From the Department of Radiology, University of Washington School of Medicine, Seattle, Wash (S.B., P.B., F.B.); Department of Radiology, VA Puget Sound Health Care System, Mail Box 358280, S-114/Radiology, 1660 S Columbian Way, Seattle, WA 98108-1597 (S.B., P.B.); and Seattle Nuclear Medicine, Seattle, Wash (D.S.W.D., D.R.H.).
Radiographics. 2014 Sep-Oct;34(5):1295-316. doi: 10.1148/rg.345130061.
The skeleton is one of the most common sites for metastatic disease, particularly from breast and prostate cancer. Bone metastases are associated with considerable morbidity, and accurate imaging of the skeleton is important in determining the appropriate therapeutic plan. Sodium fluoride labeled with fluorine 18 (sodium fluoride F 18 [(18)F-NaF]) is a positron-emitting radiopharmaceutical first introduced several decades ago for skeletal imaging. (18)F-NaF was approved for clinical use as a positron emission tomographic (PET) agent by the U.S. Food and Drug Administration in 1972. The early use of this agent was limited, given the difficulties of imaging its high-energy photons on the available gamma cameras. For skeletal imaging, it was eventually replaced by technetium 99m ((99m)Tc)-labeled agents because of the technical limitations of (18)F-NaF. During the past several years, the widespread availability and implementation of hybrid PET and computed tomographic (CT) dual-modality systems (PET/CT) have encouraged a renewed interest in (18)F-NaF PET/CT for routine clinical use in bone imaging. Because current PET/CT systems offer high sensitivity and spatial resolution, the use of (18)F-NaF has been reevaluated for the detection of malignant and nonmalignant osseous disease. Growing evidence suggests that (18)F-NaF PET/CT provides increased sensitivity and specificity in the detection of bone metastases. Furthermore, the favorable pharmacokinetics of (18)F-NaF, combined with the superior imaging characteristics of PET/CT, supports the routine clinical use of (18)F-NaF PET/CT for oncologic imaging for skeletal metastases. In this article, a review of the indications, imaging appearances, and utility of (18)F-NaF PET/CT in the evaluation of skeletal disease is provided, with an emphasis on oncologic imaging.
骨骼是转移性疾病最常见的部位之一，特别是乳腺癌和前列腺癌。骨转移与相当大的发病率有关，准确的骨骼成像对于确定适当的治疗计划非常重要。氟 18 标记的氟化钠（氟 18 标记的氟化钠 [(18)F-NaF]）是一种 20 世纪初引入的正电子发射放射性药物，用于骨骼成像。(18)F-NaF 于 1972 年由美国食品和药物管理局批准为正电子发射断层扫描（PET）药物用于临床。由于早期的伽马相机难以对其高能光子进行成像，因此该药物的早期应用受到限制。由于 (18)F-NaF 的技术限制，用于骨骼成像的最终被锝 99m（(99m)Tc）标记的药物取代。在过去的几年中，由于混合正电子发射断层扫描和计算机断层扫描（CT）双模态系统（PET/CT）的广泛应用和实施，人们对 (18)F-NaF PET/CT 在常规临床骨骼成像中的应用重新产生了兴趣。由于当前的 PET/CT 系统具有高灵敏度和空间分辨率，因此对 (18)F-NaF 在恶性和非恶性骨疾病检测中的应用进行了重新评估。越来越多的证据表明，(18)F-NaF PET/CT 在检测骨转移方面具有更高的灵敏度和特异性。此外，(18)F-NaF 的良好药代动力学特性，结合 PET/CT 的优越成像特性，支持将 (18)F-NaF PET/CT 常规用于骨骼转移的肿瘤成像。本文回顾了 (18)F-NaF PET/CT 在骨骼疾病评估中的适应证、成像表现和应用价值，重点介绍了肿瘤成像。
