Department of Radiology, Division of Nuclear Medicine, Stanford University Medical Center, Stanford, CA 94305, USA.
Mol Imaging Biol. 2012 Apr;14(2):252-9. doi: 10.1007/s11307-011-0486-2.
Technetium (Tc) methylene diphosphonate (MDP) has been the standard method for bone scintigraphy for three decades. (18)F sodium fluoride ((18)F NaF) positron emission tomography (PET)/computed tomography (CT) has better resolution and is considered superior. The role of 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F FDG) PET/CT is proven in a variety of cancers, for which it has changed the practice of oncology. There are few prospective studies comparing these three methods of detection of skeletal metastases. Thus, we were prompted to initiate this prospective pilot trial.
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 ((99m)Tc) MDP bone scintigraphy, (18)F NaF PET/CT, and (18)F FDG PET/CT were subsequently performed within 1 month.
Skeletal lesions were detected by (99m)Tc MDP bone scintigraphy in 22 of 52 patients, by (18)F NaF PET/CT in 24 of 52 patients, and by (18)F FDG PET/CT in 16 of 52 patients. The image quality and evaluation of extent of disease were superior by (18)F NaF PET/CT over (99m)Tc MDP scintigraphy in all 22 patients with skeletal lesions on both scans and over (18)F FDG PET/CT in 11 of 16 patients with skeletal metastases on (18)F FDG PET/CT. In two patients, (18)F NaF PET/CT showed skeletal metastases not seen on either of the other two scans. Extraskeletal lesions were identified by (18)F FDG PET/CT in 28 of 52 subjects.
Our prospective pilot-phase trial demonstrates superior image quality and evaluation of skeletal disease extent with (18)F NaF PET/CT over (99m)Tc MDP scintigraphy and (18)F FDG PET/CT. At the same time, (18)F FDG PET detects extraskeletal disease that can significantly change disease management. As such, a combination of (18)F FDG PET/CT and (18)F NaF PET/CT may be necessary for cancer detection. Additional evaluation with larger cohorts is required to confirm these preliminary findings.
锝（Tc）亚甲基二膦酸盐（MDP）已成为骨闪烁显像三十年的标准方法。（18）F 氟化钠（（18）F NaF）正电子发射断层扫描（PET）/计算机断层扫描（CT）具有更好的分辨率，被认为更优越。2-脱氧-2-[[18]F]氟-D-葡萄糖（（18）F FDG）PET/CT 在各种癌症中的作用已得到证实，它改变了肿瘤学的实践。很少有前瞻性研究比较这三种检测骨骼转移的方法。因此，我们着手进行了这项前瞻性试点研究。
这是一项对 52 例已确诊恶性肿瘤患者进行的前瞻性研究（2007 年 9 月至 2010 年 12 月），以评估骨骼转移。其中男性 37 例，女性 15 例，年龄 19-84 岁（平均 55.6±15.9）。随后在 1 个月内进行了 99mTc MDP 骨闪烁显像、（18）F NaF PET/CT 和（18）F FDG PET/CT。
在 52 例患者中，22 例通过 99mTc MDP 骨闪烁显像、24 例通过（18）F NaF PET/CT 检测到骨骼病变，16 例通过（18）F FDG PET/CT 检测到骨骼病变。在这两种扫描中，（18）F NaF PET/CT 对所有 22 例有骨骼病变的患者的图像质量和疾病程度的评估均优于 99mTc MDP 闪烁显像，对 16 例（18）F FDG PET/CT 中有骨骼转移的患者中的 11 例也是如此。在两名患者中，（18）F NaF PET/CT 显示了在其他两种扫描中均未发现的骨骼转移。（18）F FDG PET/CT 在 52 例患者中的 28 例中发现了骨骼外病变。
我们的前瞻性试验阶段研究表明，与 99mTc MDP 闪烁显像和（18）F FDG PET/CT 相比，（18）F NaF PET/CT 具有更好的骨骼疾病程度评估的图像质量。同时，（18）F FDG PET 可检测到可显著改变疾病管理的骨骼外疾病。因此，可能需要结合（18）F FDG PET/CT 和（18）F NaF PET/CT 进行癌症检测。需要更大的队列进行进一步评估以确认这些初步发现。
