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Sanoesan V, Phannajit J, Kingpetch K, Sawatnatee T, Phromphao B, Susantitaphong P, Sukprakun C, Khamwan K. Bone turnover prediction in patients with chronic kidney disease (CKD) undergoing hemodialysis using shortened dynamic 18F-NaF PET/CT K i-Patlak. Sci Rep 2024; 14:12536. [PMID: 38822011 PMCID: PMC11143219 DOI: 10.1038/s41598-024-63476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/29/2024] [Indexed: 06/02/2024] Open
Abstract
This study investigated whether Ki-Patlak derived from a shortened scan time for dynamic 18F-NaF PET/CT in chronic kidney disease (CKD) patients undergoing hemodialysis can provide predictive accuracy comparable to that obtained from a longer scan. Twenty-seven patients on chronic hemodialysis, involving a total of 42 scans between December 2021 and August 2023 were recruited. Dynamic 18F-NaF PET/CT scans, lasting 60-90 min, were immediately acquired post-injection, covering the mid-twelfth thoracic vertebra to the pelvis region. Ki-Patlak analysis was performed on bone time-activity curves at 15, 30, 45, 60, and 90 min in the lumbar spine (L1-L4) and both anterior iliac crests. Spearman's rank correlation (rs) and interclass correlation coefficient were used to assess the correlation and agreement of Ki-Patlak between shortened and standard scan times. Bone-specific alkaline phosphatase (BsAP) and tartrate-resistant acid phosphatase isoform 5b (TRAP5b) were tested for their correlation with individual Ki-Patlak. Strong correlations and good agreement were observed between Ki-Patlak values from shortened 30-min scans and longer 60-90-min scans in both lumbar spine (rs = 0.858, p < 0.001) and anterior iliac crest regions (rs = 0.850, p < 0.001). The correlation between BsAP and Ki-Patlak in the anterior iliac crests was weak and statistically insignificant. This finding suggests that a proposed shortened dynamic 18F-NaF PET/CT scan is effective in assessing bone metabolic flux in CKD patients undergoing hemodialysis, offering a non-invasive alternative approach for bone turnover prediction.
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Affiliation(s)
- Viyada Sanoesan
- Medical Physics Program, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Department of Radiological Technology, Faculty of Sciences, Ramkhamhaeng University, Huamark, Bangkapi, Bangkok, 10240, Thailand
| | - Jeerath Phannajit
- Division of Clinical Epidemiology, Department of Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Center of Excellence for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kanaungnit Kingpetch
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Thunyaluk Sawatnatee
- Division of Nuclear Medicine, Department of Radiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Benchamat Phromphao
- Division of Nuclear Medicine, Department of Radiology, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, 10330, Thailand
| | - Paweena Susantitaphong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
- Center of Excellence for Metabolic Bone Disease in CKD Patients, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Chanan Sukprakun
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kitiwat Khamwan
- Medical Physics Program, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
- Chulalongkorn University Biomedical Imaging Group, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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Chen M, Gerges M, Raynor WY, Park PSU, Nguyen E, Chan DH, Gholamrezanezhad A. State of the Art Imaging of Osteoporosis. Semin Nucl Med 2024; 54:415-426. [PMID: 38087745 DOI: 10.1053/j.semnuclmed.2023.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 05/18/2024]
Abstract
Osteoporosis is a common disease, particularly prevalent in geriatric populations, which causes significant worldwide morbidity due to increased bone fragility and fracture risk. Currently, the gold-standard modality for diagnosis and evaluation of osteoporosis progression and treatment relies on dual-energy x-ray absorptiometry (DXA), which measures bone mineral density (BMD) and calculates a score based upon standard deviation of measured BMD from the mean. However, other imaging modalities can also be used to evaluate osteoporosis. Here, we review historical as well as current research into development of new imaging modalities that can provide more nuanced or opportunistic analyses of bone quality, turnover, and density that can be helpful in triaging severity and determining treatment success in osteoporosis. We discuss the use of opportunistic computed tomography (CT) scans, as well as the use of quantitative CT to help determine fracture risk and perform more detailed bone quality analysis than would be allowed by DXA . Within magnetic resonance imaging (MRI), new developments include the use of advanced MRI techniques such as quantitative susceptibility mapping (QSM), magnetic resonance spectroscopy, and chemical shift encoding-based water-fat MRI (CSE-MRI) to enable clinicians improved assessment of nonmineralized bone compartments as well as a way to longitudinally assess bone quality without the repeated exposure to ionizing radiation. Within ultrasound, development of quantitative ultrasound shows promise particularly in future low-cost, broadly available screening tools. We focus primarily on historical and recent developments within radiotracer use as applicable to osteoporosis, particularly in the use of hybrid methods such as NaF-PET/CT, wherein patients with osteoporosis show reduced uptake of radiotracers such as NaF. Use of radiotracers may provide clinicians with even earlier detection windows for osteoporosis than would traditional biomarkers. Given the metabolic nature of this disease, current investigation into the role molecular imaging can play in the prediction of this disease as well as in replacing invasive diagnostic procedures shows particular promise.
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Affiliation(s)
- Michelle Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maria Gerges
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Peter Sang Uk Park
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Edward Nguyen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David H Chan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Fuglø D, Drachmann ALP, Heltø KMM, Marner L, Hansen D. Bone Turnover in Patients with Chronic Kidney Disease Stage 5D and Healthy Controls - a Quantitative [ 18F]Fluoride PET Study. Mol Imaging Biol 2023; 25:815-823. [PMID: 37433895 PMCID: PMC10598153 DOI: 10.1007/s11307-023-01834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is prevalent in the aging population and increases the risk of fracture 2-4 times. We compared optimized quantitative [18F]fluoride PET/CT methods to the reference standard with arterial input function (AIF) to identify a clinically accessible method for evaluation of bone turnover in patients with CKD. METHODS Ten patients on chronic hemodialysis treatment and ten control patients were recruited. A dynamic 60-min [18F]fluoride PET scan was obtained from the 5th lumbar vertebra to the proximal femur simultaneously with arterial blood sampling to achieve an AIF. Individual AIFs were time-shifted to compute a population curve (PDIF). Bone and vascular volumes-of-interest (VOIs) were drawn, and an image-derived-input-function (IDIF) was extracted. PDIF and IDIF were scaled to plasma. Bone turnover (Ki) was calculated with the AIF, PDIF, and IDIF and bone VOIs using a Gjedde-Patlak plot. Input methods were compared using correlations and precision errors. RESULTS The calculated Ki from the five non-invasive methods all correlated to the Ki from the AIF method with the PDIF scaled to a single late plasma sample showing the highest correlations (r > 0.94), and the lowest precision error of 3-5%. Furthermore, the femoral bone VOI's correlated positively to p-PTH and showed significant differences between patients and controls. CONCLUSIONS Dynamic 30 min [18F]fluoride PET/CT with a population based input curve scaled to a single venous plasma sample is a feasible and precise non-invasive diagnostic method for the assessment of bone turnover in patients with CKD. The method may potentially allow for earlier and more precise diagnosis and may be useful for assessment of treatment effects, which is crucial for development of future treatment strategies.
