Usmani Sharjeel, Marafi Fahad, Esmail Abdulredha, Ahmed Najeeb
aDepartment of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Khaitan, Kuwait bDepartment of Nuclear Medicine, Jack Brignall PET/CT Centre, Castle Hill Hosptial, Cottingham, UK.
Nucl Med Commun. 2017 Dec;38(12):1067-1075. doi: 10.1097/MNM.0000000000000759.
The quality of conventional bone scintigraphy can be poor in patients with end-stage renal disease (ESRD). Fluorine-18-sodium fluoride (F-NaF) PET-computed tomography (CT) has rapid single-pass extraction, fast clearance from the soft tissues and a better target to background ratio. The aim of the present study is to preliminarily assess the superior tracer kinetics of F-NaF in ESRD patients.
A cohort comprising of 13 patients with ESRD (mean age 65.5 years; median age 68.5 years; six men and seven women) and a control group of 20 patients with normal renal function (mean age 64±7.7 years, nine men and 11 women) were analyzed qualitatively and quantitatively. Both sets of patients were referred for osseous staging of malignancy. All patients underwent a PET-CT scan after an injection of 0.06 mCi/kg of F-NaF.
Qualitative analysis of the ESRD and the control group did not show a significant difference. The signal to noise ratio in the ESRD group (26.24±10.5) and the control group was similar (22.06±10.9), P=0.35. The extraction of radiotracer in bone was higher in ESRD with a bone to soft tissue index of 4.03±2.2 versus 2.48±1.0 in control patients (P=0.01). F-NaF PET-CT was positive for bone metastases in three patients and negative in 10 patients. Of the 48 total lesions, 34 (71%) were classified as benign on F-NaF PET-CT, whereas 10 (21%) were classified as malignant and four (8%) were classified as equivocal. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of F-NaF PET-CT were 91, 89.5, 90, 71.4, and 89.7%, respectively (P<0.001).
The image quality of F-NaF PET-CT in patients with ESRD was comparable to imaging in patients with normal renal function. This can potentially translate into better diagnostic performance in patients with ESRD.
终末期肾病（ESRD）患者的传统骨闪烁显像质量可能较差。氟-18-氟化钠（F-NaF）正电子发射断层扫描-计算机断层扫描（PET-CT）具有快速单次摄取、从软组织快速清除以及更好的靶本底比。本研究的目的是初步评估F-NaF在ESRD患者中更优的示踪剂动力学。
对13例ESRD患者（平均年龄65.5岁；中位年龄68.5岁；6名男性和7名女性）和20例肾功能正常的对照组患者（平均年龄64±7.7岁，9名男性和11名女性）进行定性和定量分析。两组患者均因恶性肿瘤的骨分期就诊。所有患者在注射0.06 mCi/kg的F-NaF后接受PET-CT扫描。
ESRD组和对照组的定性分析未显示出显著差异。ESRD组（26.24±10.5）和对照组的信噪比相似（22.06±10.9），P = 0.35。ESRD患者骨中放射性示踪剂的摄取更高，骨与软组织指数为4.03±2.2，而对照患者为2.48±1.0（P = 0.01）。F-NaF PET-CT在3例患者中显示骨转移阳性，10例患者中显示阴性。在总共48个病变中，34个（71%）在F-NaF PET-CT上被分类为良性，而10个（21%）被分类为恶性，4个（8%）被分类为可疑。F-NaF PET-CT的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为91%、89.5%、90%、71.4%和89.7%（P<0.001）。
ESRD患者的F-NaF PET-CT图像质量与肾功能正常患者的成像相当。这可能会转化为ESRD患者更好的诊断性能。
