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

doi:10.1007/s11307-011-0486-2

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 journal › Article › peer-review

125 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	252-259
Number of pages	8
Journal	Molecular Imaging and Biology
Volume	14
Issue number	2
DOIs	https://doi.org/10.1007/s11307-011-0486-2
State	Published - Apr 2012
Externally published	Yes

Keywords

F FDG
F NaF
Malignancy
PET/CT
Tc MDP

ASJC Scopus subject areas

Oncology
Radiology Nuclear Medicine and imaging
Cancer Research

Access to Document

10.1007/s11307-011-0486-2

Cite this

@article{e1d6e88913244259b29a07e8bce3fcb0,

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

abstract = "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.",

keywords = "F FDG, F NaF, Malignancy, PET/CT, Tc MDP",

author = "Andrei Iagaru and Erik Mittra and Dick, {David W.} and Gambhir, {Sanjiv Sam}",

note = "Funding Information: Acknowledgments. This research was supported in part by NCI ICMIC CA114747 (SSG), and the clinical studies were supported in part by the Doris Duke Foundation and Canary Foundation (SSG). We would also like to thank Dr. Fred Chin in the Cyclotron Facility, Lindee Burton, and all the technologists in the Nuclear Medicine Clinic.",

year = "2012",

month = apr,

doi = "10.1007/s11307-011-0486-2",

language = "English (US)",

volume = "14",

pages = "252--259",

journal = "Molecular Imaging and Biology",

issn = "1536-1632",

publisher = "Springer New York",

number = "2",

}

TY - JOUR

T1 - Prospective evaluation of 99mTc MDP scintigraphy, 18F NaF PET/CT, and 18F FDG PET/CT for detection of skeletal metastases

AU - Iagaru, Andrei

AU - Mittra, Erik

AU - Dick, David W.

AU - Gambhir, Sanjiv Sam

N1 - Funding Information: Acknowledgments. This research was supported in part by NCI ICMIC CA114747 (SSG), and the clinical studies were supported in part by the Doris Duke Foundation and Canary Foundation (SSG). We would also like to thank Dr. Fred Chin in the Cyclotron Facility, Lindee Burton, and all the technologists in the Nuclear Medicine Clinic.

PY - 2012/4

Y1 - 2012/4

N2 - 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.

AB - 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.

KW - F FDG

KW - F NaF

KW - Malignancy

KW - PET/CT

KW - Tc MDP

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U2 - 10.1007/s11307-011-0486-2

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M3 - Article

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AN - SCOPUS:84861479889

SN - 1536-1632

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JO - Molecular Imaging and Biology

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