis C, Hillengass J, Goldschmidt H, et al. Quantitative analysis of 18F-NaF dynamic PET/CT cannot differentiate malignant from benign lesions in multiple myeloma. Am J Nucl Med Mol Imaging. 2017;7:148–56.PubMedPubMedCentral
4.
go back to reference Frost ML, Blake GM, Cook GJ, et al. Differences in regional bone perfusion and turnover between lumbar spine and distal humerus: 18F-fluoride PET study of treatment-naive and treated postmenopausal women. Bone. 2009;45:942–8.PubMed Frost ML, Blake GM, Cook GJ, et al. Differences in regional bone perfusion and turnover between lumbar spine and distal humerus: 18F-fluoride PET study of treatment-naive and treated postmenopausal women. Bone. 2009;45:942–8.PubMed
5.
go back to reference Blake GM, Park-Holohan SJ, Cook GJ, et al. Quantitative studies of bone with the use of 18F-fluoride and 99mTc-methylene diphosphonate. Semin Nucl Med. 2001;31:28–49.PubMed Blake GM, Park-Holohan SJ, Cook GJ, et al. Quantitative studies of bone with the use of 18F-fluoride and 99mTc-methylene diphosphonate. Semin Nucl Med. 2001;31:28–49.PubMed
6.
go back to reference Beheshti M, Mottaghy FM, Payche F, et al. 18 F-NaF PET/CT: EANM procedure guidelines for bone imaging. Eur J Nucl Med Mol Imaging. 2015;42:1767–77.PubMed Beheshti M, Mottaghy FM, Payche F, et al. 18 F-NaF PET/CT: EANM procedure guidelines for bone imaging. Eur J Nucl Med Mol Imaging. 2015;42:1767–77.PubMed
7.
go back to reference Segall G, Delbeke D, Stabin MG, et al. SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0. J Nucl Med. 2010;51:1813–20.PubMed Segall G, Delbeke D, Stabin MG, et al. SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0. J Nucl Med. 2010;51:1813–20.PubMed
9.
go back to reference D’Oronzo S, Stucci S, Tucci M, Silvestris F. Cancer treatment-induced bone loss (CTIBL): pathogenesis and clinical implications. Cancer Treat Rev. 2015;41(9):798–808.PubMed D’Oronzo S, Stucci S, Tucci M, Silvestris F. Cancer treatment-induced bone loss (CTIBL): pathogenesis and clinical implications. Cancer Treat Rev. 2015;41(9):798–808.PubMed
10.
go back to reference Kwak JJ, Tirumani SH, Van den Abbeele AD, et al. Cancer immunotherapy: imaging assessment of novel treatment response patterns and immune-related adverse events. Radiographics. 2015;35:424–37.PubMed Kwak JJ, Tirumani SH, Van den Abbeele AD, et al. Cancer immunotherapy: imaging assessment of novel treatment response patterns and immune-related adverse events. Radiographics. 2015;35:424–37.PubMed
11.
go back to reference Bronstein Y, Ng CS, Hwu P, et al. Radiologic manifestations of immune-related adverse events in patients with metastatic melanoma undergoing anti-CTLA-4 antibody therapy. AJR Am J Roentgenol. 2011;197:W992–1000.PubMed Bronstein Y, Ng CS, Hwu P, et al. Radiologic manifestations of immune-related adverse events in patients with metastatic melanoma undergoing anti-CTLA-4 antibody therapy. AJR Am J Roentgenol. 2011;197:W992–1000.PubMed
12.
go back to reference Wissing MD. Chemotherapy- and irradiation-induced bone loss in adults with solid tumors. Curr Osteoporos Rep. 2015;13:140–5.PubMedPubMedCentral Wissing MD. Chemotherapy- and irradiation-induced bone loss in adults with solid tumors. Curr Osteoporos Rep. 2015;13:140–5.PubMedPubMedCentral
13.
go back to reference Haworth AE, Webb J. Skeletal complications of bisphosphonate use: what the radiologist should know. Br J Radiol. 2012;85:1333–42.PubMedPubMedCentral Haworth AE, Webb J. Skeletal complications of bisphosphonate use: what the radiologist should know. Br J Radiol. 2012;85:1333–42.PubMedPubMedCentral
14.
go back to reference Nicolatou-Galitis O, Schiødt M, Mendes RA, et al. Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;127:117–35.PubMed Nicolatou-Galitis O, Schiødt M, Mendes RA, et al. Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;127:117–35.PubMed
15.
