1
|
Sheppard AJ, Paravastu SS, Farhadi F, Donnelly E, Hartley IR, Gafni RI, Saboury B, Collins MT, Roszko KL. Structural and molecular imaging-based characterization of soft tissue and vascular calcification in hyperphosphatemic familial tumoral calcinosis. J Bone Miner Res 2024; 39:1327-1339. [PMID: 39046425 PMCID: PMC11371904 DOI: 10.1093/jbmr/zjae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/16/2024] [Accepted: 07/23/2024] [Indexed: 07/25/2024]
Abstract
Hyperphosphatemic familial tumoral calcinosis (HFTC) is a rare disorder caused by deficient FGF23 signaling and resultant ectopic calcification. Here, we systematically characterized and quantified macro- and micro-calcification in a HFTC cohort using CT and 18F-sodium fluoride PET/CT (18F-NaF PET/CT). Fourier-transform infrared (FTIR) spectroscopy was performed on 4 phenotypically different calcifications from a patient with HFTC, showing the dominant component to be hydroxyapatite. Eleven patients with HFTC were studied with CT and/or 18F-NaF PET/CT. Qualitative review was done to describe the spectrum of imaging findings on both modalities. CT-based measures of volume (eg, total calcific burden and lesion volume) and density (Hounsfield units) were quantified and compared to PET-based measures of mineralization activity (eg, mean standardized uptake values-SUVs). Microcalcification scores were calculated for the vasculature of 6 patients using 18F-NaF PET/CT and visualized on a standardized vascular atlas. Ectopic calcifications were present in 82% of patients, predominantly near joints and the distal extremities. Considerable heterogeneity was observed in total calcific burden per patient (823.0 ± 670.1 cm3, n = 9) and lesion volume (282.5 ± 414.8 cm3, n = 27). The largest lesions were found at the hips and shoulders. 18F-NaF PET offered the ability to differentiate active vs quiescent calcifications. Calcifications were also noted in multiple anatomic locations, including brain parenchyma (50%). Vascular calcification was seen in the abdominal aorta, carotid, and coronaries in 50%, 73%, and 50%, respectively. 18F-NaF-avid, but CT-negative calcification was seen in a 17-year-old patient, implicating early onset vascular calcification. This first systematic assessment of calcifications in a cohort of patients with HFTC has identified the early onset, prevalence, and extent of calcification. It supports 18F-NaF PET/CT as a clinical tool for distinguishing between active and inactive calcification, informing disease progression, and quantification of ectopic and vascular disease burden.
Collapse
MESH Headings
- Humans
- Calcinosis/diagnostic imaging
- Calcinosis/pathology
- Calcinosis/genetics
- Female
- Male
- Hyperphosphatemia/diagnostic imaging
- Hyperphosphatemia/pathology
- Hyperphosphatemia/complications
- Hyperphosphatemia/genetics
- Adult
- Positron Emission Tomography Computed Tomography
- Vascular Calcification/diagnostic imaging
- Vascular Calcification/pathology
- Vascular Calcification/metabolism
- Middle Aged
- Fibroblast Growth Factor-23
- Adolescent
- Child
- Molecular Imaging/methods
- Hyperostosis, Cortical, Congenital/diagnostic imaging
- Hyperostosis, Cortical, Congenital/genetics
- Hyperostosis, Cortical, Congenital/pathology
- Hyperostosis, Cortical, Congenital/complications
- Hyperostosis, Cortical, Congenital/metabolism
- Sodium Fluoride
- Young Adult
Collapse
Affiliation(s)
- Aaron J Sheppard
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD 20892, United States
- School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, United States
| | - Sriram S Paravastu
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD 20892, United States
- University of Missouri - Kansas City School of Medicine, Kansas City, MO 64108, United States
| | - Faraz Farhadi
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD 20892, United States
- Geisel School of Medicine, Dartmouth, Hanover, NH 03755, United States
- Institute of Nuclear Medicine, Bethesda, MD 20892, United States
| | - Eve Donnelly
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY 14853, United States
| | - Iris R Hartley
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD 20892, United States
| | - Rachel I Gafni
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD 20892, United States
| | - Babak Saboury
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD 20892, United States
- Institute of Nuclear Medicine, Bethesda, MD 20892, United States
| | - Michael T Collins
