Molecular Imaging and Biology

, Volume 14, Issue 2, pp 252–259 | Cite as

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

  • Andrei IagaruEmail author
  • Erik Mittra
  • David W. Dick
  • Sanjiv Sam Gambhir
Research Article



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.


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.


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.


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.

Key words

18F NaF 18F FDG PET/CT 99mTc MDP Malignancy 



This research was supported in part by NCI ICMIC CA114747 (SSG), and the clinical studies were supported in part by the Doris Duke Foundation and Canary Foundation (SSG). We would also like to thank Dr. Fred Chin in the Cyclotron Facility, Lindee Burton, and all the technologists in the Nuclear Medicine Clinic.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Academy of Molecular Imaging and Society for Molecular Imaging 2011

Authors and Affiliations

  • Andrei Iagaru
    • 1
    Email author
  • Erik Mittra
    • 1
  • David W. Dick
    • 2
  • Sanjiv Sam Gambhir
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of Radiology, Division of Nuclear MedicineStanford University Medical CenterStanfordUSA
  2. 2.Department of RadiologyMolecular Imaging Program at Stanford (MIPS)StanfordUSA
  3. 3.Department of BioengineeringStanfordUSA
  4. 4.Department of Materials Science & EngineeringStanfordUSA

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