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Affiliation(s)
- Dan Fuglø
- Department of Nuclear Medicine, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | | | - Kim Minh Michael Heltø
- Department of Anaesthesiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Puri T, Frost ML, Moore AEB, Choudhury A, Vinjamuri S, Mahajan A, Fynbo C, Vrist M, Theil J, Kairemo K, Wong J, Zaidi H, Revheim ME, Werner TJ, Alavi A, Cook GJR, Blake GM. Utility of a simplified [ 18F] sodium fluoride PET imaging method to quantify bone metabolic flux for a wide range of clinical applications. Front Endocrinol (Lausanne) 2023; 14:1236881. [PMID: 37780613 PMCID: PMC10534005 DOI: 10.3389/fendo.2023.1236881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
We review the rationale, methodology, and clinical utility of quantitative [18F] sodium fluoride ([18F]NaF) positron emission tomography-computed tomography (PET-CT) imaging to measure bone metabolic flux (Ki, also known as bone plasma clearance), a measurement indicative of the local rate of bone formation at the chosen region of interest. We review the bone remodelling cycle and explain what aspects of bone remodelling are addressed by [18F]NaF PET-CT. We explain how the technique works, what measurements are involved, and what makes [18F]NaF PET-CT a useful tool for the study of bone remodelling. We discuss how these measurements can be simplified without loss of accuracy to make the technique more accessible. Finally, we briefly review some key clinical applications and discuss the potential for future developments. We hope that the simplified method described here will assist in promoting the wider use of the technique.
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Affiliation(s)
- Tanuj Puri
- Faculty of Biology, Medicine and Health, School of Medical Sciences, Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Michelle L. Frost
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), The Institute of Cancer Research, Sutton, United Kingdom
| | - Amelia E. B. Moore
- Department of Cancer Imaging, and King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Ananya Choudhury
- Faculty of Biology, Medicine and Health, School of Medical Sciences, Division of Cancer Sciences, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sobhan Vinjamuri
- Nuclear Medicine Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
| | - Claire Fynbo
- Clinic of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark
| | - Marie Vrist
- University Clinic in Nephrology and Hypertension, Gødstrup Hospital, Herning, Denmark
| | - Jørn Theil
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kalevi Kairemo
- Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - James Wong
- Department of Anaesthesia, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Habib Zaidi
- Geneva University Hospital, Division of Nuclear Medicine and Molecular Imaging, Geneva, Switzerland
| | - Mona-Elisabeth Revheim
- The Intervention Centre, Oslo University Hospital, Norway Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas J. Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Gary J. R. Cook
- Department of Cancer Imaging, and King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
| | - Glen M. Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
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Puri T, Frost ML, Cook GJ, Blake GM. [ 18F] Sodium Fluoride PET Kinetic Parameters in Bone Imaging. Tomography 2021; 7:843-854. [PMID: 34941643 PMCID: PMC8708178 DOI: 10.3390/tomography7040071] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/16/2022] Open
Abstract
This report describes the significance of the kinetic parameters (k-values) obtained from the analysis of dynamic positron emission tomography (PET) scans using the Hawkins model describing the pharmacokinetics of sodium fluoride ([18F]NaF) to understand bone physiology. Dynamic [18F]NaF PET scans may be useful as an imaging biomarker in early phase clinical trials of novel drugs in development by permitting early detection of treatment-response signals that may help avoid late-stage attrition.
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Affiliation(s)
- Tanuj Puri
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK;
| | - Michelle L. Frost
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), Institute of Cancer Research, Sutton SM2 5NG, UK;
| | - Gary J. Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK;
| | - Glen M. Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London SE1 7EH, UK;
- Correspondence: ; Tel.: +44-7762717295
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6
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Vrist MH, Bech JN, Lauridsen TG, Fynbo CA, Theil J. Comparison of [18F] NaF PET/CT dynamic analysis methods and a static analysis method including derivation of a semi-population input function for site-specific measurements of bone formation in a population with chronic kidney disease-mineral and bone disorder. EJNMMI Res 2021; 11:117. [PMID: 34807325 PMCID: PMC8609091 DOI: 10.1186/s13550-021-00859-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of this study is to compare dynamic and static whole-body (WB) [18F]NaF PET/CT scan methods used for analysis of bone plasma clearance in patients with chronic kidney disease-mineral and bone disorder (CKD-MBD). METHODS Seventeen patients with CKD-MBD underwent a 60-min dynamic scan followed by a 30-min static WB scan. Tracer kinetics in four thoracic vertebrae were analysed using nonlinear regression and Patlak analysis using image-derived arterial input functions. The static WB scan was analysed using a simplified Patlak method requiring only a single data point in combination with a fixed y-intercept value (V0), both obtained using a semi-population function. The semi-population function was constructed by combining a previously derived population input function in combination with data from venous blood samples. Static WB scan analysis data, obtained from the semi-population input functions, was compared with paired data obtained using dynamic input functions. RESULTS Bone plasma clearance (Ki) from Patlak analyses correlated well with nonlinear regression analysis, but Ki results using Patlak analysis were lower than Ki results using nonlinear regression analysis. However, no significant difference was found between Ki obtained by static WB scans and Ki obtained by dynamic scans using nonlinear regression analysis (p = 0.29). CONCLUSION Bone plasma clearance measured from static WB scans correlates with clearance data measured by dynamic analysis. Static [18F]NaF PET/CT scans can be applied in future studies to measure Ki in patients with CKD-MBD, but the results should not be compared uncritically with results obtained by dynamic scan analysis.
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Affiliation(s)
- M H Vrist
- University Clinic in Nephrology and Hypertension, Gødstrup Hospital, Herning, Denmark. .,Aarhus University, Aarhus, Denmark.
| | - J N Bech
- University Clinic in Nephrology and Hypertension, Gødstrup Hospital, Herning, Denmark.,Aarhus University, Aarhus, Denmark
| | - T G Lauridsen
- Department of Nephology, Aalborg University Hospital, Aalborg, Denmark
| | - C A Fynbo
- Department of Nuclear Medicine, Gødstrup Hospital, Herning, Denmark
| | - J Theil
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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7
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Puri T, Siddique MM, Frost ML, Moore AEB, Blake GM. A Short Dynamic Scan Method of Measuring Bone Metabolic Flux Using [ 18F]NaF PET. Tomography 2021; 7:623-635. [PMID: 34842815 PMCID: PMC8628944 DOI: 10.3390/tomography7040053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022] Open
Abstract
[18F]NaF PET measurements of bone metabolic flux (Ki) are conventionally obtained with 60-min dynamic scans analysed using the Hawkins model. However, long scan times make this method expensive and uncomfortable for subjects. Therefore, we evaluated and compared measurements of Ki with shorter scan times analysed with fixed values of the Hawkins model rate constants. The scans were acquired in a trial in 30 postmenopausal women, half treated with teriparatide (TPT) and half untreated. Sixty-minute PET-CT scans of both hips were acquired at baseline and week 12 after injection with 180 MBq [18F]NaF. Scans were analysed using the Hawkins model by fitting bone time–activity curves at seven volumes of interest (VOIs) with a semi-population arterial input function. The model was re-run with fixed rate-constants for dynamic scan times from 0–12 min increasing in 4-min steps up to 0–60 min. Using the Hawkins model with fixed rate-constants, Ki measurements with statistical power equivalent or superior to conventionally analysed 60-min dynamic scans were obtained with scan times as short as 12 min.