go back to reference Kim Y, Lee HY, Yoon HJ, et al. Utility of 18F-fluorodeoxy glucose and 18F-sodium fluoride positron emission tomography/computed tomography in the diagnosis of medication-related osteonecrosis of the jaw: a preclinical study in a rat model. J Craniomaxillofac Surg. 2016;44:357–63.PubMed Kim Y, Lee HY, Yoon HJ, et al. Utility of 18F-fluorodeoxy glucose and 18F-sodium fluoride positron emission tomography/computed tomography in the diagnosis of medication-related osteonecrosis of the jaw: a preclinical study in a rat model. J Craniomaxillofac Surg. 2016;44:357–63.PubMed
16.
go back to reference Wilde F, Steinhoff K, Frerich B, et al. Positron-emission tomography imaging in the diagnosis of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:412–9.PubMed Wilde F, Steinhoff K, Frerich B, et al. Positron-emission tomography imaging in the diagnosis of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:412–9.PubMed
17.
go back to reference Raje N, Woo SB, Hande K, et al. Clinical, radiographic, and biochemical characterization of multiple myeloma patients with osteonecrosis of the jaw. Clin Cancer Res. 2008;14:2387–95.PubMed Raje N, Woo SB, Hande K, et al. Clinical, radiographic, and biochemical characterization of multiple myeloma patients with osteonecrosis of the jaw. Clin Cancer Res. 2008;14:2387–95.PubMed
19.
go back to reference Laarschot DM, Somford MP, Jager A, et al. “Atypical” atypical femur fractures and use of bisphosphonates. Clin Cases Miner Bone Metab. 2016;13:204–8.PubMed Laarschot DM, Somford MP, Jager A, et al. “Atypical” atypical femur fractures and use of bisphosphonates. Clin Cases Miner Bone Metab. 2016;13:204–8.PubMed
20.
go back to reference Roca-Ayats N, Balcells S, Garcia-Giralt N, et al. GGPS1 mutation and atypical femoral fractures with bisphosphonates. N Engl J Med. 2017;376:1794–5.PubMed Roca-Ayats N, Balcells S, Garcia-Giralt N, et al. GGPS1 mutation and atypical femoral fractures with bisphosphonates. N Engl J Med. 2017;376:1794–5.PubMed
21.
go back to reference Spyridonidis TJ, Mousafiris KV, Rapti EK, et al. Bone scintigraphy depicts bilateral atypical femoral stress fractures with metachronous presentation, long before a complete fracture occurs. Hell J Nucl Med. 2014;17:54–7.PubMed Spyridonidis TJ, Mousafiris KV, Rapti EK, et al. Bone scintigraphy depicts bilateral atypical femoral stress fractures with metachronous presentation, long before a complete fracture occurs. Hell J Nucl Med. 2014;17:54–7.PubMed
22.
go back to reference D’Oronzo S, Stucci S, Tucci M, Silvestris F. Cancer treatment-induced bone loss (CTIBL): pathogenesis and clinical implications. Cancer Treat Rev. 2015;41:798–808.PubMed D’Oronzo S, Stucci S, Tucci M, Silvestris F. Cancer treatment-induced bone loss (CTIBL): pathogenesis and clinical implications. Cancer Treat Rev. 2015;41:798–808.PubMed
23.
go back to reference Brufsky AM. Cancer treatment-induced bone loss: pathophysiology and clinical perspectives. Oncologist. 2008;13:187–95.PubMed Brufsky AM. Cancer treatment-induced bone loss: pathophysiology and clinical perspectives. Oncologist. 2008;13:187–95.PubMed
24.
go back to reference Bjarnason NH, Hitz M, Jorgensen NR, et al. Adverse bone effects during pharmacological breast cancer therapy. Acta Oncol. 2008;47:747–54.PubMed Bjarnason NH, Hitz M, Jorgensen NR, et al. Adverse bone effects during pharmacological breast cancer therapy. Acta Oncol. 2008;47:747–54.PubMed
25.
go back to reference Agrawal K, Tripathy SK, Sen RK, et al. Nuclear medicine imaging in osteonecrosis of hip: old and current concepts. World J Orthop. 2017;8:747–53.PubMedPubMedCentral Agrawal K, Tripathy SK, Sen RK, et al. Nuclear medicine imaging in osteonecrosis of hip: old and current concepts. World J Orthop. 2017;8:747–53.PubMedPubMedCentral
26.