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD 20892, United States
| | - Kelly L Roszko
- National Institute of Dental and Craniofacial Research, NIH, Bethesda, MD 20892, United States
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Mostert JM, Dur NB, Li X, Ellermann JM, Hemke R, Hales L, Mazzoli V, Kogan F, Griffith JF, Oei EH, van der Heijden RA. Advanced Magnetic Resonance Imaging and Molecular Imaging of the Painful Knee. Semin Musculoskelet Radiol 2023; 27:618-631. [PMID: 37935208 PMCID: PMC10629992 DOI: 10.1055/s-0043-1775741] [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] [Indexed: 11/09/2023]
Abstract
Chronic knee pain is a common condition. Causes of knee pain include trauma, inflammation, and degeneration, but in many patients the pathophysiology remains unknown. Recent developments in advanced magnetic resonance imaging (MRI) techniques and molecular imaging facilitate more in-depth research focused on the pathophysiology of chronic musculoskeletal pain and more specifically inflammation. The forthcoming new insights can help develop better targeted treatment, and some imaging techniques may even serve as imaging biomarkers for predicting and assessing treatment response in the future. This review highlights the latest developments in perfusion MRI, diffusion MRI, and molecular imaging with positron emission tomography/MRI and their application in the painful knee. The primary focus is synovial inflammation, also known as synovitis. Bone perfusion and bone metabolism are also addressed.
Collapse
Affiliation(s)
- Jacob M. Mostert
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niels B.J. Dur
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xiufeng Li
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Jutta M. Ellermann
- Department of Radiology, Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, Minnesota
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurel Hales
- Department of Radiology, Stanford University, Stanford, California
| | | | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California
| | - James F. Griffith
- Department of Imaging and Interventional Radiology Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rianne A. van der Heijden
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
4
|
Assiri R, Knapp K, Fulford J, Chen J. Correlation of the quantitative methods for the measurement of bone uptake and plasma clearance of 18F-NaF using positron emission tomography. Systematic review and meta-analysis. Eur J Radiol 2021; 146:110081. [PMID: 34911006 DOI: 10.1016/j.ejrad.2021.110081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 11/16/2021] [Accepted: 11/27/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE 18F-NaF PET is valuable for detecting bone metabolism through osteoblastic activity in the assessment of bone disease. Hawkins, Patlak, and standardised uptake value (SUV) are the most common quantitative measurements used to evaluate bone metabolism. This systematic review evaluates the correlation between quantitative positron emission tomography (PET) methods and to compare their precision. METHODS A systematic search in Medline, PubMed, SCOPUS, and Web of Science was undertaken to find relevant papers published from 2000. All studies with human adults undergoing 18F-NaF PET, PET/CT, or PET/MRI were included except for subjects diagnosed with non-diffuse metabolic bone disease or malignancy. Quality Assessment Tool for Studies of Diverse Designs (QATSDD) was used to assess risk of bias. A qualitative review and meta-analysis using Hedges random-effect model was used producing summary size effects of the correlation between methods in healthy and unhealthy bone sites and assessing study heterogeneity. RESULTS 228 healthy and unhealthy participants were included across 12 studies resulted from the systematic search. One-third of studies had a moderate quality percentage while the rest had relatively high quality. The pooled correlation coefficient in meta-analysis showed a high correlation of more than 0.88 (0.71-1.05. 95 %CI) between SUV and Hawkins and more than 0.96 (0.88-1.03. 95 %CI) between Patlak and Hawkins within all subgroups, suggesting all methods yield similar results in healthy and unhealthy bone sites. SUV has the lowest precision error followed by Patlak while Hawkins method showed the highest precision error. CONCLUSION Patlak is the best within research and SUV is better within clinical practice.