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Affiliation(s)
- Tanuj Puri
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, St. Thomas’ Hospital, London SE1 7EH, UK;
| | - Musib M. Siddique
- Radcliffe Department of Medicine, Level 6 West Wing, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK;
| | - Michelle L. Frost
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), Institute of Cancer Research, 15 Cotswold Road, Sutton SM2 5NG, UK;
| | - Amelia E. B. Moore
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, St. Thomas’ Hospital, London SE1 7EH, UK;
| | - Glen M. Blake
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, 4th Floor Lambeth Wing, St. Thomas’ Hospital, London SE1 7EH, UK;
- Correspondence: ; Tel.: +44-77-6271-7295
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8
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Guo Y, Tian Y, Deng Y, Lu C, Wang Y, Yu C. Diagnostic Performance of [18F]-Labeled PET/CT Tracers for Lymph Node/Bone Metastasis and Biochemical Recurrence Detection in Advanced Prostate Cancer: A Meta-Analysis. Urol Int 2021; 106:1107-1125. [PMID: 34818225 DOI: 10.1159/000518478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/11/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to explore the diagnostic value of different fluorine-18 (18F)-labeled tracers for lymph node/bone metastasis and biochemical recurrence detection in advanced prostate cancer (PCa). METHODS PubMed, Embase, Web of Science, Cochrane databases, and the WHO International Clinical Trial Center were searched. The inclusion criteria were determined based on the Preferred Report Items of the Systematic Review and Meta-Analysis Guidelines. The Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the quality assessment of the included studies. The quantitative analysis of the included literature was performed on the patient and lesion basis, and the equivocal findings were considered negative or positive results, respectively. RESULTS Thirty-seven articles were included. On the patient basis, the pooled sensitivity and specificity of [18F]-labeled tracers were 0.80 (95% confidence interval [CI]: 0.78-0.83) and 0.89 (95% CI: 0.87-0.90) when equivocal results were considered to be positive and 0.80 (95% CI: 0.77-0.82) and 0.87 (95% CI: 0.85-0.89) when equivocal results were considered to be negative. On the lesion basis, the pooled sensitivity and specificity of [18F]-labeled tracers were 0.82 (95% CI: 0.80-0.83) and 0.91 (95% CI: 0.90-0.92) when equivocal lesions were regarded as positive and 0.81 (95% CI: 0.80-0.82) and 0.91 (95% CI: 0.90-0.92) when equivocal lesions were considered to be negative. CONCLUSION [18F]-labeled tracers have high diagnostic efficacy for lymph node/bone metastasis and biochemical recurrence in advanced PCa.
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Affiliation(s)
- YiRui Guo
- Wuxi School of Medicine, Jiangnan University, Wuxi, China,
| | - Yu Tian
- Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Yuxin Deng
- School of Design, Jiangnan University, Wuxi, China
| | - ChunMei Lu
- School of Chemical and Material Engineering, Jiangnan University, Wuxi, China
| | - YanJuan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Chunjing Yu
- Wuxi School of Medicine, Jiangnan University, Wuxi, China.,Department of Nuclear Medicine, Affiliated Hospital of Jiangnan University, Wuxi, China
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9
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Raynor WY, Borja AJ, Hancin EC, Werner TJ, Alavi A, Revheim ME. Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET. PET Clin 2021; 16:295-311. [PMID: 33589389 DOI: 10.1016/j.cpet.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PET imaging with 18F-sodium fluoride (NaF), combined with computed tomography or magnetic resonance, is a sensitive method of assessing bone turnover. Although NaF-PET is gaining popularity in detecting prostate cancer metastases to bone marrow, osseous changes represent secondary effects of cancer cell growth. PET tracers more appropriate for assessing prostate cancer metastases directly portray malignant activity and include 18F-fluciclovine and prostatic specific membrane antigen ligands. Recent studies investigating NaF-PET suggest utility in the assessment of benign musculoskeletal disorders. Emerging applications in assessing traumatic injuries, joint disease, back pain, orthopedic complications, and metabolic bone disease are discussed.
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Affiliation(s)
- William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Emily C Hancin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway.
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Manhas NS, Salehi S, Joyce P, Guermazi A, Ahmadzadehfar H, Gholamrezanezhad A. PET/Computed Tomography Scans and PET/MR Imaging in the Diagnosis and Management of Musculoskeletal Diseases. PET Clin 2020; 15:535-545. [DOI: 10.1016/j.cpet.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Karakatsanis NA, Abgral R, Trivieri MG, Dweck MR, Robson PM, Calcagno C, Boeykens G, Senders ML, Mulder WJM, Tsoumpas C, Fayad ZA. Hybrid PET- and MR-driven attenuation correction for enhanced 18F-NaF and 18F-FDG quantification in cardiovascular PET/MR imaging. J Nucl Cardiol 2020; 27:1126-1141. [PMID: 31667675 PMCID: PMC7190435 DOI: 10.1007/s12350-019-01928-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The standard MR Dixon-based attenuation correction (AC) method in positron emission tomography/magnetic resonance (PET/MR) imaging segments only the air, lung, fat and soft-tissues (4-class), thus neglecting the highly attenuating bone tissues and affecting quantification in bones and adjacent vessels. We sought to address this limitation by utilizing the distinctively high bone uptake rate constant Ki expected from 18F-Sodium Fluoride (18F-NaF) to segment bones from PET data and support 5-class hybrid PET/MR-driven AC for 18F-NaF and 18F-Fluorodeoxyglucose (18F-FDG) PET/MR cardiovascular imaging. METHODS We introduce 5-class Ki/MR-AC for (i) 18F-NaF studies where the bones are segmented from Patlak Ki images and added as the 5th tissue class to the MR Dixon 4-class AC map. Furthermore, we propose two alternative dual-tracer protocols to permit 5-class Ki/MR-AC for (ii) 18F-FDG-only data, with a streamlined simultaneous administration of 18F-FDG and 18F-NaF at 4:1 ratio (R4:1), or (iii) for 18F-FDG-only or both 18F-FDG and 18F-NaF dual-tracer data, by administering 18F-NaF 90 minutes after an equal 18F-FDG dosage (R1:1). The Ki-driven bone segmentation was validated against computed tomography (CT)-based segmentation in rabbits, followed by PET/MR validation on 108 vertebral bone and carotid wall regions in 16 human volunteers with and without prior indication of carotid atherosclerosis disease (CAD). RESULTS In rabbits, we observed similar (< 1.2% mean difference) vertebral bone 18F-NaF SUVmean scores when applying 5-class AC with Ki-segmented bone (5-class Ki/CT-AC) vs CT-segmented bone (5-class CT-AC) tissue. Considering the PET data corrected with continuous CT-AC maps as gold-standard, the percentage SUVmean bias was reduced by 17.6% (18F-NaF) and 15.4% (R4:1) with 5-class Ki/CT-AC vs 4-class CT-AC. In humans without prior CAD indication, we reported 17.7% and 20% higher 18F-NaF target-to-background ratio (TBR) at carotid bifurcations wall and vertebral bones, respectively, with 5- vs 4-class AC. In the R4:1 human cohort, the mean 18F-FDG:18F-NaF TBR increased by 12.2% at carotid bifurcations wall and 19.9% at vertebral bones. For the R1:1 cohort of subjects without CAD indication, mean TBR increased by 15.3% (18F-FDG) and 15.5% (18F-NaF) at carotid bifurcations and 21.6% (18F-FDG) and 22.5% (18F-NaF) at vertebral bones. Similar TBR enhancements were observed when applying the proposed AC method to human subjects with prior CAD indication. CONCLUSIONS Ki-driven bone segmentation and 5-class hybrid PET/MR-driven AC is feasible and can significantly enhance 18F-NaF and 18F-FDG contrast and quantification in bone tissues and carotid walls.
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Affiliation(s)
- Nicolas A Karakatsanis
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA.
- Department of Radiology, Weill Cornell Medical College, Cornell University, 515 E 71st Street, S-120, New York, NY, 10021, USA.
| | - Ronan Abgral
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Maria Giovanna Trivieri
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
| | - Marc R Dweck
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
- British Heart Foundation, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Philip M Robson
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
| | - Claudia Calcagno
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
| | - Gilles Boeykens
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - Max L Senders
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - Willem J M Mulder
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - Charalampos Tsoumpas
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Zahi A Fayad
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, NY, 10029, USA
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Clinical Nononcologic Applications of PET/CT and PET/MRI in Musculoskeletal, Orthopedic, and Rheumatologic Imaging. AJR Am J Roentgenol 2019; 210:W245-W263. [PMID: 29787313 DOI: 10.2214/ajr.17.18523] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE With improvements in PET/CT and PET/MRI over the last decade, as well as increased understanding of the pathophysiology of musculoskeletal diseases, there is an emerging potential for PET as a primary or complementary modality in the management of rheumatologic and orthopedic conditions. CONCLUSION We discuss the role of PET/CT and PET/MRI in nononcologic musculoskeletal disorders, including inflammatory and infectious conditions and postoperative complications. There is great potential for an increased role for PET to serve as a primary or complementary modality in the management of orthopedic and rheumatologic disorders.
