Differences in sodium fluoride-18 uptake in the normal skeleton depending on the location and characteristics of the bone

Summary

Aim: The aim of this study was to evaluate the normal distribution of sodium fluoride-18 (NaF-18) and to clarify the differences in uptake according to location and the type of the bone using positron emission tomography (PET) / computed tomography (CT). Methods: We retrospectively reviewed NaF-18 PET/CT images from 30 patients with hip joint disorders. PET/CT scans were performed 40 min after injection of approximately 185 MBq of NaF-18. To evaluate the relationship between the distribution of NaF-18 uptake and bone density, we compared the maximum standardised uptake values (SUV_max) on PET and the Hounsfield Units (HUs) on CT of the lumbar vertebra, ilium, and proximal and distal femurs. Regions of interests were defined both outside and inside the cortical bone to measure whole bone and cancellous bone only, respectively. Results: The distribution of NaF-18 differed according to the skeletal site. The lumbar vertebra showed the highest SUV_max for both whole bone and cancellous bone, followed by the ilium, proximal femur, and distal femur. The bones differed significantly in SUV_max. The distal femur showed the highest HU, followed by the proximal femur, ilium, and vertebra. Profile curve analyses demonstrated that the cancellous bones showed higher SUV_max and lower HU than the cortical bones. Conclusions: Our results demonstrate the difference in NaF-18 uptake between cancellous and cortical bones, which may explain differences in uptake by location. NaF-18 uptake does not appear to be strongly correlated with bone density, but rather with bone turnover and blood flow.

Zusammenfassung

Ziel: In dieser Studie sollten mittels Positro- nen-Emissions-Tomografie (PET)/Computerto- mografie (CT) die normale Verteilung von ¹⁸F-Natriumfluorid (¹⁸F-NaF) evaluiert sowie der je nach Lokalisation und Knochentyp variable Uptake geklärt werden. Methoden: Wir prüften retrospektiv die ¹⁸F-NaF-PET/CT-Aufnahmen von 30 Patienten mit Erkrankungen des Hüftgelenks. Die PET/CT-Scans wurden 40 Minuten nach Injektion von ca. 185 MBq ¹⁸F-NaF aufgenommen. Um den Zusammenhang zwischen Verteilung des ¹⁸F-NaF-Upta- ke und Knochendichte zu beurteilen, verglichen wir bei Lendenwirbeln, Darmbein, proximalem und distalem Femur die maximalen standardisierten Aufnahmewerte (SUV_max) im PET bzw. die Hounsfield-Einheiten (HE) im CT. Bereiche von Interesse wurden sowohl außerhalb als auch innerhalb der Substantia compacta definiert, um den gesamten Knochen bzw. nur die Spongiosa zu erfassen. Ergebnisse: Die Verteilung von ¹⁸F-NaF unterschied sich je nach Skelettbereich. Die höchste SUV_max ergab sich in Lendenwirbeln, sowohl im gesamten Knochen als auch in der Spongiosa, gefolgt vom Darmbein, dem proximalen und dem distalen Femur. Die Knochen wiesen signifikante Unterschiede bei der SUV_max auf. Der distale Femur zeigte den höchsten HE-Wert, gefolgt vom proximalen Femur, dem Darmbein und den Wirbeln. Die Analyse der Profilkurven ergab für die spongiösen Anteile höhere SUV_max und niedrigere HE-Werte als für die Compacta. Schlussfolgerungen: Unsere Untersuchung ergab ein unterschiedliches ¹⁸F-NaF-Uptake für spongiöse bzw. kompakte Knochen, was die Aufnahmeunterschiede in verschiedenen Lokalisationen erklären könnte. Der ¹⁸F-NaF-Uptake scheint weniger mit der Knochendichte zu korrelieren als vielmehr mit dem Knochenumsatz und der Durchblutung.

Keywords

Sodium fluoride - NaF - PET - SUV - bone imaging

Schlüsselwörter

Natriumfluorid - NaF - PET - SUV - Knochenbildgebung

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