Collapse
Affiliation(s)
- Rajeh Assiri
- Department of Radiological Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia.
| | - Karen Knapp
- Department of Medical Imaging, Medical School, The University of Exeter, South Cloisters, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
| | - Jon Fulford
- Medical School, The University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK.
| | - Junning Chen
- College of Engineering, Mathematics and Physical Sciences, The University of Exeter, UK.
| |
Collapse
|
5
|
Jena A, Taneja S, Rana P, Goyal N, Vaish A, Botchu R, Vaishya R. Emerging role of integrated PET-MRI in osteoarthritis. Skeletal Radiol 2021; 50:2349-2363. [PMID: 34185124 DOI: 10.1007/s00256-021-03847-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is a common degenerative disorder of the articular cartilage, which is associated with hypertrophic changes in the bone, synovial inflammation, subchondral sclerosis, and joint space narrowing (JSN). Radiography remains the first line of imaging till now. Due to the lack of soft-tissue depiction in radiography, researchers are exploring various imaging techniques to detect OA at an early stage and understand its pathophysiology to restrict its progression and discover disease-modifying agents in OA. As the OA relates to the degradation of articular cartilage and remodeling of the underlying bone, an optimal imaging tool must be sensitive to the bone and soft tissue health. In that line, many non-invasive imaging and minimally invasive techniques have been explored. Out of these, the non-invasive compositional magnetic resonance imaging (MRI) for evaluation of the integrity of articular cartilage and positron emission tomography (PET) scan with fluorodeoxyglucose (FDG) and more specific bone-seeking tracer like sodium fluoride (18F-NaF) for bone cartilage interface are some of the leading areas of ongoing work. Integrated PET-MRI system, a new hybrid modality that combines the virtues of the above two individual modalities, allows detailed imaging of the entire joint, including soft tissue cartilage and bone, and holds great potential to research complex disease processes of OA. This narrative review attempts to signify individual characteristics of MRI, PET, the fusion of these characteristics in PET-MRI, and the ongoing research on PET-MRI as a potential tool to understand the pathophysiology of OA.
Collapse
Affiliation(s)
- Amarnath Jena
- PET SUITE (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Sangeeta Taneja
- PET SUITE (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Prerana Rana
- PET SUITE (Indraprastha Apollo Hospitals and House of Diagnostics), Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India.,Apollo Hospitals Education & Research Foundation, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Nidhi Goyal
- Department of Radiodiagnosis and Imaging, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK.
| | - Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi, 110076, India
| |
Collapse
|
6
|
Identifying Musculoskeletal Pain Generators Using Molecular Imaging. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
7
|
Yoon D, Kogan F, Gold GE, Biswal S. Identifying Musculoskeletal Pain Generators Using Clinical PET. Semin Musculoskelet Radiol 2020; 24:441-450. [DOI: 10.1055/s-0040-1713607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractIdentifying the source of a person's pain is a significant clinical challenge because the physical sensation of pain is believed to be subjective and difficult to quantify. The experience of pain is not only modulated by the individual's threshold to painful stimuli but also a product of the person's affective contributions, such as fear, anxiety, and previous experiences. Perhaps then to quantify pain is to examine the degree of nociception and pro-nociceptive inflammation, that is, the extent of cellular, chemical, and molecular changes that occur in pain-generating processes. Measuring changes in the local density of receptors, ion channels, mediators, and inflammatory/immune cells that are involved in the painful phenotype using targeted, highly sensitive, and specific positron emission tomography (PET) radiotracers is therefore a promising approach toward objectively identifying peripheral pain generators. Although several preclinical radiotracer candidates are being developed, a growing number of ongoing clinical PET imaging approaches can measure the degree of target concentration and thus serve as a readout for sites of pain generation. Further, when PET is combined with the spatial and contrast resolution afforded by magnetic resonance imaging, nuclear medicine physicians and radiologists can potentially identify pain drivers with greater accuracy and confidence. Clinical PET imaging approaches with fluorine-18 fluorodeoxyglucose, fluorine-18 sodium fluoride, and sigma-1 receptor PET radioligand and translocator protein radioligands to isolate the source of pain are described here.
Collapse
Affiliation(s)
- Daehyun Yoon
- Division of Musculoskeletal Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Feliks Kogan
- Division of Musculoskeletal Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Garry E. Gold
- Division of Musculoskeletal Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Sandip Biswal
- Division of Musculoskeletal Radiology, Department of Radiology, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
8
|
Zhang V, Koa B, Borja AJ, Padmanhabhan S, Bhattaru A, Raynor WY, Rojulpote C, Seraj SM, Werner TJ, Rajapakse C, Alavi A, Revheim ME. Diagnosis and Monitoring of Osteoporosis with Total-Body 18F-Sodium Fluoride-PET/CT. PET Clin 2020; 15:487-496. [PMID: 32768370 DOI: 10.1016/j.cpet.2020.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In recent years, 18F-Sodium Fluoride (NaF)-PET/CT has seen its role in the detection and management of osteoporosis increase. This article reviews the extent of this application in the literature, its efficacy compared with other comparable imaging tools, and how total-body PET/CT combined with global disease assessment can revolutionize measurement of total osteoporotic disease activity. NaF-PET/CT eventually can be the modality of choice for metabolic bone disorders, especially with these advances in technology and computation.