go back to reference Dasa V, Adbel-Nabi H, Anders MJ, Mihalko WM. F-18 fluoride positron emission tomography of the hip for osteonecrosis. Clin Orthop Relat Res. 2008;466(5):1081–6.PubMedPubMedCentral Dasa V, Adbel-Nabi H, Anders MJ, Mihalko WM. F-18 fluoride positron emission tomography of the hip for osteonecrosis. Clin Orthop Relat Res. 2008;466(5):1081–6.PubMedPubMedCentral
27.
go back to reference Gayana S, Bhattacharya A, Sen RK, Singh P, Prakash M, Mittal BR. F-18 fluoride positron emission tomography/computed tomography in the diagnosis of avascular necrosis of the femoral head: comparison with magnetic resonance imaging. Indian J Nucl Med. 2016;31:3–8.PubMedPubMedCentral Gayana S, Bhattacharya A, Sen RK, Singh P, Prakash M, Mittal BR. F-18 fluoride positron emission tomography/computed tomography in the diagnosis of avascular necrosis of the femoral head: comparison with magnetic resonance imaging. Indian J Nucl Med. 2016;31:3–8.PubMedPubMedCentral
28.
go back to reference Huh SJ, Kim B, Kang MK, et al. Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. Gynecol Oncol. 2002;86:264–8.PubMed Huh SJ, Kim B, Kang MK, et al. Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. Gynecol Oncol. 2002;86:264–8.PubMed
29.
go back to reference Chung YK, Lee YK, Yoon BH, Suh DH, Koo KH. Pelvic insufficiency fractures in cervical cancer after radiation therapy: a meta-analysis and review. In Vivo. 2021;35:1109–15.PubMedPubMedCentral Chung YK, Lee YK, Yoon BH, Suh DH, Koo KH. Pelvic insufficiency fractures in cervical cancer after radiation therapy: a meta-analysis and review. In Vivo. 2021;35:1109–15.PubMedPubMedCentral
30.
go back to reference Peh WC, Khong PL, Yin Y, et al. Imaging of pelvic insufficiency fractures. Radiographics. 1996;16:335–48.PubMed Peh WC, Khong PL, Yin Y, et al. Imaging of pelvic insufficiency fractures. Radiographics. 1996;16:335–48.PubMed
31.
go back to reference Lapina O, Tiškevičius S. Sacral insufficiency fracture after pelvic radiotherapy: a diagnostic challenge for a radiologist. Medicina (Kaunas). 2014;50:249–54. Lapina O, Tiškevičius S. Sacral insufficiency fracture after pelvic radiotherapy: a diagnostic challenge for a radiologist. Medicina (Kaunas). 2014;50:249–54.
32.
go back to reference Soares PBF, Soares CJ, Limirio PHJO, et al. Effect of ionizing radiation after-therapy interval on bone: histomorphometric and biomechanical characteristics. Clin Oral Investig. 2019;23:2785–93.PubMed Soares PBF, Soares CJ, Limirio PHJO, et al. Effect of ionizing radiation after-therapy interval on bone: histomorphometric and biomechanical characteristics. Clin Oral Investig. 2019;23:2785–93.PubMed
33.
go back to reference Israel O, Gorenberg M, Frenkel A, et al. Local and systemic effects of radiation on bone metabolism measured by quantitative SPECT. J Nucl Med. 1992;33:1774–80.PubMed Israel O, Gorenberg M, Frenkel A, et al. Local and systemic effects of radiation on bone metabolism measured by quantitative SPECT. J Nucl Med. 1992;33:1774–80.PubMed
34.
go back to reference Lloyd S, Decker RH, Evans SB. Bone scan findings of chest wall pain syndrome after stereotactic body radiation therapy: implications for the pathophysiology of the syndrome. J Thorac Dis. 2013;5:E41–4.PubMedPubMedCentral Lloyd S, Decker RH, Evans SB. Bone scan findings of chest wall pain syndrome after stereotactic body radiation therapy: implications for the pathophysiology of the syndrome. J Thorac Dis. 2013;5:E41–4.PubMedPubMedCentral
35.
go back to reference Park W, Huh SJ, Yang JH, et al. The implication of hot spots on bone scans within the irradiated field of breast cancer patients treated with mastectomy followed by radiotherapy. Ann Nucl Med. 2008;22:685–91.PubMed Park W, Huh SJ, Yang JH, et al. The implication of hot spots on bone scans within the irradiated field of breast cancer patients treated with mastectomy followed by radiotherapy. Ann Nucl Med. 2008;22:685–91.PubMed
36.
