Advertisement

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

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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 

Notes

Acknowledgments

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.

References

  1. 1.
    Bombardieri E, Aktolun C, Baum RP et al (2003) Bone scintigraphy: procedure guidelines for tumour imaging. Eur J Nucl Med Mol Imaging 30(12):BP99–BP106PubMedGoogle Scholar
  2. 2.
    Jacobson AF, Fogelman I (1998) Bone scanning in clinical oncology: does it have a future? Eur J Nucl Med 25(9):1219–1223PubMedCrossRefGoogle Scholar
  3. 3.
    Even-Sapir E (2005) Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities. J Nucl Med 46(8):1356–1367PubMedGoogle Scholar
  4. 4.
    Schirrmeister H, Glatting G, Hetzel J et al (2001) Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18)F-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 42(12):1800–1804PubMedGoogle Scholar
  5. 5.
    Min JW, Um SW, Yim JJ et al (2009) The role of whole-body FDG PET/CT, Tc 99m MDP bone scintigraphy, and serum alkaline phosphatase in detecting bone metastasis in patients with newly diagnosed lung cancer. J Korean Med Sci 24(2):275–280PubMedCrossRefGoogle Scholar
  6. 6.
    Chua S, Gnanasegaran G, Cook GJ (2009) Miscellaneous cancers (lung, thyroid, renal cancer, myeloma, and neuroendocrine tumors): role of SPECT and PET in imaging bone metastases. Semin Nucl Med 39(6):416–430PubMedCrossRefGoogle Scholar
  7. 7.
    Hsu WK, Virk MS, Feeley BT, Stout DB, Chatziioannou AF, Lieberman JR (2008) Characterization of osteolytic, osteoblastic, and mixed lesions in a prostate cancer mouse model using 18F-FDG and 18F-fluoride PET/CT. J Nucl Med 49(3):414–421PubMedCrossRefGoogle Scholar
  8. 8.
    Chen YW, Huang MY, Hsieh JS, Hou MF, Chou SH, Lin CL (2007) Discordant findings of skeletal metastasis between tc 99M MDP bone scans and F18 FDG PET/CT imaging for advanced breast and lung cancers—two case reports and literature review. Kaohsiung J Med Sci 23(12):639–646PubMedCrossRefGoogle Scholar
  9. 9.
    Schirrmeister H, Guhlmann A, Elsner K et al (1999) Sensitivity in detecting osseous lesions depends on anatomic localization: planar bone scintigraphy versus 18F PET. J Nucl Med 40(10):1623–1629PubMedGoogle Scholar
  10. 10.
    Ben-Haim S, Israel O (2009) Breast cancer: role of SPECT and PET in imaging bone metastases. Semin Nucl Med 39(6):408–415PubMedCrossRefGoogle Scholar
  11. 11.
    Bridges RL, Wiley CR, Christian JC, Strohm AP (2007) An introduction to Na(18)F bone scintigraphy: basic principles, advanced imaging concepts, and case examples. J Nucl Med Technol 35(2):64–76, quiz 78–69PubMedCrossRefGoogle Scholar
  12. 12.
    Shirazi PH, Rayudu GV, Fordham EW (1974) 18F bone scanning: review of indications and results of 1,500 scans. Radiology 112(2):361–368PubMedGoogle Scholar
  13. 13.
    Grant FD, Fahey FH, Packard AB, Davis RT, Alavi A, Treves ST (2008) Skeletal PET with 18F-fluoride: applying new technology to an old tracer. J Nucl Med 49(1):68–78PubMedCrossRefGoogle Scholar
  14. 14.
    Gamie S, El-Maghraby T (2008) The role of PET/CT in evaluation of Facet and Disc abnormalities in patients with low back pain using (18)F-fluoride. Nucl Med Rev Cent East Eur 11(1):17–21PubMedGoogle Scholar
  15. 15.
    Drubach LA, Sapp MV, Laffin S, Kleinman PK (2008) Fluorine-18 NaF PET imaging of child abuse. Pediatr Radiol 38(7):776–779PubMedCrossRefGoogle Scholar
  16. 16.
    Bhargava P, Hanif M, Nash C (2008) Whole-body F-18 sodium fluoride PET-CT in a patient with renal cell carcinoma. Clin Nucl Med 33(12):894–895PubMedCrossRefGoogle Scholar
  17. 17.
    Lim R, Fahey FH, Drubach LA, Connolly LP, Treves ST (2007) Early experience with fluorine-18 sodium fluoride bone PET in young patients with back pain. J Pediatr Orthop 27(3):277–282PubMedCrossRefGoogle Scholar
  18. 18.
    Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I (2006) The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med 47(2):287–297PubMedGoogle Scholar
  19. 19.
    Even-Sapir E, Mishani E, Flusser G, Metser U (2007) 18F-fluoride positron emission tomography and positron emission tomography/computed tomography. Semin Nucl Med 37(6):462–469PubMedCrossRefGoogle Scholar
  20. 20.
    Even-Sapir E, Metser U, Flusser G et al (2004) Assessment of malignant skeletal disease: initial experience with 18F-fluoride PET/CT and comparison between 18F-fluoride PET and 18F-fluoride PET/CT. J Nucl Med 45(2):272–278PubMedGoogle Scholar
  21. 21.
    Hetzel M, Arslandemir C, Konig HH et al (2003) F-18 NaF PET for detection of bone metastases in lung cancer: accuracy, cost-effectiveness, and impact on patient management. J Bone Miner Res 18(12):2206–2214PubMedCrossRefGoogle Scholar
  22. 22.
    Schirrmeister H, Buck A, Guhlmann A, Reske SN (2001) Anatomical distribution and sclerotic activity of bone metastases from thyroid cancer assessed with F-18 sodium fluoride positron emission tomography. Thyroid 11(7):677–683PubMedCrossRefGoogle Scholar
  23. 23.
    Cook GJ, Fogelman I (2001) Detection of bone metastases in cancer patients by 18F-fluoride and 18F-fluorodeoxyglucose positron emission tomography. Q J Nucl Med 45(1):47–52PubMedGoogle Scholar
  24. 24.
    Blake GM, Park-Holohan SJ, Cook GJ, Fogelman I (2001) Quantitative studies of bone with the use of 18F-fluoride and 99mTc-methylene diphosphonate. Semin Nucl Med 31(1):28–49PubMedCrossRefGoogle Scholar
  25. 25.
    Kruger S, Buck A, Mottaghy F et al (2009) Detection of bone metastases in patients with lung cancer: 99mTc-MDP planar bone scintigraphy, 18F-fluoride PET or 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging 36(11):1807–1812PubMedCrossRefGoogle Scholar
  26. 26.
    Feldman F, van Heertum R, Manos C (2003) 18FDG PET scanning of benign and malignant musculoskeletal lesions. Skeletal Radiol 32(4):201–208PubMedCrossRefGoogle Scholar
  27. 27.
    Uematsu T, Yuen S, Yukisawa S et al (2005) Comparison of FDG PET and SPECT for detection of bone metastases in breast cancer. Am J Roentgenol 184(4):1266–1273Google Scholar
  28. 28.
    Nakai T, Okuyama C, Kubota T et al (2005) Pitfalls of FDG-PET for the diagnosis of osteoblastic bone metastases in patients with breast cancer. Eur J Nucl Med Mol Imaging 32(11):1253–1258PubMedCrossRefGoogle Scholar
  29. 29.
    Meirelles GSP, Schoder H, Ravizzini GC et al (2010) Prognostic value of baseline [18F] fluorodeoxyglucose positron emission tomography and 99mTc-MDP bone scan in progressing metastatic prostate cancer. Clin Cancer Res 16(24):6093–6099PubMedCrossRefGoogle Scholar
  30. 30.
    Jadvar H, Pinski J, Conti P (2003) FDG PET in suspected recurrent and metastatic prostate cancer. Oncol Rep 10(5):1485–1488PubMedGoogle Scholar
  31. 31.
    Shulkin B, Goodin G, McCarville M et al (2009) Bone and [18F]fluorodeoxyglucose positron-emission tomography/computed tomography scanning for the assessment of osseous involvement in Hodgkin lymphoma in children and young adults. Leuk Lymphoma 50(11):1794–1802PubMedCrossRefGoogle Scholar
  32. 32.
    Jadvar H, Conti P (2002) Diagnostic utility of FDG PET in multiple myeloma. Skeletal Radiol 31(12):690–694PubMedCrossRefGoogle Scholar
  33. 33.
    Fogelman I, Cook G, Israel O, Van der Wall H (2005) Positron emission tomography and bone metastases. Semin Nucl Med 35(2):135–142PubMedCrossRefGoogle Scholar
  34. 34.
    Jadvar H, Gamie S, Ramanna L, Conti P (2004) Musculoskeletal system. Semin Nucl Med 34(4):254–261PubMedCrossRefGoogle Scholar
  35. 35.
    Peterson J, Kransdorf M, O’Connor M (2003) Diagnosis of occult bone metastases: positron emission tomography. Clin Orthop Relat Res 415(Suppl):S120–S128PubMedCrossRefGoogle Scholar

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

Personalised recommendations