F-18-Fluorid-Skelettdiagnostik mit PET, PET/CT und PET/MRT

Zusammenfassung

F-18-Natriumfluorid ist ein osteotropes Radiopharmakon für die szintigrafische Darstellung des Knochenstoffwechsels. Seine FDA-Zulassung erhielt das Radiopharmakon bereits im Jahr 1972. Die Entwicklung von Tc-99m-markierten osteotropen Substanzen sowie deren bessere Verfügbarkeit drängte Natriumfluorid zunehmend in den Hintergrund. Der Molybdänengpass ist jedoch bereits einmal zu einem Problem für die konventionelle Skelettszintigrafie geworden und wird dies wohl in Zukunft wieder. Durch die Entwicklung von modernen Hybridgeräten (PET/CT, PET/MR) erlaubt die Skelettdiagnostik mit F-18-Natriumfluorid des Weiteren eine viel sensitivere und spezifische Diagnostik als die spätstatische konventionelle Skelettszintigrafie und bringt daher diesen Tracer erneut in den Vordergrund. Wir zeigen hier Indikationen, Durchführung, Datenakquisition und -auswertung sowie Befundungskonzepte der Untersuchung. Ein Vergleich von Natriumfluorid mit der konventionellen Skelettszintigrafie wird ebenfalls bei den verschiedenen Indikationen vorgenommen.

Abstract

F-18 sodium fluoride is a bone-seeking agent for the scintigrafic imaging of bone metabolism. It was approved for clinical use by the US Food- and Drug-Administration (FDA) in 1972. The development of Tc-99m-based radiotracers for bone scintigrafy and their wide availability forced PET imaging with sodium fluoride to the background. However the global molybdenum shortage emerged to a huge problem for the conventional bone scintigrafy a few years ago and, as the problem has not been solved, we will be probably facing it again in the next years. Furthermore, the development of modern hybrid scanners (PET/CT, PET/MR) allows a higher diagnostic accuracy with sodium fluoride than the conventional bone scintigrafy and that is the reason for the rising interest for this tracer. In this article we will be focusing on indications, protocols, interpretation and reporting of sodium fluoride PET and perform a comparison between PET imaging and conventional bone scanning.