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13
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Azad GK, Siddique M, Taylor B, Green A, O'Doherty J, Gariani J, Blake GM, Mansi J, Goh V, Cook GJR. Is Response Assessment of Breast Cancer Bone Metastases Better with Measurement of 18F-Fluoride Metabolic Flux Than with Measurement of 18F-Fluoride PET/CT SUV? J Nucl Med 2019; 60:322-327. [PMID: 30042160 PMCID: PMC6424232 DOI: 10.2967/jnumed.118.208710] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/18/2018] [Indexed: 11/21/2022] Open
Abstract
Our purpose was to establish whether noninvasive measurement of changes in 18F-fluoride metabolic flux to bone mineral (Ki) by PET/CT can provide incremental value in response assessment of bone metastases in breast cancer compared with SUVmax and SUVmeanMethods: Twelve breast cancer patients starting endocrine treatment for de novo or progressive bone metastases were included. Static 18F-fluoride PET/CT scans were acquired 60 min after injection, before and 8 wk after commencing treatment. Venous blood samples were taken at 55 and 85 min after injection to measure plasma 18F-fluoride activity concentrations, and Ki in individual bone metastases was calculated using a previously validated method. Percentage changes in Ki, SUVmax, and SUVmean were calculated from the same index lesions (≤5 lesions) from each patient. Clinical response up to 24 wk, assessed in consensus by 2 experienced oncologists masked to PET imaging findings, was used as a reference standard. Results: Of the 4 patients with clinically progressive disease (PD), mean Ki significantly increased (>25%) in all, SUVmax in 3, and SUVmean in 2. Of the 8 non-PD patients, Ki decreased or remained stable in 7, SUVmax in 5, and SUVmean in 6. A significant mean percentage increase from baseline for Ki, compared with SUVmax and SUVmean, occurred in the 4 patients with PD (89.7% vs. 41.8% and 43.5%, respectively; P < 0.001). Conclusion: After 8 wk of endocrine treatment for bone-predominant metastatic breast cancer, Ki more reliably differentiated PD from non-PD than did SUVmax and SUVmean, probably because measurement of SUV underestimates fluoride clearance by not considering changes in input function.
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Affiliation(s)
- Gurdip K Azad
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Musib Siddique
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Benjamin Taylor
- Department of Oncology, Guys and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Adrian Green
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Jim O'Doherty
- King's College London and Guy's and St. Thomas' PET Centre, St. Thomas' Hospital, London, United Kingdom
- Department of Molecular Imaging, Sidra Medicine, Doha, Qatar; and
| | | | - Glen M Blake
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Janine Mansi
- Department of Oncology, Guys and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Vicky Goh
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Gary J R Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
- King's College London and Guy's and St. Thomas' PET Centre, St. Thomas' Hospital, London, United Kingdom
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14
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Liu Y, Sheng J, Dong Z, Xu Y, Huang Q, Pan D, Wang L, Yang M. The diagnostic performance of 18F-fluoride PET/CT in bone metastases detection: a meta-analysis. Clin Radiol 2019; 74:196-206. [DOI: 10.1016/j.crad.2018.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
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15
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Jassel IS, Siddique M, Frost ML, Moore AEB, Puri T, Blake GM. The influence of CT and dual-energy X-ray absorptiometry (DXA) bone density on quantitative [ 18F] sodium fluoride PET. Quant Imaging Med Surg 2019; 9:201-209. [PMID: 30976544 DOI: 10.21037/qims.2019.01.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background [18F] sodium fluoride PET/CT provides quantitative measures of bone metabolic activity expressed by the parameters standardised uptake value (SUV) and bone plasma clearance (K i) that correlate with measurements of bone formation rate obtained by bone biopsy with double tetracycline labelling. Both SUV and K i relate to the tracer uptake in each millilitre of tissue. In general, the bone region of interest (ROI) includes both mineralised bone {generally with a high concentration of [18F]NaF} and bone marrow (with a much lower concentration), suggesting that correcting SUV and K i for volumetric bone mineral density (vBMD) and measuring them with respect to the tracer uptake in each gram of bone mineral might improve the correlation with the findings of bone biopsy. As a first test of this hypothesis, we looked for positive correlations between SUV and K i values with CT and DXA bone mineral density (BMD) parameters measured in the same ROI. Methods A retrospective reanalysis was performed of 63 lumbar spine [18F]NaF PET/CT scans acquired in four earlier studies. The quantitative PET parameters SUV and K i were measured in L1-L4 and Hounsfield units (HU) measured on the CT scans in the same ROI. Spine BMD data was also obtained from DXA scans in the form of areal BMD and used to derive the bone mineral apparent density (BMAD, an estimate of vBMD). Scatter plots were drawn of SUV and K i against HU, BMAD and areal BMD and the Spearman rank correlation coefficients derived for each plot. Results All correlations were positive and statistically significant. Correlations were highest for HU (SUV: RS =0.513, P<0.0001; K i: RS =0.429, P=0.0005) and lowest for areal BMD (SUV: RS =0.353, P=0.005; K i: RS =0.274, P=0.03). Conclusions The results demonstrate significant positive correlations between SUV and K i and vBMD measurements in the form of HU from CT or BMAD and areal BMD from DXA. These findings justify further exploration of the relationship between SUV and K i [18F]NaF PET/CT measurements and CT or DXA measurements of vBMD to examine whether normalization for bone density might improve their correlation with bone metabolic activity as measured by bone biopsy.
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Affiliation(s)
- Inderbir S Jassel
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Musib Siddique
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Michelle L Frost
- Osteoporosis Research Unit, King's College London, Guy's Hospital, London, UK
| | - Amelia E B Moore
- Osteoporosis Research Unit, King's College London, Guy's Hospital, London, UK
| | - Tanuj Puri
- Osteoporosis Research Unit, King's College London, Guy's Hospital, London, UK
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
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16
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Doot RK. Practical Methods for Estimating Metabolic Flux (Ki) to Assess Response to Therapy via Static PET Scans. J Nucl Med 2019; 60:320-321. [PMID: 30683760 DOI: 10.2967/jnumed.118.220913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/15/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Robert K Doot
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Reilly CC, Raynor WY, Hong AL, Kargilis DC, Lee JS, Alecxih AG, Gupta N, Lim MK, Al-Zaghal A, Werner TJ, Rhodes SS, Alavi A, Rajapakse CS. Diagnosis and Monitoring of Osteoporosis With 18F-Sodium Fluoride PET: An Unavoidable Path for the Foreseeable Future. Semin Nucl Med 2018; 48:535-540. [PMID: 30322479 DOI: 10.1053/j.semnuclmed.2018.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The prevalence of metabolic bone diseases particularly osteoporosis and its precursor, osteopenia, continue to grow as serious global health issues today. On a worldwide perspective, 200million people suffer from osteoporosis and in 2005, over 2million fracture incidents were estimated due to osteoporosis in the United States. Currently, osteoporosis and other metabolic bone diseases are evaluated primarily through dual energy X-ray absorptiometry, and rarely by bone biopsy with tetracycline labeling or Technetium-99m (99mTc) based bone scintigraphy. Deficiencies in these methods have prompted the use of more precise methods of assessment. This review highlights the use of 18F-sodium fluoride (NaF) with PET (NaF-PET), NaF-PET/CT, or NaF-PET/MRI in the evaluation of osteoporosis and osteopenia in the lumbar spine and hip. This imaging modality provides a molecular perspective with respect to the underlying metabolic alterations that lead to osseous disorders by measuring bone turnover through standardized uptake values. Its sensitivity and ability to examine the entire skeletal system make it a more superior imaging modality compared to standard structural imaging techniques. Further research is needed to determine its accuracy in reflecting the efficacy of therapeutic interventions in metabolic bone diseases.
