Prospective evaluation of 99mTc MDP scintigraphy, 18F NaF PET/CT, and 18F FDG PET/CT for detection of skeletal metastases

Andrei Iagaru, Erik Mittra, David W. Dick, Sanjiv Sam Gambhir

Research output: Contribution to journalArticlepeer-review

112 Scopus citations


Introduction: Technetium (Tc) methylene diphosphonate (MDP) has been the standard method for bone scintigraphy for three decades. 18F sodiumfluoride ( 18F NaF) positron emission tomography (PET)/computed tomography (CT) has better resolution and is considered superior. The role of 2-deoxy-2-[ 18F]fluoro-D-glucose ( 18F FDG) PET/CT is proven in a variety of cancers, for which it has changed the practice of oncology. There are fewprospective studies comparing these threemethods of detection of skeletal metastases. Thus, we were prompted to initiate this prospective pilot trial. Methods: This is a prospective study (Sep 2007-Dec 2010) of 52 patients with proven malignancy referred for evaluation of skeletal metastases. There were 37 men and 15 women, 19-84 years old (average, 55.6±15.9). Technetium-99m ( 99mTc) MDP bone scintigraphy, 18F NaF PET/CT, and 18F FDG PET/CT were subsequently performed within 1 month. Results: Skeletal lesions were detected by 99mTc MDP bone scintigraphy in 22 of 52 patients, by 18F NaF PET/CT in 24 of 52 patients, and by 18F FDG PET/CT in 16 of 52 patients. The image quality and evaluation of extent of disease were superior by 18F NaF PET/CT over 99mTc MDP scintigraphy in all 22 patients with skeletal lesions on both scans and over 18F FDG PET/CT in 11 of 16 patients with skeletal metastases on 18F FDG PET/CT. In two patients, 18F NaF PET/CT showed skeletal metastases not seen on either of the other two scans. Extraskeletal lesions were identified by 18F FDG PET/CT in 28 of 52 subjects. Conclusion: Our prospective pilot-phase trial demonstrates superior image quality and evaluation of skeletal disease extent with 18F NaF PET/CT over 99mTc MDP scintigraphy and 18F FDG PET/CT. At the same time, 18F FDG PET detects extraskeletal disease that can significantly change disease management. As such, a combination of 18F FDG PET/CT and 18F NaF PET/CT may be necessary for cancer detection. Additional evaluation with larger cohorts is required to confirm these preliminary findings.

Original languageEnglish (US)
Pages (from-to)252-259
Number of pages8
JournalMolecular Imaging and Biology
Issue number2
StatePublished - Apr 2012
Externally publishedYes


  • F FDG
  • F NaF
  • Malignancy
  • PET/CT
  • Tc MDP

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


Dive into the research topics of 'Prospective evaluation of <sup>99m</sup>Tc MDP scintigraphy, <sup>18</sup>F NaF PET/CT, and <sup>18</sup>F FDG PET/CT for detection of skeletal metastases'. Together they form a unique fingerprint.

Cite this