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Precision of 18F-fluoride PET skeletal kinetic studies in the assessment of bone metabolism

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Abstract

Summary

We assessed the precision of lumbar spine 18F-PET measurements based on 58 scans performed on 20 postmenopausal women. The percentage coefficient of variation (%CV) (95% confidence interval) was 9.2% (7.5–11.8) for standardised uptake values, 11.7% (9.5–14.9) for plasma clearance measurements using the Patlak method and 14.5% (11.7–18.5) for plasma clearance measurements using the Hawkins three-compartment model.

Introduction

18F-Fluoride positron emission tomography (18F-PET) is a non-invasive technique that allows the assessment of regional bone turnover in patients with metabolic bone disease. Knowledge of the precision errors of 18F-PET measurements is important for planning the number of subjects required for research studies.

Methods

Twenty osteoporotic postmenopausal women had 18F-PET scans of the lumbar spine at 0, 6 and 12 months after stopping long-term bisphosphonate treatment. No significant changes in the PET measurements were seen over the 12-month period, and the data were deemed suitable for a precision study. Precision errors were evaluated for standardised uptake values (SUVs) and for the fluoride plasma clearance to bone mineral (K i) determined using the Patlak and Hawkins methods. Precision errors were expressed as the %CV and were calculated for the mean L1–L4 region and for individual vertebrae.

Results

%CV (95% confidence interval) for the L1–L4 region was 9.2% (7.5–11.8) for SUV, 11.7% (9.5–14.9) for K i measured using the Patlak method and 14.5% (11.7–18.5) for K i measured using the Hawkins method. There was no significant difference between precision errors obtained for the L1–L4 region and those obtained for a single vertebra.

Conclusions

SUV measurements showed the smallest precision error followed by the Patlak method, while the Hawkins method gave the largest error. Measuring a smaller region of interest did not increase the precision error, suggesting that the factor determining the errors may be scanner calibration.

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References

  1. Gruber R, Pietschmann P, Peterlik M (2008) Introduction to bone development, remodelling and repair. In: Grampp S (ed) Radiology of osteoporosis, 2nd edn. Springer, Berlin, pp 1–23

    Chapter  Google Scholar 

  2. Kiel DP, Rosen CJ, Dempster D (2008) Age-related bone loss. In: Rosen CJ, Compston JE, Lian JB (eds) Primer on the metabolic bone diseases and disorders of mineral metabolism, 7th edn. American Society of Bone and Mineral Research, Washington, DC, pp 98–102

    Chapter  Google Scholar 

  3. Garnero P, Shih WJ, Gineyts E, Karpf DB, Delmas PD (1994) Comparison of new biochemical markers of bone turnover in late postmenopausal osteoporotic women in response to alendronate treatment. J Clin Endocrinol Metab 79:1693–1700

    Article  PubMed  CAS  Google Scholar 

  4. Glover SJ, Eastell R, McCloskey EV, Rogers A, Garnero P, Lowery J, Belleli R, Wright TM, John MR (2009) Rapid and robust response of biochemical markers of bone formation to teriparatide therapy. Bone 45:1053–1058

    Article  PubMed  CAS  Google Scholar 

  5. Recker RR (2008) Bone biopsy and histomorphometry in clinical practice. In: Rosen CJ, Compston JE, Lian JB (eds) Primer on the metabolic bone diseases and disorders of mineral metabolism, 7th edn. The American Society for Bone and Mineral Research, Washington, DC, pp 180–186

    Chapter  Google Scholar 

  6. Szulc P, Delmas PD (2008) Biochemical markers of bone turnover in osteoporosis. In: Rosen CJ, Compston JE, Lian JB (eds) Primer on the metabolic bone diseases and disorders of mineral metabolism, 7th edn. The American Society for Bone and Mineral Research, Washington, DC, pp 174–179

