Pilot prospective evaluation of 99mTc-MDP scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and whole-body MRI for detection of skeletal metastases

Clin Nucl Med. 2013 Jul;38(7):e290-6. doi: 10.1097/RLU.0b013e3182815f64.

Abstract

Objective: The aim of this study was to compare 99mTc-MDP bone scanning, 18F NaF PET/CT, 18F FDG PET/CT, and whole-body MRI (WBMRI) for detection of known osseous metastases.

Patients and methods: This prospective pilot trial (September 2007-April 2009) enrolled 10 participants (5 men, 5 women, 47-81 years old) diagnosed with cancer and known osseous metastases. 18F NaF PET/CT, 18F FDG PET/CT, and WBMRI were performed within 1 month for each participant.

Results: The image quality and evaluation of extent of disease were superior by 18F NaF PET/CT compared to 99mTc-MDP scintigraphy in all patients with skeletal lesions and compared to 18F FDG PET/CT in 3 of the patients with skeletal metastases. 18F NaF PET/CT showed osseous metastases where 18F FDG PET/CT was negative in another 3 participants. Extraskeletal metastases were identified by 18F FDG PET/CT in 6 participants. WBMRI with the combination of iterative decomposition of water and fat with echo asymmetry and least-squares estimation, short tau inversion recovery, and diffusion-weighted imaging pulse sequences showed fewer lesions than 18F NaF PET/CT in 5 patients, same number of lesions in 2 patients, and more lesions in 1 patient. WBMRI showed fewer lesions than 18F FDG in 3 patients and same lesions in 6 patients.

Conclusions: Our pilot phase prospective trial demonstrated superior image quality and evaluation of skeletal disease extent with 18F NaF PET/CT compared to 99mTc-MDP scintigraphy and 18F FDG PET/CT, as well as the feasibility of multisequence WBMRI. In addition, 18F FDG PET/CT provided valuable soft-tissue information that can change disease management. Further evaluation of these findings using the recently introduced PET/MRI scanners is warranted.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / diagnostic imaging*
  • Bone Neoplasms / secondary*
  • Female
  • Fluorine Radioisotopes
  • Fluorodeoxyglucose F18*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Multimodal Imaging*
  • Pilot Projects
  • Positron-Emission Tomography
  • Prospective Studies
  • Sodium Fluoride*
  • Technetium Tc 99m Medronate*
  • Tomography, X-Ray Computed
  • Whole Body Imaging*

Substances

  • Fluorine Radioisotopes
  • Fluorodeoxyglucose F18
  • Sodium Fluoride
  • Technetium Tc 99m Medronate