Collapse
Affiliation(s)
- Vincent Zhang
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin Koa
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sayuri Padmanhabhan
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abhijit Bhattaru
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Drexel University College of Medicine, Philadelphia, PA, USA
| | - Chaitanya Rojulpote
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | | | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Chamith Rajapakse
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Kogan F, Broski SM, Yoon D, Gold GE. Applications of PET-MRI in musculoskeletal disease. J Magn Reson Imaging 2019; 48:27-47. [PMID: 29969193 DOI: 10.1002/jmri.26183] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/19/2018] [Indexed: 12/26/2022] Open
Abstract
New integrated PET-MRI systems potentially provide a complete imaging modality for diagnosis and evaluation of musculoskeletal disease. MRI is able to provide excellent high-resolution morphologic information with multiple contrast mechanisms that has made it the imaging modality of choice in evaluation of many musculoskeletal disorders. PET offers incomparable abilities to provide quantitative information about molecular and physiologic changes that often precede structural and biochemical changes. In combination, hybrid PET-MRI can enhance imaging of musculoskeletal disorders through early detection of disease as well as improved diagnostic sensitivity and specificity. The purpose of this article is to review emerging applications of PET-MRI in musculoskeletal disease. Both clinical applications of malignant musculoskeletal disease as well as new opportunities to incorporate the molecular capabilities of nuclear imaging into studies of nononcologic musculoskeletal disease are discussed. Lastly, we discuss some of the technical considerations and challenges of PET-MRI as they specifically relate to musculoskeletal disease. LEVEL OF EVIDENCE 5 TECHNICAL EFFICACY: Stage 3 J. Magn. Reson. Imaging 2018;48:27-47.
Collapse
Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | | | - Daehyun Yoon
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA.,Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| |
Collapse
|
10
|
Haddock B, Fan AP, Uhlrich SD, Jørgensen NR, Suetta C, Gold GE, Kogan F. Assessment of acute bone loading in humans using [ 18F]NaF PET/MRI. Eur J Nucl Med Mol Imaging 2019; 46:2452-2463. [PMID: 31385012 PMCID: PMC6813760 DOI: 10.1007/s00259-019-04424-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/02/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The acute effect of loading on bone tissue and physiology can offer important information with regard to joint function in diseases such as osteoarthritis. Imaging studies using [18F]-sodium fluoride ([18F]NaF) have found changes in tracer kinetics in animals after subjecting bones to strain, indicating an acute physiological response. The aim of this study is to measure acute changes in NaF uptake in human bone due to exercise-induced loading. METHODS Twelve healthy subjects underwent two consecutive 50-min [18F]NaF PET/MRI examinations of the knees, one baseline followed by one post-exercise scan. Quantification of tracer kinetics was performed using an image-derived input function from the popliteal artery. For both scans, kinetic parameters of KiNLR, K1, k2, k3, and blood volume were mapped parametrically using nonlinear regression with the Hawkins model. The kinetic parameters along with mean SUV and SUVmax were compared between the pre- and post-exercise examinations. Differences in response to exercise were analysed between bone tissue types (subchondral, cortical, and trabecular bone) and between regional subsections of knee subchondral bone. RESULTS Exercise induced a significant (p < <0.001) increase in [18F]NaF uptake in all bone tissues in both knees, with mean SUV increases ranging from 47% in trabecular bone tissue to 131% in subchondral bone tissue. Kinetic parameters involving vascularization (K1 and blood volume) increased, whereas the NaF extraction fraction [k3/(k2 + k3)] was reduced. CONCLUSIONS Bone loading induces an acute response in bone physiology as quantified by [18F]NaF PET kinetics. Dynamic imaging after bone loading using [18F]NaF PET is a promising diagnostic tool in bone physiology and imaging of biomechanics.
