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Nuclear Medicine Modalities to Image Bone Metastases with Bone-Targeting Agents: Conventional Scintigraphy and Positron-Emission Tomography

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Bone Metastases from Prostate Cancer

Abstract

99mTc-MDP whole-body bone scintigraphy is a sensitive, an available, and a relatively low-cost modality which is utilized for the evaluation of skeletal metastases from prostate cancer, in response to treatment and patient’s prognosis, using the bone scan index. However, due to tracer uptake by benign bone lesions such as inflammatory, degenerative, and traumatic changes, the method is not highly specific. To mitigate this shortcoming, the planar imaging is complemented with SPECT to better detect and localize the lesions. Also, application of hybrid SPECT/CT scan may provide both anatomic and functional data in a single study and more accurately differentiate metastatic from benign lesions.

The other technique that has been increasingly used during the last decade is 18F-NaF PET/CT. It provides better sensitivity, specificity, and spatial resolution as well as monitoring the response to treatment when compared with conventional bone scan. Furthermore, 18F-NaF PET/CT exhibits the occult metastases more accurately in lower PSA level.

Recently, the combination of 18F-NaF with other specific PET tracers (e.g., 18F-choline) in a single PET/CT (i.e., dual tracer PET/CT) is introduced as a promising imaging technique in the evaluation of prostate cancer patients which allows more accurate assessment of both skeletal and soft tissue malignancies.

In summary, we believe that based on increasing number of established PET/CT scanners and decreasing price for PET radiotracers, as well as better accuracy in detecting metastatic lesions, 18F-NaF PET/CT will supplant conventional 99mTc-MDP whole-body bone scintigraphy in the near future for evaluation of skeletal metastatic disease from prostate cancer.

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Authors and Affiliations

  1. Department of Nuclear Medicine and Endocrinology, PET – CT Center LINZ, St Vincent’s Hospital, Seilerstaette 4 A-4020, Linz, Austria

    Werner Langsteger, Alireza Rezaee & Mohsen Beheshti MD, FEBNM, FASNC

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  1. Werner Langsteger
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  2. Alireza Rezaee
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  3. Mohsen Beheshti MD, FEBNM, FASNC
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Correspondence to Mohsen Beheshti MD, FEBNM, FASNC .

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Editors and Affiliations

  1. University of Verona, Director of Metabolic Bone Diseases and Osteoncology Unit, Internal Medicine Department of Medicine, Verona, Italy

    Francesco Bertoldo

  2. IRCCS AOU San Martino-IST National Cancer Research Institute, Department of Internal Medicine and Medical specialties (DIMI), School of Medical and Pharmacological Sciences, University of Genoa, Academic Unit of Medical Oncology, Department of Oncology (DIPOE), Genoa, Italy

    Francesco Boccardo

  3. Humanitas Gavazzeni Clinic, Clical Scientific Director Department of Nuclear Medicine, Bergamo, Italy

    Emilio Bombardieri

  4. Veneto Institute of Oncology IOV - IRCCS, Nuclear Medicine and Molecular imaging Unit, Padova, Italy

    Laura Evangelista

  5. Radiation Oncology 1 and Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Oncology and Hemato-oncology, Università di Milano, Milan, Italy

    Riccardo Valdagni

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Langsteger, W., Rezaee, A., Beheshti, M. (2017). Nuclear Medicine Modalities to Image Bone Metastases with Bone-Targeting Agents: Conventional Scintigraphy and Positron-Emission Tomography. In: Bertoldo, F., Boccardo, F., Bombardieri, E., Evangelista, L., Valdagni, R. (eds) Bone Metastases from Prostate Cancer . Springer, Cham. https://doi.org/10.1007/978-3-319-42327-2_6

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