Schlüsselwörter

F-18 Natriumfluorid - PET - PET/CT - PET/MRT - Skelettszintigrafie

Key words

F-18 Fluoride - PET - PET/CT - PET/MRI - bone scanning

• Literatur

• 1 Bares R. Leitlinie für die Skelettszintigraphie. Deutsche Gesellschaft für Nuklearmedizin 1999;
• 2 Beheshti M, Mottaghy FM, Payche F et al. 18F- NaF PET/CT: EANM procedure guidelines for bone imaging. Eur J Nucl Med Mol Imaging 2015; 42: 1767-1777
• 3 Beheshti M, Vail R, Walden Berger P et al. Detection of bone metastases in patients with prostate cancer by 18F-fluorocholine and 18F-fluoride PET/ CT: A comparative study. Eur J Nucl Med Mol Imaging 2008; 35: 1766-1774
• 4 Blau M, Nagler W, Bender M. Fluorine-18: A new isotope for bone scanning. J Nucl Med 1962; 3: 332-334
• 5 Chakraborty D, Bhattacharya A, Mete UK et al. Comparison of 18F-fluoride PET/CT and 99mTc-MDP bone scan in the detection of skeletal metastases in urinary bladder carcinoma. Clin Nucl Med 2013; 38: 616-621
• 6 Cook Jr G, Parker C, Chua S et al. 18F-fluoride PET: changes in uptake as a method to assess response in bone metastases from castrate-resistant prostate cancer patients treated with 223Ra-chloride (Alpharadin). EJNMMI Res 2011; 7: 4
• 7 Even-Sapir E, Metser U, Mishani E et al. The detection of bone metastases in patients with high-riskprostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multifield-of-view SPECT, 18F-fluoride PET, and 18F fluoride PET/CT. J Nucl Med 2006; 47: 287-297
• 8 Fuccio C, Spinapolice EG, Cavalli C et al. 18F-Fluoride PET/CT in the detection of bone metastases in clear cellrenal cell carcinoma: discordance with bone scintigraphy. Eur J Nucl Med Mol Imaging 2013; 40: 1930-1931
• 9 Gerety EL, Laurence EM, Wason J et al. Prospective study evaluating the relative sensitivity of 18F-NaF PET/CT for detecting skeletal metastases from renal cell carcinoma in comparison to multidetector CT and 99mTc-MDP bone scintigraphy, using an adaptive trial design. Ann Oncol 2015; 26: 2113-2118
• 10 Grant FD, Fahey FH, Packard AB et al. Skeletal PET with 18F-fluoride: Applying new technology to an oldtracer. J Nucl Med 2008; 49: 68-78
• 11 Hellwig D, Krause B-J, Schirrmeister H et al. Leitlinie für die Skelettdiagnostik mittels F-18-Natriumfluorid-PET und -PET/CT. Nuklearmedizin 2010; 49: 173-201
• 12 Iagaru A, Young P, Mittra E et al. Pilot prospective evaluation of 99mTc- MDP scintigraphy, 18F NaFPET/CT, 18F-FDG PET/CT and whole-body MRI for detection of skeletal metastases. Clin Nucl Med 2013; 38: e290-e296
• 13 Jadvar H, Desai B, Ji L et al. Prospective evaluation of 18F-NaF and 18F-FDG PET/CT in detection ofoccult metastases in biochemical recurrence of prostate cancer. Clin Nucl Med 2012; 37: 637-643
• 14 Joshi NV, Vesey AT, Williams MC et al. 18F-fluoride positron emission tomography for identification of ruptured and high-risk coronary atherosclerotic plaques: a prospective clinical trial. Lancet 2014; 383: 705-713
• 15 Kawaguchi M, Tateishi U, Shizukuishi K et al. 18F-fluoride uptake in bone metastasis: morphologic and metabolic analysis on integrated PET/CT. Ann Nucl Med 2010; 24: 241-247
• 16 Kjolhede H, Ahlgren G, Almquist H et al. Combined 18F-fluorocholine and 18F-fluoride positron emissiontomography/ computed tomography imaging for staging of high-risk prostate cancer. B J U Int 2012; 110: 1501-1516
• 17 Kobayashi N, Inaba Y, Tateishi U et al. New application of 18F-fluoride PET for the detection of bone remodeling in early stage osteoarthritis of the hip. Clin Nucl Med 2013; 38: e379-e383
• 18 Kobayashi N, Inaba Y, Choe H et al. Use of F-18 fluoride PET to differentiate septic from aseptic loosening in total hip arthroplasty patients. Clin Nucl Med 2011; 36: e156-e161
• 19 Krause BJ, Beyer T, Bockisch A et al. FDG-PET/CT in der Onkologie – Leitlinie. Nuklearmedizin 2007; 46: 291-301
• 20 Langsteger W, Balogova S, Hachette V et al. Fluorocholine (18F) and sodium fluoride (18F) PET/CT in the detection of prostate cancer: Prospective comparison of diagnostic performance determined by masked reading. Q J Nucl Med Mol Imaging 2011; 55: 448-457
• 21 Lee JW, Lee SM, Kim SJ et al. Clinical utility of fluoride-18 positron emission tomography/CT in temporomandibular disorder with osteoarthritis: Comparisons with 99mTc-MDP bone scan. Dentomaxillofac Radiol 2013; 42 29292350
• 22 Ota N, Kato K, Iwano S et al. Comparison of 18F-fluoride PET/CT, 18F-FDG PET/CT and bone scintigraphy (planarand SPECT) in detection of bone metastases of differentiated thyroid cancer: A pilot study. Br J Radiol 2014; 87 20130444
• 23 Peters M, Willems P, Weijers R et al. Pseudarthrosis after lumbar spinal fusion: the role of 18F-fluoride PET/CT. Eur J Nucl Med Mol Imaging 2015; 42: 1891-1898
• 24 Petren-Mallmin M, Andreasson I, Ljunggren O et al. Skeletal metastases from breast cancer: Uptake of 18F-fluoride measured with positron emission tomography in correlation with CT. Skeletal Radiol 1999; 27: 72-76
• 25 Piccardo A, Altrinetti V, Bacigalupo L et al. Detection of metastatic bone lesions in breast cancer patients: Fused (18)F-Fluoride-PET/MDCT has higher accuracy than MDCT. Preliminary experience. Eur J Radiol 2012; 81: 2632-2638
• 26 Poulsen MH, Petersen H, Hoilund-Carlsen PF et al. Spine metastases in prostate cancer: Comparison of [99mTc]MDP whole-body bone scintigraphy, [18F]choline PET/CT, and [18F]NaF PET/CT. BJU Int 2014; 114: 818-823
• 27 Rauscher I, Beer AJ, Schaeffeler C et al. Evaluation of 18F-fluoride PET/MR and PET/CT in patients with foot pain of unclear cause. J Nucl Med 2015; 56: 430-435
• 28 Rohren EM, Etchebehere EC, Araujo JC et al. Determination of Skeletal Tumor Burden on 18F-Fluoride PET/CT. J Nucl Med 2015; 56: 1507-1512
• 29 Schirrmeister H, Glatting G, Hetzel J et al. Prospective evaluation of the clinical value of planar bone scans, SPECT, and (18F)-labeled NaF PET in newly diagnosed lung cancer. J Nucl Med 2011; 42: 1800-1804
• 30 Segall G, Delbeke D, Stabin MG et al. SNM Guideline for Sodium 18F- Fluoride PET/CT Bone Scans. Society of Nuclear Medicine 2010; 51: 1813-1820
• 31 Sharma P, Karunanithi S, Chakraborty PS et al. 18F-Fluoride PET/CT for detection of bone metastasis in patients with renal cell carcinoma: a pilot study. Nucl Med Commun 2014; 35: 1247-1253
• 32 Stauss J, Hahn K, Mann M et al. Guidelines for paediatric bone scanning with (99m)Tc-labelled radiopharmaceuticals and (18)F-fluoride. Eur J Nucl Med Mol Imaging 2010; 37: 1621-1628
• 33 Wondergem M, van der Zant FM, van der Ploeg T et al. A literature review of 18F-fluoride PET/CT and 18F-choline or 11C-choline PET/CT for detection of bone metastases in patients with prostate cancer. Nucl Med Commun 2013; 34: 935-945
• 34 Yen RF, Chen CY, Cheng MF et al. The diagnostic and prognostic effectiveness of F-18 sodium fluoride PET-CT in detecting bone metastases for hepatocellular carcinoma patients. Nucl Med Commun 2010; 31: 637-645