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The Role of 18F-Sodium Fluoride PET/CT Bone Scans in the Diagnosis of Metastatic Bone Disease from Breast and Prostate Cancer

Randeep Kumar Kulshrestha, Sobhan Vinjamuri, Andrew England, Julie Nightingale and Peter Hogg
Journal of Nuclear Medicine Technology December 2016, 44 (4) 217-222; DOI: https://doi.org/10.2967/jnmt.116.176859

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Early 18F-NaF image of breast cancer patient with bone metastases (arrows). Examination was undertaken on rectilinear scanner at Guy’s Hospital, London, 1973. (Reproduced by permission of Taylor & Francis Books UK from (20).)

  • FIGURE 2.
    FIGURE 2.

    Photograph of rectilinear bone scanner.

  • FIGURE 3.
    FIGURE 3.

    (A) Conventional 99mTc-MDP planar scintigraphy shows several bone metastases in right scapula (black arrow), left lower anterior ribcage (red arrow), and right proximal femoral shaft (blue arrow) in patient with prostate cancer metastases. (B) 18F-NaF PET/CT bone scan obtained shortly afterward clearly shows greater burden of bone metastases than was seen on the 99mTc-MDP scan, especially in ribcage (black arrow), spine (red arrow), and pelvis (blue arrow). (Adapted from (12).)

  • FIGURE 4.
    FIGURE 4.

    Maximum-intensity-projection 18F-NaF PET/CT bone scan (posterior view) shows bone metastases in left frontoparietal skull near vertex (red arrow), left posterior ribs (black arrows), right pedicle of T12 (green arrow), and right hemipelvis (blue arrows) that were not seen clearly on a previous planar bone scan. (Courtesy of Department of Nuclear Medicine, Royal Liverpool Hospital, Liverpool, U.K., 2016.)

  • FIGURE 5.
    FIGURE 5.

    Axial fused 18F-NaF PET/CT bone scan of same patient as in Figure 4 shows left frontoparietal skull metastasis for which the CT component clearly reveals bony involvement (arrows). (Courtesy of Department of Nuclear Medicine, Royal Liverpool Hospital, Liverpool, U.K., 2015.)

  • FIGURE 6.
    FIGURE 6.

    False-positive maximum-intensity-projection 18F-NaF PET/CT scan shows lesions in left upper cervical region (black arrow) and right iliac bone region close to right sacroiliac joint (red arrow). (Courtesy of Department of Nuclear Medicine, Royal Liverpool Hospital, Liverpool, U.K., 2015.)

  • FIGURE 7.
    FIGURE 7.

    Axial fused 18F-NaF PET/CT bone scan shows degenerative change in upper left cervical facet joint (arrow), corresponding to lesion seen in this area on previous maximum-intensity-projection image. (Courtesy of Department of Nuclear Medicine, Royal Liverpool Hospital, Liverpool, U.K., 2015.)

Tables

  • TABLE 1

    Comparison of 99mTc-MDP, 99mTc-MDP SPECT, and 18F-NaF PET (44 High-Risk Prostate Cancer Patients (12))

    Measure (%)99mTc-MDP99mTc-MDP SPECT18F-NaF PET18F-NaF PET/CT
    Sensitivity7092100100
    Specificity578262100
  • TABLE 2

    Other Studies Showing Improved Accuracy of Bone Lesion Detection Using 18F-NaF PET/CT Over Planar Bone Scintigraphy

    ReferenceSensitivity (%)Specificity (%)Positive predictive value (%)Negative predictive value (%)
    Withofs et al. (14), 99mTc-MDP  bone scintigraphy, prostate66.784.257.188.9
    Withofs et al. (14), 18F-NaF PET/CT,  prostate10094.785.7100
    Bortot et al. (16), 18F-NaF PET/CT,  all tumor subtypes1008884100
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