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Affiliation(s)
| | | | | | | | - Jae S Lee
- University of Pennsylvania, Philadelphia, PA
| | | | | | - Marie K Lim
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Abass Alavi
- University of Pennsylvania, Philadelphia, PA
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18
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Cook GJ, Goh V. Functional and Hybrid Imaging of Bone Metastases. J Bone Miner Res 2018; 33:961-972. [PMID: 29665140 PMCID: PMC7616187 DOI: 10.1002/jbmr.3444] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/02/2018] [Accepted: 04/06/2018] [Indexed: 12/21/2022]
Abstract
Bone metastases are common, cause significant morbidity, and impact on healthcare resources. Although radiography, computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy have frequently been used for staging the skeleton, these methods are insensitive and nonspecific for monitoring treatment response in a clinically relevant time frame. We summarize several recent reports on new functional and hybrid imaging methods including single photon emission CT/CT, positron emission tomography/CT, and whole-body MRI with diffusion-weighted imaging. These modalities generally show improvements in diagnostic accuracy for staging and response assessment over standard imaging methods, with the ability to quantify biological processes related to the bone microenvironment as well as tumor cells. As some of these methods are now being adopted into routine clinical practice and clinical trials, further evaluation with comparative studies is required to guide optimal and cost-effective clinical management of patients with skeletal metastases. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Gary Jr Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom
- King's College London and Guy's & St Thomas' PET Centre, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom
- Radiology Department, Guy's & St Thomas' Hospitals, London SE1 7EH, United Kingdom
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19
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Menendez MI, Hettlich B, Wei L, Knopp MV. Feasibility of Na 18F PET/CT and MRI for Noninvasive In Vivo Quantification of Knee Pathophysiological Bone Metabolism in a Canine Model of Post-traumatic Osteoarthritis. Mol Imaging 2018; 16:1536012117714575. [PMID: 28730928 PMCID: PMC5524230 DOI: 10.1177/1536012117714575] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: To assess and quantify by molecular imaging knee osseous metabolic changes serially in an in vivo canine model of posttraumatic osteoarthritis (PTOA) of the knee utilizing sodium fluoride (Na18F) positron emission tomography (PET)/computed tomography (CT) coregistered with magnetic resonance imaging (MRI). Materials and Methods: Sodium fluoride PET imaging of 5 canines was performed prior to anterior cruciate ligament transection (ACLT) and 2 times post-ACLT (3 and 12 weeks). The PET/CT was coregistered with MRI, enabling serial anatomically guided visual and quantitative three-dimensional (3D) region of interest (ROI) assessment by maximum standardized uptake value. Results: Prior to ACLT, every 3D ROI assessed in both knees showed no Na18F uptake above background. The uptake of Na18F in the bone of the ACLT knees increased exponentially, presenting significantly higher uptake at 12 weeks in every region compared to the ACLT knees at baseline. Furthermore, the uninjured contralateral limb and the ipsilateral distal bones and joints presented Na18F uptake at 3 and 12 weeks post-ACLT. Conclusion: This study demonstrated that Na18F PET/CT coregistered with MRI is a feasible molecular imaging biomarker to assess knee osseous metabolic changes serially in an in vivo canine model of knee PTOA. Moreover, it brings a novel musculoskeletal preclinical imaging methodology that can provide unique insights into PTOA pathophysiology.
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Affiliation(s)
- Maria I Menendez
- 1 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
| | - Bianca Hettlich
- 1 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA.,2 Vetsuisse Faculty Bern, Bern, Switzerland
| | - Lai Wei
- 3 Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Michael V Knopp
- 1 Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University, Columbus, OH, USA
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20
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Blake GM, Puri T, Siddique M, Frost ML, Moore AEB, Fogelman I. Site specific measurements of bone formation using [ 18F] sodium fluoride PET/CT. Quant Imaging Med Surg 2018. [PMID: 29541623 DOI: 10.21037/qims.2018.01.02] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dynamic positron emission tomography (PET) imaging with fluorine-18 labelled sodium fluoride ([18F]NaF) allows the quantitative assessment of regional bone formation by measuring the plasma clearance of fluoride to bone at any site in the skeleton. Today, hybrid PET and computed tomography (CT) dual-modality systems (PET/CT) are widely available, and [18F]NaF PET/CT offers a convenient non-invasive method of studying bone formation at the important osteoporotic fracture sites at the hip and spine, as well as sites of pure cortical or trabecular bone. The technique complements conventional measurements of bone turnover using biochemical markers or bone biopsy as a tool to investigate new therapies for osteoporosis, and has a potential role as an early biomarker of treatment efficacy in clinical trials. This article reviews methods of acquiring and analyzing dynamic [18F]NaF PET/CT scan data, and outlines a simplified approach combining venous blood sampling with a series of short (3- to 5-minute) static PET/CT scans acquired at different bed positions to estimate [18F]NaF plasma clearance at multiple sites in the skeleton with just a single injection of tracer.
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Affiliation(s)
- Glen M Blake
- Biomedical Engineering Department, King's College London, Strand, LondonUK
| | - Tanuj Puri
- Biomedical Engineering Department, King's College London, Strand, LondonUK
| | - Musib Siddique
- Biomedical Engineering Department, King's College London, Strand, LondonUK
| | - Michelle L Frost
- Department of Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Amelia E B Moore
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, UK
| | - Ignac Fogelman
- Nuclear Medicine Department, King's College London, Guy's Campus, London, UK
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21
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Raynor W, Houshmand S, Gholami S, Emamzadehfard S, Rajapakse CS, Blomberg BA, Werner TJ, Høilund-Carlsen PF, Baker JF, Alavi A. Evolving Role of Molecular Imaging with (18)F-Sodium Fluoride PET as a Biomarker for Calcium Metabolism. Curr Osteoporos Rep 2016; 14:115-25. [PMID: 27301549 DOI: 10.1007/s11914-016-0312-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
(18)F-sodium fluoride (NaF) as an imaging tracer portrays calcium metabolic activity either in the osseous structures or in soft tissue. Currently, clinical use of NaF-PET is confined to detecting metastasis to the bone, but this approach reveals indirect evidence for disease activity and will have limited use in the future in favor of more direct approaches that visualize cancer cells in the read marrow where they reside. This has proven to be the case with FDG-PET imaging in most cancers. However, a variety of studies support the application of NaF-PET to assess benign osseous diseases. In particular, bone turnover can be measured from NaF uptake to diagnose osteoporosis. Several studies have evaluated the efficacy of bisphosphonates and their lasting effects as treatment for osteoporosis using bone turnover measured by NaF-PET. Additionally, NaF uptake in vessels tracks calcification in the plaques at the molecular level, which is relevant to coronary artery disease. Also, NaF-PET imaging of diseased joints is able to project disease progression in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. Further studies suggest potential use of NaF-PET in domains such as back pain, osteosarcoma, stress-related fracture, and bisphosphonate-induced osteonecrosis of the jaw. The critical role of NaF-PET in disease detection and characterization of many musculoskeletal disorders has been clearly demonstrated in the literature, and these methods will become more widespread in the future. The data from PET imaging are quantitative in nature, and as such, it adds a major dimension to assessing disease activity.
