Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland.
Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland.
Bone. 2020 May;134:115267. doi: 10.1016/j.bone.2020.115267. Epub 2020 Feb 11.
The diagnosis of renal osteodystrophy is challenging. Bone biopsy is the gold standard, but it is invasive and limited to one site of the skeleton. The ability of biomarkers to estimate the underlying bone pathology is limited. F-Sodium Fluoride positron emission tomography (F-NaF PET) is a noninvasive quantitative imaging technique that allows assessment of regional bone turnover at clinically relevant sites. The hypothesis of this study was, that F-NaF PET correlates with bone histomorphometry in dialysis patients and could act as a noninvasive diagnostic tool in this patient group.
This was a cross-sectional diagnostic test study. 26 dialysis patients with biochemical abnormalities indicating mineral and bone disorder were included. All the participants underwent a F-NaF PET scan and a bone biopsy. Fluoride activity in the PET scan was measured in the lumbar spine and at the anterior iliac crest. Dynamic and static histomorphometric parameters of the bone biopsy were assessed. As histomorphometric markers for bone turnover we used bone formation rate per bone surface (BFR/BS) and activation frequency per year (Ac.f).
There was a statistically significant correlation between fluoride activity in the F-NaF PET scan and histomorphometric parameters such as bone formation rate, activation frequency and osteoclast and osteoblast surfaces and mineralized surfaces. F-NaF PET's sensitivity to recognize low turnover in respect to non-low turnover was 76% and specificity 78%. Because of the small number of patients with high turnover, we were unable to demonstrate significant predictive value in this group.
A clear correlation between histomorphometric parameters and fluoride activity in the F-NaF PET scan was established. F-NaF PET may possibly be a noninvasive diagnostic tool in dialysis patients with low turnover bone disease, but further research is needed.
肾性骨营养不良的诊断具有挑战性。骨活检是金标准，但它具有侵袭性且仅限于骨骼的一个部位。生物标志物估计潜在骨病理学的能力有限。氟- 氟[18F] 钠正电子发射断层扫描（F-NaF PET）是一种非侵入性定量成像技术，可在临床相关部位评估局部骨转换。本研究的假设是，F-NaF PET 与透析患者的骨组织形态计量学相关，并可在该患者群体中作为一种非侵入性诊断工具。
这是一项横断面诊断测试研究。纳入了 26 名生化异常表明存在矿物质和骨骼紊乱的透析患者。所有参与者均接受了 F-NaF PET 扫描和骨活检。在腰椎和髂前嵴测量 PET 扫描中的氟化物活性。评估骨活检的动态和静态组织形态计量学参数。我们将骨形成率/骨表面（BFR/BS）和每年激活频率（Ac.f）等组织形态计量学骨转换标志物用于研究。
F-NaF PET 扫描中的氟化物活性与组织形态计量学参数（如骨形成率、激活频率以及破骨细胞和成骨细胞表面和矿化表面）之间存在统计学显著相关性。F-NaF PET 识别低转换相对于非低转换的灵敏度为 76%，特异性为 78%。由于高转换患者数量较少，我们无法在该组中证明具有显著的预测价值。
建立了组织形态计量学参数与 F-NaF PET 扫描中氟化物活性之间的明确相关性。F-NaF PET 可能是低转换骨疾病透析患者的一种非侵入性诊断工具，但需要进一步研究。
