Article Figures & Data
Figures
- FIGURE 1.
A 66-y-old man with history of prostate adenocarcinoma, seen for evaluation of bony metastasis after androgen deprivation therapy and definitive radiotherapy. (A and B) Anterior and posterior maximum-intensity projections of 18F-NaF PET scan show normal physiologic biodistribution. Mild scattered degenerative changes are seen in spine. (C and D) Anterior and posterior views of whole-body 99mTc-MDP bone scan of same patient performed 3 wk earlier show normal physiologic biodistribution. Both scans show no metastatic lesions.
- FIGURE 2.
An 81-y-old woman with history of metastatic breast cancer. Sagittal 18F-NaF PET (A) and CT (B) images and anterior maximum-intensity projection (C) show diffuse sclerotic metastasis to entire spine and sternum with abnormally increased tracer uptake. Maximum-intensity projection also demonstrates abnormal uptake in ribs and pelvis.
- FIGURE 3.
A 48-y-old woman with history of plasma cell dyscrasia. (A and B) Anterior and posterior maximum-intensity projections of 18F-NaF PET scan show multifocal areas of abnormally increased tracer uptake in spine, bilateral ribs, and mandible. (C–H) Selected axial PET and CT bone window images show expansile lesions involving bilateral ribs with ground glass density and associated abnormal tracer uptake. These lesions were stable on multiple follow-up scans and were attributable to polyostotic fibrous dysplasia.
- FIGURE 4.
A 58-y-old woman with history of metastatic colorectal cancer, seen after radiation therapy and placement of fixation hardware for lytic metastasis to left proximal humerus. Anterior maximum-intensity projection of 18F-NaF (A) and 18F-FDG (B) PET scans shows heterogeneously increased tracer uptake in left proximal humerus secondary to bone remodeling. No other area of abnormal tracer activity is seen elsewhere. (C) X-ray of left humerus shows cement and fixation hardware.
Tables
Characteristic 18F-NaF 99mTc-MDP Production Cyclotron Generator Half-life 109.7 min 6 h Photon energy 511 keV 140 keV Spatial resolution Higher (4–5 mm) Lower Critical organ Urinary bladder Bones Typical dose 185–370 MBq (5–10 mCi) 740–1,100 MBq (20–30 mCi) Injection to imaging time 30–60 min 3–4 h Effective dose 8.9 mSv (370 MBq [10 mCi]) 5.3 mSv (925 MBq [25 mCi]) Study Parameter Sn Sp PPV NPV Ac Meta-analysis of 18F-NaF in both benign and malignant lesions (5) Patient-based pooled 96% 98% Lesion-based pooled 97% 98% Bone metastasis detection in hepatocellular carcinoma (37) 99mTc-MDP 73.3% 79.2% 86.8% 61.3% 75.4% 18F-NaF PET/CT 93.3% 100% 100% 88.9% 97.5% Bone metastasis detection in urinary bladder cancer (36) 99mTc-MDP 82.35% 64.51% 56% 86.95% 70.83% 99mTc-MDP SPECT/CT 88.23% 74.19% 65.21% 92% 79.16% 18F-NaF PET/CT 100% 87.09% 80.95% 100% 91.66% High-risk prostate cancer (35) 99mTc-MDP 70% 57% 64% 55% 99mTc-MDP SPECT/CT 92% 82% 86% 90% 18F-NaF PET 100% 62% 74% 100% 18F-NaF PET/CT 100% 100% 100% 100% Spine metastasis in prostate cancer (42) 99mTc-MDP 51% 82% 86% 43% 61% 18F-NaF PET/CT 93% 54% 82% 78% 81% 18F-fluoromethylcholine PET/CT 85% 91% 95% 75% 87% Bone metastasis detection in head and neck cancer (60) 18F-NaF PET/CT 69.4% 18F-FDG PET/CT 57.1% Detection of skull-base invasion in nasopharyngeal cancer (62) 18F-NaF PET/CT 100% 94.7% 96.3% 100% 97.8% 18F-FDG PET/CT 65.4% 100% 100% 67.9% 80% Detection of bone metastasis in nasopharyngeal cancer (62) 18F-NaF PET/CT 98.3% 65.7% 18F-FDG PET/CT 42.9% 97.1% Sn = sensitivity; Sp = specificity; PPV = positive predictive value; NPV = negative predictive value; Ac = accuracy.