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Affiliation(s)
- William Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sina Houshmand
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Saeid Gholami
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Sahra Emamzadehfard
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Chamith S Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Björn Alexander Blomberg
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | | | - Joshua F Baker
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
- Division of Rheumatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
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Karakatsanis NA, Casey ME, Lodge MA, Rahmim A, Zaidi H. Whole-body direct 4D parametric PET imaging employing nested generalized Patlak expectation-maximization reconstruction. Phys Med Biol 2016; 61:5456-85. [PMID: 27383991 DOI: 10.1088/0031-9155/61/15/5456] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Whole-body (WB) dynamic PET has recently demonstrated its potential in translating the quantitative benefits of parametric imaging to the clinic. Post-reconstruction standard Patlak (sPatlak) WB graphical analysis utilizes multi-bed multi-pass PET acquisition to produce quantitative WB images of the tracer influx rate K i as a complimentary metric to the semi-quantitative standardized uptake value (SUV). The resulting K i images may suffer from high noise due to the need for short acquisition frames. Meanwhile, a generalized Patlak (gPatlak) WB post-reconstruction method had been suggested to limit K i bias of sPatlak analysis at regions with non-negligible (18)F-FDG uptake reversibility; however, gPatlak analysis is non-linear and thus can further amplify noise. In the present study, we implemented, within the open-source software for tomographic image reconstruction platform, a clinically adoptable 4D WB reconstruction framework enabling efficient estimation of sPatlak and gPatlak images directly from dynamic multi-bed PET raw data with substantial noise reduction. Furthermore, we employed the optimization transfer methodology to accelerate 4D expectation-maximization (EM) convergence by nesting the fast image-based estimation of Patlak parameters within each iteration cycle of the slower projection-based estimation of dynamic PET images. The novel gPatlak 4D method was initialized from an optimized set of sPatlak ML-EM iterations to facilitate EM convergence. Initially, realistic simulations were conducted utilizing published (18)F-FDG kinetic parameters coupled with the XCAT phantom. Quantitative analyses illustrated enhanced K i target-to-background ratio (TBR) and especially contrast-to-noise ratio (CNR) performance for the 4D versus the indirect methods and static SUV. Furthermore, considerable convergence acceleration was observed for the nested algorithms involving 10-20 sub-iterations. Moreover, systematic reduction in K i % bias and improved TBR were observed for gPatlak versus sPatlak. Finally, validation on clinical WB dynamic data demonstrated the clinical feasibility and superior K i CNR performance for the proposed 4D framework compared to indirect Patlak and SUV imaging.
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Affiliation(s)
- Nicolas A Karakatsanis
- Division of Nuclear Medicine and Molecular Imaging, School of Medicine, University of Geneva, Geneva, CH-1211, Switzerland
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Karakatsanis NA, Zhou Y, Lodge MA, Casey ME, Wahl RL, Zaidi H, Rahmim A. Generalized whole-body Patlak parametric imaging for enhanced quantification in clinical PET. Phys Med Biol 2015; 60:8643-73. [PMID: 26509251 DOI: 10.1088/0031-9155/60/22/8643] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We recently developed a dynamic multi-bed PET data acquisition framework to translate the quantitative benefits of Patlak voxel-wise analysis to the domain of routine clinical whole-body (WB) imaging. The standard Patlak (sPatlak) linear graphical analysis assumes irreversible PET tracer uptake, ignoring the effect of FDG dephosphorylation, which has been suggested by a number of PET studies. In this work: (i) a non-linear generalized Patlak (gPatlak) model is utilized, including a net efflux rate constant kloss, and (ii) a hybrid (s/g)Patlak (hPatlak) imaging technique is introduced to enhance contrast to noise ratios (CNRs) of uptake rate Ki images. Representative set of kinetic parameter values and the XCAT phantom were employed to generate realistic 4D simulation PET data, and the proposed methods were additionally evaluated on 11 WB dynamic PET patient studies. Quantitative analysis on the simulated Ki images over 2 groups of regions-of-interest (ROIs), with low (ROI A) or high (ROI B) true kloss relative to Ki, suggested superior accuracy for gPatlak. Bias of sPatlak was found to be 16-18% and 20-40% poorer than gPatlak for ROIs A and B, respectively. By contrast, gPatlak exhibited, on average, 10% higher noise than sPatlak. Meanwhile, the bias and noise levels for hPatlak always ranged between the other two methods. In general, hPatlak was seen to outperform all methods in terms of target-to-background ratio (TBR) and CNR for all ROIs. Validation on patient datasets demonstrated clinical feasibility for all Patlak methods, while TBR and CNR evaluations confirmed our simulation findings, and suggested presence of non-negligible kloss reversibility in clinical data. As such, we recommend gPatlak for highly quantitative imaging tasks, while, for tasks emphasizing lesion detectability (e.g. TBR, CNR) over quantification, or for high levels of noise, hPatlak is instead preferred. Finally, gPatlak and hPatlak CNR was systematically higher compared to routine SUV values.
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Affiliation(s)
- Nicolas A Karakatsanis
- Division of Nuclear Medicine and Molecular Imaging, School of Medicine, University of Geneva, Geneva, CH-1211, Switzerland
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Peters MJM, Wierts R, Jutten EMC, Halders SGEA, Willems PCPH, Brans B. Evaluation of a short dynamic 18F-fluoride PET/CT scanning method to assess bone metabolic activity in spinal orthopedics. Ann Nucl Med 2015; 29:799-809. [PMID: 26243500 PMCID: PMC4624823 DOI: 10.1007/s12149-015-1008-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 07/14/2015] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A complication after spinal fusion surgery is pseudarthrosis, but its radiological diagnosis is of limited value. (18)F-fluoride PET with its ability to assess bone metabolism activity could be of value. The goal of this study was to assess the clinical feasibility of calculating the static standardized uptake value (SUV) from a short dynamic scan without the use of blood sampling, thereby obtaining all dynamic and static parameters in a scan of only 30 min. This approach was tested on a retrospective patient population with persisting pain after spinal fusion surgery. METHODS In 16 patients, SUVs (SUV max, SUV mean) and kinetic parameters (K 1, k 2, k 3, v b, K i,NLR, K 1/k 2, k 3/(k 2 + k 3), K i,patlak) were derived from static and dynamic PET/CT scans of operated and control regions of the spine, after intravenous administration of 156-214 MBq (18)F-fluoride. Parameter differences between control and operated regions, as well as between pseudarthrosis and fused segments were evaluated. SUVmean at 30 and 60 min was calculated from kinetic parameters obtained from the dynamic data set (SUV mean,2TCM). Agreement between measured and calculated SUVs was evaluated through Bland-Altman plots. RESULTS Overall, statistically significant differences between control and operated regions were observed for SUV max, SUV mean, K i,NLR, K i,patlak, K 1/k 2 and k 3/(k 2 + k 3). Diagnostic CT showed pseudarthrosis in 6/16 patients, while in 10/16 patients, segments were fused. Of all parameters, only those regarding the incorporation of bone [K i,NLR, K i,patlak, k 3/(k 2 + k 3)] differed statistically significant in the intervertebral disc space between the pseudarthrosis and fused patients group. The mean values of the patient-specific blood clearance rate [Formula: see text] differed statistically significant between the pseudarthrosis and the fusion group, with a p value of 0.011. This may correspond with the lack of statistical significance of the SUV values between pseudarthrosis and fused patients. Bland-Altman plots show that calculated SUV mean,2TCM values corresponded well with the measured SUV mean values. CONCLUSION This study shows the feasibility of a 30-min dynamic (18)F-fluoride PET/CT scanning and this may provide dynamic parameters clinically relevant to the diagnosis of pseudarthrosis.