    Chapter  Google Scholar 

  7. Uchida K, Nakajima H, Miyazaki T, Takafumi Y, Kawahara H, Kobayashi S, Tsuchida T, Okazawa H, Fukibayashi Y, Baba H (2009) Effects of alendronate on bone metabolism in glucocorticoid induced osteoporosis measured by 18F-fluoride PET: a prospective study. J Nucl Med 50:1808–1814

    Article  PubMed  CAS  Google Scholar 

  8. Installe J, Nzeusseu A, Bol A, Depresseux G, Devogelaer J, Lonneux M (2005) 18F-Fluoride PET for monitoring therapeutic response in Paget’s disease of bone. J Nucl Med 46:1650–1658

    PubMed  CAS  Google Scholar 

  9. Blau M, Nagler W, Bender MA (1962) Fluorine-18: a new isotope for bone scanning. J Nucl Med 3:332–334

    PubMed  CAS  Google Scholar 

  10. Even-Sapir E, Mishani E, Flusser G, Metser U (2007) 18F-Fluoride positron emission tomography and positron emission tomography/computed tomography. Semin Nucl Med 37:462–469

    Article  PubMed  Google Scholar 

  11. Hawkins RA, Choi Y, Huang SC, Hoh CK, Dahlbom M, Schiepers C, Satyamurthy N, Barrio JR, Phelps ME (1992) Evaluation of the skeletal kinetics of fluorine-18-fluoride ion with PET. J Nucl Med 33:633–642

    PubMed  CAS  Google Scholar 

  12. Brenner W, Vernon C, Muzi M, Mankoff DA, Link JM, Conrad EU, Eary JF (2004) Comparison of different quantitative approaches to 18F-fluoride PET scans. J Nucl Med 45:1493–1500

    PubMed  CAS  Google Scholar 

  13. Messa C, Goodman WG, Hoh CK, Choi Y, Nissenson AR, Salusky IB, Phelps ME, Hawkins RA (1993) Bone metabolic activity measured with positron emission tomography and 18F-fluoride ion in renal osteodystrophy: correlation with bone histomorphometry. J Clin Endocrinol Metab 77:949–955

    Article  PubMed  CAS  Google Scholar 

  14. Piert M, Zittel TT, Becker GA, Jahn M, Stahlschmidt A, Maier G, Machulla HJ, Bares R (2001) Assessment of porcine bone metabolism by dynamic 18F-fluoride PET: correlation with bone histomorphometry. J Nucl Med 42:1091–1100

    PubMed  CAS  Google Scholar 

  15. Frost ML, Blake GM, Park-Holohan SJ, Cook GJR, Curran KM, Marsden PK, Fogelman I (2008) Long-term precision of 18F-fluoride PET skeletal kinetic studies in the assessment of bone metabolism. J Nucl Med 49:700–707

    Article  PubMed  Google Scholar 

  16. Bonnick SL, Johnston C, Kleerekoper M, Lindsay R, Miller P, Sherwood L, Siris E (2001) Importance of precision in bone density measurements. J Clin Densitom 4:105–110

    Article  PubMed  CAS  Google Scholar 

  17. Frost ML, Siddique M, Blake GM, Moore AE, Marsden PK, Schleyer PJ, Eastell R, Fogelman I (2011) Regional bone metabolism at the lumbar spine and hip following discontinuation of alendronate and risedronate treatment in postmenopausal women. Osteoporos Int. doi:10.1007/s00198-011-1805-9

  18. Frost ML, Siddique M, Blake GM, Moore AE, Schleyer PJ, Dunn JT, Somer EJ, Marsden PK, Eastell R, Fogelman I (2011) Differential effects of teriparatide on regional bone formation using 18F-fluoride positron emission tomography. J Bone Miner Res 26:1002–1011

    Article  PubMed  CAS  Google Scholar 

  19. Cook GJR, Lodge MA, Marsden PK, Dynes A, Fogelman I (1999) Noninvasive assessment of skeletal kinetics using fluorine-18 fluoride positron emission tomography: evaluation of image and population-derived arterial input functions. Eur J Nucl Med 26:1424–1429