go back to reference Benfaremo D, Manfredi L, Luchetti MM, et al. Musculoskeletal and rheumatic diseases induced by immune checkpoint inhibitors: a review of the literature. Curr Drug Saf. 2018;13:150–64.PubMedPubMedCentral Benfaremo D, Manfredi L, Luchetti MM, et al. Musculoskeletal and rheumatic diseases induced by immune checkpoint inhibitors: a review of the literature. Curr Drug Saf. 2018;13:150–64.PubMedPubMedCentral
37.
go back to reference Naidoo J, Cappelli LC, Forde PM, et al. Inflammatory arthritis: a newly recognized adverse event of immune checkpoint blockade. Oncologist. 2017;22:627–30.PubMedPubMedCentral Naidoo J, Cappelli LC, Forde PM, et al. Inflammatory arthritis: a newly recognized adverse event of immune checkpoint blockade. Oncologist. 2017;22:627–30.PubMedPubMedCentral
38.
go back to reference Smith MH, Bass AR. Arthritis after cancer immunotherapy: symptom duration and treatment response. Arthritis Care Res (Hoboken). 2019;71:362–6. Smith MH, Bass AR. Arthritis after cancer immunotherapy: symptom duration and treatment response. Arthritis Care Res (Hoboken). 2019;71:362–6.
39.
go back to reference Belkhir R, Burel SL, Dunogeant L, et al. Rheumatoid arthritis and polymyalgia rheumatica occurring after immune checkpoint inhibitor treatment. Ann Rheum Dis. 2017;76:1747–50.PubMed Belkhir R, Burel SL, Dunogeant L, et al. Rheumatoid arthritis and polymyalgia rheumatica occurring after immune checkpoint inhibitor treatment. Ann Rheum Dis. 2017;76:1747–50.PubMed
40.
go back to reference Nobashi T, Mittra E. PD-1 blockade–induced inflammatory arthritis. Radiology. 2018;289:616.PubMed Nobashi T, Mittra E. PD-1 blockade–induced inflammatory arthritis. Radiology. 2018;289:616.PubMed
41.
go back to reference Jiang W, Rixiati Y, Zhao B, Li Y, Tang C, Liu J. Incidence, prevalence, and outcomes of systemic malignancy with bone metastases. J Orthop Surg (Hong Kong). 2020;28:2309499020915989. Jiang W, Rixiati Y, Zhao B, Li Y, Tang C, Liu J. Incidence, prevalence, and outcomes of systemic malignancy with bone metastases. J Orthop Surg (Hong Kong). 2020;28:2309499020915989.
42.
go back to reference Vaz S, Usmani S, Gnanasegaran G, et al. Molecular imaging of bone metastases using bone targeted tracers. Q J Nucl Med Mol Imaging. 2019;63:112–28.PubMed Vaz S, Usmani S, Gnanasegaran G, et al. Molecular imaging of bone metastases using bone targeted tracers. Q J Nucl Med Mol Imaging. 2019;63:112–28.PubMed
43.
go back to reference Hillner BE, Siegel BA, Hanna L, et al. Impact of 18F-fluoride PET in patients with known prostate cancer: initial results from the National Oncologic PET Registry. J Nucl Med. 2014;55:574–81.PubMed Hillner BE, Siegel BA, Hanna L, et al. Impact of 18F-fluoride PET in patients with known prostate cancer: initial results from the National Oncologic PET Registry. J Nucl Med. 2014;55:574–81.PubMed
44.
go back to reference Drubach LA. Clinical utility of 18F NaF PET/CT in benign and malignant disorders. Pet Clin. 2012;7:293–301.PubMed Drubach LA. Clinical utility of 18F NaF PET/CT in benign and malignant disorders. Pet Clin. 2012;7:293–301.PubMed
45.
go back to reference Usmani S, Ahmed N, Muzaffar S, et al. Spectrum of false positive 18F-sodium fluoride (NaF) bone PET/CT findings in oncology imaging; a narrative pictorial review of cases from a single institution. Hell J Nucl Med. 2020;23:67–75.PubMed Usmani S, Ahmed N, Muzaffar S, et al. Spectrum of false positive 18F-sodium fluoride (NaF) bone PET/CT findings in oncology imaging; a narrative pictorial review of cases from a single institution. Hell J Nucl Med. 2020;23:67–75.PubMed
Metadata
Title
Therapy-induced bone changes in oncology imaging with 18F-sodium fluoride (NaF) PET–CT
Authors
Najeeb Ahmed
Alyaa Sadeq
Fahad Marafi
Gopinath Gnanasegaran
Sharjeel Usmani
Publication date
01-04-2022
Publisher
Springer Singapore
Published in
Annals of Nuclear Medicine / Issue 4/2022
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-022-01730-y

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