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Affiliation(s)
- Marloes J M Peters
- Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Roel Wierts
- Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisabeth M C Jutten
- Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Servé G E A Halders
- Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul C P H Willems
- Department of Orthopedic Surgery, Maastricht University Medical Center, Postbox 5800, 6202 AZ, Maastricht, The Netherlands
| | - Boudewijn Brans
- Department of Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Abstract
The aim of this guideline is to provide minimum standards for the performance and interpretation of (18)F-NaF PET/CT scans. Standard acquisition and interpretation of nuclear imaging modalities will help to provide consistent data acquisition and numeric values between different platforms and institutes and to promote the use of PET/CT modality as an established diagnostic modality in routine clinical practice. This will also improve the value of scientific work and its contribution to evidence-based medicine.
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Blake GM, Siddique M, Frost ML, Moore AEB, Fogelman I. Imaging of site specific bone turnover in osteoporosis using positron emission tomography. Curr Osteoporos Rep 2014; 12:475-85. [PMID: 25168931 DOI: 10.1007/s11914-014-0231-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The functional imaging technique of dynamic fluorine-18 labeled sodium fluoride positron emission tomography ((18)F-NaF PET) allows the quantitative assessment of regional bone formation by measuring the plasma clearance of fluoride to bone at any site in the skeleton. (18)F-NaF PET provides a novel and noninvasive method of studying site-specific bone formation at the hip and spine, as well as areas of pure cortical or trabecular bone. The technique complements conventional measurements of bone turnover using biochemical markers and bone biopsy as a tool to investigate new treatments for osteoporosis, and holds promise of a future role as an early biomarker of treatment efficacy in clinical trials. This article reviews methods of acquiring and analyzing (18)F-NaF PET scan data, and outlines a simplified approach that uses 5-minute static PET scan images combined with venous blood samples to estimate (18)F-NaF plasma clearance at multiple sites in the skeleton with a single injection of tracer.
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Affiliation(s)
- Glen M Blake
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, SE1 9RT, UK,
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27
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Win AZ, Aparici CM. Factors Affecting Uptake of NaF-18 by the Normal Skeleton. J Clin Med Res 2014; 6:435-42. [PMID: 25247017 PMCID: PMC4169085 DOI: 10.14740/jocmr1901w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2014] [Indexed: 11/17/2022] Open
Abstract
Background The primary aim of this study was to examine if factors such as renal function, height, weight and age could affect the uptake of sodium fluoride-18 (NaF-18) by the normal bone. This is the first study to examine the possible factors that can influence NaF-18 uptake in the normal bone. Methods A retrospective study was done on NaF-18 PET/CT bone scans from January 2010 to May 2012 at our institution. All NaF-18 PET/CT studies used the same clinical protocol. Our excluding criteria were patients with abnormal renal function and patients with past history of cancer and metabolic bone diseases. Spearman’s correlation was used to analyze the data. Results From our study (n = 11 patients), no correlation was found between SUVmax and serum creatinine and between SUVmax and age. However, significant correlations were found between SUVmax and height (cm) and between SUVmax and weight (kg) for thoracic 5, 7, 12 and lumbar 2 vertebral levels. Conclusion Based on our findings, SUVmax values in NaF-18 PET/CT bone scans can vary depending on the patient’s height, weight and bone region. This information can be helpful in diagnosing and monitoring bone pathologies and can help explain the clinical findings.
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Affiliation(s)
- Aung Zaw Win
- Department of Radiology, San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
| | - Carina Mari Aparici
- Department of Radiology, University California San Francisco (UCSF), 500 Parnassus Ave, San Francisco, CA 94143, USA
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Tower RJ, Campbell GM, Müller M, Will O, Glüer CC, Tiwari S. Binding kinetics of a fluorescently labeled bisphosphonate as a tool for dynamic monitoring of bone mineral deposition in vivo. J Bone Miner Res 2014; 29:1993-2003. [PMID: 24644087 DOI: 10.1002/jbmr.2224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 02/07/2014] [Accepted: 02/18/2014] [Indexed: 12/20/2022]
Abstract
Bone mineral deposition during the modeling of new bone and remodeling of old bone can be perturbed by several pathological conditions, including osteoporosis and skeletal metastases. A site-specific marker depicting the dynamics of bone mineral deposition would provide insight into skeletal disease location and severity, and prove useful in evaluating the efficacy of pharmacological interventions. Fluorescent labels may combine advantages of both radioisotope imaging and detailed microscopic analyses. The purpose of this study was to determine if the fluorescent bisphosphonate OsteoSense could detect localized changes in bone mineral deposition in established mouse models of accelerated bone loss (ovariectomy) (OVX) and anabolic bone gain resulting from parathyroid hormone (PTH) treatment. We hypothesized that the early rate of binding, as well as the total amount of bisphosphonate, which binds over long periods of time, could be useful in evaluating changes in bone metabolism. Evaluation of the kinetic uptake of bisphosphonates revealed a significant reduction in both the rate constant and plateau binding after OVX, whereas treatment with PTH resulted in a 36-fold increase in the bisphosphonate binding rate constant compared with untreated OVX controls. Localization of bisphosphonate binding revealed initial binding at sites of ossification adjacent to the growth plate and, to a lesser extent, along more distal trabecular and cortical elements. Micro-computed tomography (CT) was used to confirm that initial bisphosphonate binding is localized to sites of low tissue mineral density, associated with new bone mineral deposition. Our results suggest monitoring binding kinetics based on fluorescently labeled bisphosphonates represents a highly sensitive, site-specific method for monitoring changes in bone mineral deposition with the potential for translation into human applications in osteoporosis and bone metastatic processes and their treatment.
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Affiliation(s)
- Robert J Tower
- Section Biomedical Imaging, Department of Diagnostic Radiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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29
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Abstract
Imaging plays a central role in the detection, diagnosis, staging, and follow-up of prostate carcinoma. This article discusses the role of multiple imaging modalities in the diagnosis and staging of prostate cancer, with attention to imaging features of localized and metastatic disease, imaging adjuncts to improve prostate biopsy, and potential imaging biomarkers. In addition, the role of imaging in the management of prostate cancer, with emphasis on surveillance, evaluation of response to new therapies, and detection of recurrent disease is described. Lastly, future directions in prostate cancer imaging are presented.
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Frost ML, Compston JE, Goldsmith D, Moore AE, Blake GM, Siddique M, Skingle L, Fogelman I. (18)F-fluoride positron emission tomography measurements of regional bone formation in hemodialysis patients with suspected adynamic bone disease. Calcif Tissue Int 2013; 93:436-47. [PMID: 23995764 PMCID: PMC3824308 DOI: 10.1007/s00223-013-9778-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 07/25/2013] [Indexed: 01/10/2023]
Abstract
(18)F-fluoride positron emission tomography ((18)F-PET) allows the assessment of regional bone formation and could have a role in the diagnosis of adynamic bone disease (ABD) in patients with chronic kidney disease (CKD). The purpose of this study was to examine bone formation at multiple sites of the skeleton in hemodialysis patients (CKD5D) and assess the correlation with bone biopsy. Seven CKD5D patients with suspected ABD and 12 osteoporotic postmenopausal women underwent an (18)F-PET scan, and bone plasma clearance, K i, was measured at ten skeletal regions of interest (ROI). Fifteen subjects had a transiliac bone biopsy following double tetracycline labeling. Two CKD5D patients had ABD confirmed by biopsy. There was significant heterogeneity in K i between skeletal sites, ranging from 0.008 at the forearm to 0.028 mL/min/mL at the spine in the CKD5D group. There were no significant differences in K i between the two study groups or between the two subjects with ABD and the other CKD5D subjects at any skeletal ROI. Five biopsies from the CKD5D patients had single tetracycline labels only, including the two with ABD. Using an imputed value of 0.3 μm/day for mineral apposition rate (MAR) for biopsies with single labels, no significant correlations were observed between lumbar spine K i corrected for BMAD (K i/BMAD) and bone formation rate (BFR/BS), or MAR. When biopsies with single labels were excluded, a significant correlation was observed between K i/BMAD and MAR (r = 0.81, p = 0.008) but not BFR/BS. Further studies are required to establish the sensitivity of (18)F-PET as a diagnostic tool for identifying CKD patients with ABD.