Collapse
Affiliation(s)
- Bryan Haddock
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Valdemar Hansens Vej 3-13, 2600, Glostrup, Denmark.
| | - Audrey P Fan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Scott D Uhlrich
- Department of Mechanical Engineering, Stanford University, Stanford, CA, USA
| | - Niklas R Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, København, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Suetta
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Valdemar Hansens Vej 3-13, 2600, Glostrup, Denmark.,Geriatric Research Unit, Bispebjerg-Frederiksberg and Herlev-Gentofte Hospitals, Copenhagen University Hospital, København, Denmark
| | - Garry Evan Gold
- Department of Radiology, Stanford University, Stanford, CA, USA.,Department of Bioengineering, Stanford University, Stanford, CA, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, CA, USA
| |
Collapse
|
11
|
Al-Zaghal A, Ayubcha C, Kothekar E, Alavi A. Clinical Applications of Positron Emission Tomography in the Evaluation of Spine and Joint Disorders. PET Clin 2019; 14:61-69. [DOI: 10.1016/j.cpet.2018.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
12
|
Abstract
PURPOSE OF REVIEW This review article attempts to summarize the current state and applications of the hybrid imaging modality of PET-MRI to metabolic bone diseases. The advances of PET and MRI are also discussed for metabolic bone diseases as potentially applied via PET-MRI. RECENT FINDINGS Etiologies and mechanisms of metabolic bone disease can be complex where molecular changes precede structural changes. Although PET-MRI has yet to be applied directly to metabolic bone disease, possible applications exist since PET, specifically 18F-NaF PET, can quantitatively track changes in bone metabolism and is useful for assessing treatment, while MRI can give detailed information on bone water concentration, porosity, and architecture through novel techniques such as UTE and ZTE MRI. Earlier detection and further understanding of metabolic bone disease via PET and MRI could lead to better treatment and prevention. More research using this modality is needed to further understand how it can be implemented in this realm.
Collapse
Affiliation(s)
- James S Yoder
- Department of Radiology, Stanford University, 1201 Welch Rd, Stanford, CA, 94305, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, 1201 Welch Rd, Stanford, CA, 94305, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, 1201 Welch Rd, Stanford, CA, 94305, USA.
- Bioengineering, Stanford University, Stanford, CA, USA.
- Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
| |
Collapse
|
13
|
|
14
|
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.
Collapse
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
| | | |
Collapse
|
15
|
Kogan F, Fan AP, Monu U, Iagaru A, Hargreaves BA, Gold GE. Quantitative imaging of bone-cartilage interactions in ACL-injured patients with PET-MRI. Osteoarthritis Cartilage 2018; 26:790-796. [PMID: 29656143 PMCID: PMC6037170 DOI: 10.1016/j.joca.2018.04.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/10/2018] [Accepted: 04/04/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate changes in bone metabolism by positron emission tomography (PET), as well as spatial relationships between bone metabolism and magnetic resonance imaging (MRI) quantitative markers of early cartilage degradation, in anterior cruciate ligament (ACL)-reconstructed knees. DESIGN Both knees of 15 participants with unilateral reconstructed ACL tears and unaffected contralateral knees were scanned using a simultaneous 3.0T PET-MRI system following injection of 18F-sodium fluoride (18F-NaF). The maximum pixel standardized uptake value (SUVmax) in the subchondral bone and the average T2 relaxation time in cartilage were measured in each knee in eight knee compartments. We tested differences in SUVmax and cartilage T2 relaxation times between the ACL-injured knee and the contralateral control knee as well as spatial relationships between these bone and cartilage changes. RESULTS Significantly increased subchondral bone 18F-NaF SUVmax and cartilage T2 times were observed in the ACL-reconstructed knees (median [inter-quartile-range (IQR)]: 5.0 [5.8], 36.8 [3.6] ms) compared to the contralateral knees (median [IQR]: 1.9 [1.4], 34.4 [3.8] ms). A spatial relationship between the two markers was also seen. Using the contralateral knee as a control, we observed a significant correlation of r = 0.59 between the difference in subchondral bone SUVmax (between injured and contralateral knees) and the adjacent cartilage T2 (between the two knees) [P < 0.001], with a slope of 0.49 ms/a.u. This correlation and slope were higher in deep layers (r = 0.73, slope = 0.60 ms/a.u.) of cartilage compared to superficial layers (r = 0.40, slope = 0.43 ms/a.u.). CONCLUSIONS 18F-NaF PET-MR imaging enables detection of increased subchondral bone metabolism in ACL-reconstructed knees and may serve as an important marker of early osteoarthritis (OA) progression. Spatial relationships observed between early OA changes across bone and cartilage support the need to study whole-joint disease mechanisms in OA.