    Article  PubMed  CAS  Google Scholar 

  20. Patlak CS, Blasberg RG, Fenstermacher JD (1983) Graphical evaluation of blood-to-brain transfer constants from multiple-time uptake data. J Cereb Blood Flow Metab 3:1–7

    Article  PubMed  CAS  Google Scholar 

  21. Gluer CC, Blake G, Lu Y, Blunt BA, Jergas M, Genant HK (1995) Accurate assessment of precision errors: how to measure the reproducibility of bone densitometry techniques. Osteoporos Int 5:262–270

    Article  PubMed  CAS  Google Scholar 

  22. Levene H (1960) Robust tests for equality of variances. In: Olkin I, Ghurye SG, Hoeffding W, Madow WG, Mann HB (eds) Contributions to probability and statistics. Stanford University Press, Stanford, pp 278–292

    Google Scholar 

  23. Frost ML, Blake GM, Fogelman I (2010) 18F-fluoride PET in Osteoporosis. PET Clin 5:259–274

    Article  Google Scholar 

  24. Sowers MF, Karvonen-Gutierrez CA (2007) Epidemiological methods in studies of osteoporosis. In: Marcus R, Feldman D, Nelson DA, Rosen CJ (eds) Osteoporosis, 3rd edn. Elsevier Academic, Burlington, pp 645–665

    Google Scholar 

  25. Weber WA, Ziegler SI, Thodtmann R, Hanauske AR, Schwaiger M (1999) Reproducibility of metabolic measurements in malignant tumors using FDG PET. J Nucl Med 40:1771–1777

    PubMed  CAS  Google Scholar 

  26. Velasquez LM, Boellard R, Kollia G, Hayes W, Hoekstra OS, Lammertsma AA, Galbraith SM (2009) Repeatability of 18F-FDG PET in a multicenter phase I study of patients with advanced gastrointestinal malignancies. J Nucl Med 50:1646–1654

    Article  PubMed  CAS  Google Scholar 

  27. Blake GM, Siddique M, Frost ML, Moore AE, Fogelman I (2011) Radionuclide studies of bone metabolism: do bone uptake and bone plasma clearance provide equivalent measurements of bone turnover? Bone 49:537–542

    Article  PubMed  CAS  Google Scholar 

  28. Blake GM, Jagathesan T, Herd RJM, Fogelman I (1994) Dual X-ray absorptiometry of the lumbar spine: the precision of paired anteroposterior/ lateral studies. Br J Radiol 67:624–630

    Article  PubMed  CAS  Google Scholar 

  29. Lockhard CM, Macdonald LR, Alessio AM, McDougald WA, Doot RK, Kinahan PE (2011) Quantifying and reducing the effect of calibration error on variability of PET/CT standardized uptake value measurements. J Nucl Med 52:218–224

    Article  Google Scholar 

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Acknowledgements

The 18F-PET bisphosphonate treatment withdrawal study was supported by an unrestricted grant from Warner Chilcott.

Conflicts of interest

MF, IF and GB received research funding from Warner Chilcott to undertake the 18F-PET treatment withdrawal study. YA and MS have no disclosures.

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Authors and Affiliations

  1. Osteoporosis Screening & Research Unit, Guy’s Hospital, King’s College London, 1st Floor, Tower Wing, London, SE1 9RT, UK

    Y. Al-beyatti, M. Siddique, M. L. Frost, I. Fogelman & G. M. Blake

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  1. Y. Al-beyatti
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  2. M. Siddique
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  3. M. L. Frost
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  4. I. Fogelman
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  5. G. M. Blake
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Correspondence to Y. Al-beyatti.

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Al-beyatti, Y., Siddique, M., Frost, M.L. et al. Precision of 18F-fluoride PET skeletal kinetic studies in the assessment of bone metabolism. Osteoporos Int 23, 2535–2541 (2012). https://doi.org/10.1007/s00198-011-1889-2

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  • DOI: https://doi.org/10.1007/s00198-011-1889-2

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