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Affiliation(s)
- Michelle L Frost
- Osteoporosis Unit, Division of Imaging Sciences and Biomedical Engineering, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK,
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Frost ML, Moore AE, Siddique M, Blake GM, Laurent D, Borah B, Schramm U, Valentin MA, Pellas TC, Marsden PK, Schleyer PJ, Fogelman I. ¹⁸F-fluoride PET as a noninvasive imaging biomarker for determining treatment efficacy of bone active agents at the hip: a prospective, randomized, controlled clinical study. J Bone Miner Res 2013; 28:1337-47. [PMID: 23322666 DOI: 10.1002/jbmr.1862] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 12/19/2012] [Accepted: 12/27/2012] [Indexed: 11/12/2022]
Abstract
The functional imaging technique of ¹⁸F-fluoride positron emission tomography (¹⁸F-PET) allows the noninvasive quantitative assessment of regional bone formation at any skeletal site, including the spine and hip. The aim of this study was to determine if ¹⁸F-PET can be used as an early biomarker of treatment efficacy at the hip. Twenty-seven treatment-naive postmenopausal women with osteopenia were randomized to receive teriparatide and calcium and vitamin D (TPT group, n = 13) or calcium and vitamin D only (control group, n = 14). Subjects in the TPT group were treated with 20 µg/day teriparatide for 12 weeks. ¹⁸F-PET scans of the proximal femur, pelvis, and lumbar spine were performed at baseline and 12 weeks. The plasma clearance of ¹⁸F-fluoride to bone, K(i), a validated measurement of bone formation, was measured at four regions of the hip, lumbar spine, and pelvis. A significant increase in K(i) was observed at all regions of interest (ROIs), including the total hip (+27%, p = 0.002), femoral neck (+25%, p = 0.040), hip trabecular ROI (+21%, p = 0.017), and hip cortical ROI (+51%, p = 0.001) in the TPT group. Significant increases in K(i) in response to TPT were also observed at the lumbar spine (+18%, p = 0.001) and pelvis (+42%, p = 0.001). No significant changes in K(i) were observed for the control group. Changes in BMD and bone turnover markers were consistent with previous trials of teriparatide. In conclusion, this is the first study to our knowledge to demonstrate that ¹⁸F-PET can be used as an imaging biomarker for determining treatment efficacy at the hip as early as 12 weeks after initiation of therapy.
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Affiliation(s)
- Michelle L Frost
- Osteoporosis Screening and Research Unit, King's College London, King's Health Partners, Guy's Campus, London, United Kingdom.
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Fogelman I, Blake GM, Cook GJR. The isotope bone scan: we can do better. Eur J Nucl Med Mol Imaging 2013; 40:1139-40. [PMID: 23674209 DOI: 10.1007/s00259-013-2439-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
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Suenaga H, Yokoyama M, Yamaguchi K, Sasaki K. Time course of bone metabolism at the residual ridge beneath dentures observed using ¹⁸F-fluoride positron emission computerized-tomography/computed tomography (PET/CT). Ann Nucl Med 2012; 26:817-22. [PMID: 22903818 PMCID: PMC3524501 DOI: 10.1007/s12149-012-0648-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 07/31/2012] [Indexed: 11/29/2022]
Abstract
Objective Excessive pressure due to wearing mal-adapting dentures is well known to cause residual bone resorption beneath the denture. X-rays have been commonly utilized to evaluate the changes in the bone beneath the denture. However, X-ray images merely detect bone density and relatively large changes in the bone shape and structure, whereas nuclear medicine imaging can detect functional changes, which occur prior to structural changes. This article aimed to describe the time course of the bone metabolism at the residual ridge beneath the denture following denture use by 18F-fluoride positron emission computerized-tomography (PET)/computed tomography (CT) scanning. Methods Three subjects, who had a free-end edentulous mandible, were treated with a denture replacing the edentulous region of the dental arch. The metabolic changes in the residual bone beneath the denture were assessed by 18F-fluoride PET/CT imaging. 18F-fluoride PET/CT scanning was performed at baseline, and 4–6 and 13 weeks after denture use. A volume of interest (VOI) was placed on their mandibles at the edentulous region beneath the denture on the PET/CT image. CT value and mean standardized uptake value (SUV) of the VOI were calculated. The difference in the time variation between the CT value and SUV was analyzed. Results The adaptation of the denture base to the residual ridge was successful, and there was no trouble such as pain at the residual ridge beneath the denture. The SUVs of each VOI significantly increased at 4–6 weeks after denture use and then decreased at 13 weeks in all three subjects (P < 0.05; two-way ANOVA, Dunnett test). On the other hand, the CT images showed no obvious changes in the bone shape or structure beneath the dentures, and the CT values of each VOI remained static after denture use in all three subjects. Conclusions This study indicates that in the present first-time removable partial denture (RPD) users, wearing of a well-adapted RPD initially increased bone metabolism beneath the denture and then decreased it at around 13 weeks after RPD use without any bone structural changes detectable by clinical X-rays. These metabolic changes are a mechanobiological reaction to the pressure induced by RPD use.
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Affiliation(s)
- Hanako Suenaga
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
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A semipopulation input function for quantifying static and dynamic 18F-fluoride PET scans. Nucl Med Commun 2012; 33:881-8. [DOI: 10.1097/mnm.0b013e3283550275] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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Blake GM, Siddique M, Frost ML, Moore AEB, Fogelman I. Quantitative PET Imaging Using (18)F Sodium Fluoride in the Assessment of Metabolic Bone Diseases and the Monitoring of Their Response to Therapy. PET Clin 2012; 7:275-91. [PMID: 27157458 DOI: 10.1016/j.cpet.2012.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Studies of bone remodeling using bone biopsy and biochemical markers of bone turnover measured in serum and urine are important for investigating how new treatments for osteoporosis affect bone metabolism. Positron emission tomography with (18)F sodium fluoride ((18)F NaF PET) for studying bone metabolism complements these conventional methods. Unlike biochemical markers, which measure the integrated response to treatment across the whole skeleton, (18)F NaF PET can distinguish changes occurring at sites of clinically important osteoporotic fractures. Future studies using (18)F NaF PET may illuminate current clinical problems, such as the possible association between long-term treatment with bisphosphonates and atypical fractures of the femur.
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Affiliation(s)
- Glen M Blake
- Osteoporosis Unit, King's College London, King's Health Partners, Guy's Hospital, London SE1 9RT, UK
| | - Musib Siddique
- Osteoporosis Unit, King's College London, King's Health Partners, Guy's Hospital, London SE1 9RT, UK
| | - Michelle L Frost
- Osteoporosis Unit, King's College London, King's Health Partners, Guy's Hospital, London SE1 9RT, UK
| | - Amelia E B Moore
- Osteoporosis Unit, King's College London, King's Health Partners, Guy's Hospital, London SE1 9RT, UK
| | - Ignac Fogelman
- Department of Nuclear Medicine, King's College London, King's Health Partners, Guy's Hospital, London SE1 9RT, UK
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