Collapse
Affiliation(s)
- F Kogan
- Department of Radiology, Stanford University, Stanford, CA, USA.
| | - A P Fan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - U Monu
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - A Iagaru
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - B A Hargreaves
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA; Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - G E Gold
- Department of Radiology, Stanford University, Stanford, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Lundblad H, Karlsson-Thur C, Maguire GQ, Jonsson C, Noz ME, Zeleznik MP, Weidenhielm L. Can Spatiotemporal Fluoride ( 18F -) Uptake be Used to Assess Bone Formation in the Tibia? A Longitudinal Study Using PET/CT. Clin Orthop Relat Res 2017; 475:1486-1498. [PMID: 28150226 PMCID: PMC5384929 DOI: 10.1007/s11999-017-5250-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/13/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND When a bone is broken for any reason, it is important for the orthopaedic surgeon to know how bone healing is progressing. There has been resurgence in the use of the fluoride (18F-) ion to evaluate various bone conditions. This has been made possible by availability of positron emission tomography (PET)/CT hybrid scanners together with cyclotrons. Absorbed on the bone surface from blood flow, 18F- attaches to the osteoblasts in cancellous bone and acts as a pharmacokinetic agent, which reflects the local physiologic activity of bone. This is important because it shows bone formation indicating that the bone is healing or no bone formation indicating no healing. As 18F- is extracted from blood in proportion to blood flow and bone formation, it thus enables determination of bone healing progress. QUESTIONS/PURPOSES The primary objective of this study was to determine whether videos showing the spatiotemporal uptake of 18F- via PET bone scans could show problematic bone healing in patients with complex tibia conditions. A secondary objective was to determine if semiquantification of radionuclide uptake was consistent with bone healing. METHODS This study investigated measurements of tibia bone formation in patients with complex fractures, osteomyelitis, and osteotomies treated with a Taylor Spatial FrameTM (TSF) by comparing clinical healing progress with spatiotemporal fluoride (18F-) uptake and the semiquantitative standardized uptake value (SUV). This procedure included static and dynamic image acquisition. For intrapatient volumes acquired at different times, the CT and PET data were spatially registered to bring the ends of the bones that were supposed to heal into alignment. To qualitatively observe how and where bone formation was occurring, time-sequenced volumes were reconstructed and viewed as a video. To semiquantify the uptake, the mean and maximum SUVs (SUVmean, SUVmax) were calculated for the ends of the bones that were supposed to heal and for normal bone, using a spherical volume of interest drawn on the registered volumes. To make the semiquantitative data comparable for all patients with multiple examinations, the SUVmean and SUVmax difference per day (SUVmeanDPD and SUVmaxDPD) between the first PET/CT scan and each subsequent one was calculated. Indicators of poor healing progress were (1) uneven distribution of the radionuclide uptake between ends of the bones that were supposed to heal as seen in the video or, (2) low absolute magnitude of the SUV difference data. Twenty-four patients treated between October 2013 and April 2015 with a TSF gave informed consent to be examined with 18F- PET/CT bone scans. Twenty-two patients successfully completed treatment, one of whom had only one PET/CT scan. RESULTS Observation of 18F- uptake was able to identify three patients whose healing progress was poor, indicated by uneven distribution of radionuclide uptake across the ends of the bones that were supposed to heal. An absolute magnitude of the SUVmaxDPD of 0.18 or greater indicated good bone formation progress. This was verified in 10 patients by the days between the operation to attach and to remove the TSF being less than 250 days, whereas other SUVmaxDPD values were ambiguous, with 11 patients achieving successful completion. CONCLUSIONS Observation of the spatiotemporal uptake of 18F- appears to be a promising method to enable the clinician to assess the progress of bone formation in different parts of the bone. Bone uptake which is uneven across the ends of bone that were supposed to heal or very low bone uptake might indicate impaired bone healing where early intervention may then be needed. However, semiquantification of 18F- uptake (SUVmaxDPD), SUVmeanDPD) was ambiguous in showing consistency with the bone-healing progress. LEVEL OF EVIDENCE Level III, diagnostic study.
