Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and whole-body MRI for detection of skeletal metastases.

Abstract

OBJECTIVE:

The aim of this study was to compare 99mTc-MDP bone scanning, 18F NaF PET/CT, 18F FDG PET/CT, and whole-body MRI (WBMRI) for detection of known osseous metastases.

PATIENTS AND METHODS:

This prospective pilot trial (September 2007-April 2009) enrolled 10 participants (5 men, 5 women, 47-81 years old) diagnosed with cancer and known osseous metastases. 18F NaF PET/CT, 18F FDG PET/CT, and WBMRI were performed within 1 month for each participant.

RESULTS:

The image quality and evaluation of extent of disease were superior by 18F NaF PET/CT compared to 99mTc-MDP scintigraphy in all patients with skeletal lesions and compared to 18F FDG PET/CT in 3 of the patients with skeletal metastases. 18F NaF PET/CT showed osseous metastases where 18F FDG PET/CT was negative in another 3 participants. Extraskeletal metastases were identified by 18F FDG PET/CT in 6 participants. WBMRI with the combination of iterative decomposition of water and fat with echo asymmetry and least-squares estimation, short tau inversion recovery, and diffusion-weighted imaging pulse sequences showed fewer lesions than 18F NaF PET/CT in 5 patients, same number of lesions in 2 patients, and more lesions in 1 patient. WBMRI showed fewer lesions than 18F FDG in 3 patients and same lesions in 6 patients.

CONCLUSIONS:

Our pilot phase prospective trial demonstrated superior image quality and evaluation of skeletal disease extent with 18F NaF PET/CT compared to 99mTc-MDP scintigraphy and 18F FDG PET/CT, as well as the feasibility of multisequence WBMRI. In addition, 18F FDG PET/CT provided valuable soft-tissue information that can change disease management. Further evaluation of these findings using the recently introduced PET/MRI scanners is warranted.

• Authors: Andrei Iagaru, Phillip Young, Erik Mittra, David W Dick, Robert Herfkens, Sanjiv Sam Gambhir
• Journal: Clinical nuclear medicine (Clin Nucl Med) Vol. 38 Issue 7 Pg. e290-6 (Jul 2013) ISSN: 1536-0229 [Electronic] United States
• PMID: 23455520 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Fluorine Radioisotopes
• Fluorodeoxyglucose F18
• Sodium Fluoride
• Technetium Tc 99m Medronate

Topics

• Aged
• Aged, 80 and over
• Bone Neoplasms (diagnostic imaging, secondary)
• Female
• Fluorine Radioisotopes
• Fluorodeoxyglucose F18
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Multimodal Imaging
• Pilot Projects
• Positron-Emission Tomography
• Prospective Studies
• Sodium Fluoride
• Technetium Tc 99m Medronate
• Tomography, X-Ray Computed
• Whole Body Imaging