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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.
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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.
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Menezes ME, Das SK, Minn I, Emdad L, Wang XY, Sarkar D, Pomper MG, Fisher PB. Detecting Tumor Metastases: The Road to Therapy Starts Here. Adv Cancer Res 2016; 132:1-44. [PMID: 27613128 DOI: 10.1016/bs.acr.2016.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Metastasis is the complex process by which primary tumor cells migrate and establish secondary tumors in an adjacent or distant location in the body. Early detection of metastatic disease and effective therapeutic options for targeting these detected metastases remain impediments to effectively treating patients with advanced cancers. If metastatic lesions are identified early, patients might maximally benefit from effective early therapeutic interventions. Further, monitoring patients whose primary tumors are effectively treated for potential metastatic disease onset is also highly valuable. Finally, patients with metastatic disease can be monitored for efficacy of specific therapeutic interventions through effective metastatic detection techniques. Thus, being able to detect and visualize metastatic lesions is key and provides potential to greatly improve overall patient outcomes. In order to achieve these objectives, researchers have endeavored to mechanistically define the steps involved in the metastatic process as well as ways to effectively detect metastatic progression. We presently overview various preclinical and clinical in vitro and in vivo assays developed to more efficiently detect tumor metastases, which provides the foundation for developing more effective therapies for this invariably fatal component of the cancerous process.
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Affiliation(s)
- M E Menezes
- Virginia Commonwealth University, School of Medicine, Richmond, VA, United States
| | - S K Das
- Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Institute of Molecular Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Massey Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States
| | - I Minn
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - L Emdad
- Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Institute of Molecular Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Massey Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States
| | - X-Y Wang
- Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Institute of Molecular Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Massey Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States
| | - D Sarkar
- Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Institute of Molecular Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Massey Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States
| | - M G Pomper
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - P B Fisher
- Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Institute of Molecular Medicine, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States; VCU Massey Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States.
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Schramm G, Maus J, Hofheinz F, Petr J, Lougovski A, Beuthien‐Baumann B, Oehme L, Platzek I, Hoff J. Correction of quantification errors in pelvic and spinal lesions caused by ignoring higher photon attenuation of bone in [
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F]NaF PET/MR. Med Phys 2015; 42:6468-76. [DOI: 10.1118/1.4932367] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Georg Schramm
- Helmholtz‐Zentrum Dresden‐Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden 01328, Germany
| | - Jens Maus
- Helmholtz‐Zentrum Dresden‐Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden 01328, Germany
| | - Frank Hofheinz
- Helmholtz‐Zentrum Dresden‐Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden 01328, Germany
| | - Jan Petr
- Helmholtz‐Zentrum Dresden‐Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden 01328, Germany
| | - Alexandr Lougovski
- Helmholtz‐Zentrum Dresden‐Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden 01328, Germany
| | | | - Liane Oehme
- Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden 01307, Germany
| | - Ivan Platzek
- Department of Radiology, University Hospital Carl Gustav Carus, Dresden 01307, Germany
| | - Jörg Hoff
- Helmholtz‐Zentrum Dresden‐Rossendorf, Institute for Radiopharmaceutical Cancer Research, Dresden 01328, Germany and Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden 01307, Germany
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Contemporary approaches for imaging skeletal metastasis. Bone Res 2015; 3:15024. [PMID: 26273541 PMCID: PMC4502405 DOI: 10.1038/boneres.2015.24] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/23/2015] [Indexed: 01/13/2023] Open
Abstract
The skeleton is a common site of cancer metastasis. Notably high incidences of bone lesions are found for breast, prostate, and renal carcinoma. Malignant bone tumors result in significant patient morbidity. Identification of these lesions is a critical step to accurately stratify patients, guide treatment course, monitor disease progression, and evaluate response to therapy. Diagnosis of cancer in the skeleton typically relies on indirect bone-targeted radiotracer uptake at sites of active bone remodeling. In this manuscript, we discuss established and emerging tools and techniques for detection of bone lesions, quantification of skeletal tumor burden, and current clinical challenges.
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