The diagnostic and prognostic effectiveness of F-18 sodium fluoride PET-CT in detecting bone metastases for hepatocellular carcinoma patients

Nucl Med Commun. 2010 Jul;31(7):637-45. doi: 10.1097/MNM.0b013e3283399120.


Background: The aim of this prospective study is to evaluate the diagnostic and prognostic usefulness of F-18 sodium fluoride (NaF) positron emission tomography-computed tomography (PET-CT) relative to Tc-99m methylene diphosphonate (MDP) planar bone scintigraphy with no CT (BS) for hepatocellular carcinoma (HCC) patients with suspicious bone metastasis.

Methods: Both Tc-99m MDP BS and F-18 NaF PET-CT were performed for 34 consecutive Taiwanese HCC patients (five female and 29 male; mean age, 61.0+/-12.0 years) within a time span of 1 month (mean: 11.3+/-10.4 days). The accuracies of BS and PET-CT were determined by comparing their results with the finalized clinical data in a lesion-by-lesion manner.

Results: According to the pathological and/or follow-up results, the accuracy for detecting metastatic bone lesions by Tc-99m MDP BS is 75.4% and that by F-18 NaF PET-CT is 95.7%, respectively. F-18 NaF PET-CT is significantly more accurate than Tc-99m MDP BS (P=0.0001). Furthermore, there is a significant correlation between the presence of F-18 NaF PET-CT-positive bone lesions and the survival time of HCC patients. On the other hand, the diagnostic results from BS are not correlated with the survival time of these HCC patients.

Conclusion: F-18 NaF using PET-CT system has significantly better sensitivity and specificity than conventional Tc-99m MDP BS in detecting metastatic HCC bone lesions that are predominantly osteolytic. The diagnostic result of PET-CT also serves as a more effective prognostic indictor for HCC patients.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Bone Neoplasms / diagnosis*
  • Bone Neoplasms / diagnostic imaging
  • Bone Neoplasms / secondary*
  • Bone and Bones / diagnostic imaging
  • Carcinoma, Hepatocellular / pathology*
  • Female
  • Fluorine Radioisotopes*
  • Follow-Up Studies
  • Humans
  • Liver Neoplasms / pathology*
  • Male
  • Middle Aged
  • Positron-Emission Tomography / methods*
  • Prognosis
  • Prospective Studies
  • Sodium Fluoride*
  • Survival Analysis
  • Technetium Tc 99m Medronate
  • Tomography, X-Ray Computed / methods*


  • Fluorine Radioisotopes
  • Sodium Fluoride
  • Technetium Tc 99m Medronate