Collapse
Affiliation(s)
- Henrik Lundblad
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Gerald Q Maguire
- School of Information and Communication Technology, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Cathrine Jonsson
- Department of Medical Physics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Marilyn E Noz
- Department of Radiology, New York University, New York, NY, USA
| | - Michael P Zeleznik
- School of Computing, College of Engineering, University of Utah, Salt Lake City, UT, USA
| | - Lars Weidenhielm
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
- Department of Molecular Medicine and Surgery, K l, Orthopedics, A2:07, 171 76, Stockholm, Sweden.
| |
Collapse
|
18
|
Kogan F, Fan AP, Gold GE. Potential of PET-MRI for imaging of non-oncologic musculoskeletal disease. Quant Imaging Med Surg 2016; 6:756-771. [PMID: 28090451 DOI: 10.21037/qims.2016.12.16] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Early detection of musculoskeletal disease leads to improved therapies and patient outcomes, and would benefit greatly from imaging at the cellular and molecular level. As it becomes clear that assessment of multiple tissues and functional processes are often necessary to study the complex pathogenesis of musculoskeletal disorders, the role of multi-modality molecular imaging becomes increasingly important. New positron emission tomography-magnetic resonance imaging (PET-MRI) systems offer to combine high-resolution MRI with simultaneous molecular information from PET to study the multifaceted processes involved in numerous musculoskeletal disorders. In this article, we aim to outline the potential clinical utility of hybrid PET-MRI to these non-oncologic musculoskeletal diseases. We summarize current applications of PET molecular imaging in osteoarthritis (OA), rheumatoid arthritis (RA), metabolic bone diseases and neuropathic peripheral pain. Advanced MRI approaches that reveal biochemical and functional information offer complementary assessment in soft tissues. Additionally, we discuss technical considerations for hybrid PET-MR imaging including MR attenuation correction, workflow, radiation dose, and quantification.
Collapse
Affiliation(s)
- Feliks Kogan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Audrey P Fan
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Garry E Gold
- Department of Radiology, Stanford University, Stanford, California, USA; Department of Bioengineering, Stanford University, Stanford, California, USA; Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| |
Collapse
|
19
|
Using PET/CT Bone Scan Dynamic Data to Evaluate Tibia Remodeling When a Taylor Spatial Frame Is Used: Short and Longer Term Differences. BIOMED RESEARCH INTERNATIONAL 2015; 2015:574705. [PMID: 26436093 PMCID: PMC4575986 DOI: 10.1155/2015/574705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/23/2015] [Indexed: 11/27/2022]
Abstract
Eighteen consecutive patients, treated with a Taylor Spatial Frame for complex tibia conditions, gave their informed consent to undergo Na18F− PET/CT bone scans. We present a Patlak-like analysis utilizing an approximated blood time-activity curve eliminating the need for blood aliquots. Additionally, standardized uptake values (SUV) derived from dynamic acquisitions were compared to this Patlak-like approach. Spherical volumes of interest (VOIs) were drawn to include broken bone, other (normal) bone, and muscle. The SUVm(t) (m = max, mean) and a series of slopes were computed as (SUVm(ti) − SUVm(tj))/(ti − tj), for pairs of time values ti and tj. A Patlak-like analysis was performed for the same time values by computing ((VOIp(ti)/VOIe(ti))−(VOIp(tj)/VOIe(tj)))/(ti − tj), where p = broken bone, other bone, and muscle and e = expected activity in a VOI. Paired comparisons between Patlak-like and SUVm slopes showed good agreement by both linear regression and correlation coefficient analysis (r = 84%, rs = 78%-SUVmax, r = 92%, and rs = 91%-SUVmean), suggesting static scans could substitute for dynamic studies. Patlak-like slope differences of 0.1 min−1 or greater between examinations and SUVmax differences of ~5 usually indicated good remodeling progress, while negative Patlak-like slope differences of −0.06 min−1 usually indicated poor remodeling progress in this cohort.
Collapse
|
20
|
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.
Collapse
|
21
|
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.
Collapse
Affiliation(s)
- Glen M Blake
- Osteoporosis Research Unit, King's College London, Guy's Campus, London, SE1 9RT, UK,
| | | | | | | | | |
Collapse
|