Simultaneous PET/MRI in the Evaluation of Breast and Prostate Cancer Using Combined Na[ 18 F] F and [ 18 F]FDG: a Focus on Skeletal Lesions

Mol Imaging Biol. 2020 Apr;22(2):397-406. doi: 10.1007/s11307-019-01392-9.


Purpose: The purpose of this study is to prospectively evaluate the performance of sodium 18F]fluoride (Na[18F]F)/2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) simultaneous time-of-flight enabled positron emission tomography (PET)/magnetic resonance imaging (MRI) for the detection of skeletal metastases in selected patients with advanced breast and prostate cancers.

Procedure: The institutional review board approved this HIPAA-compliant protocol. Written informed consent was obtained from each patient. A total of 74 patients (23 women and 51 men with breast and prostate cancer, respectively) referred for standard-of-care whole-body bone scintigraphy (WBBS) were enrolled in this prospective study. All patients underwent a [99mTc]methyldiphosphonate ([99mTc]MDP) WBBS followed by Na[18F]F/[18F]FDG PET/MRI. Lesions detected by each imaging modality were tabulated and a lesion-based and patient-based analysis was conducted.

Results: On a patient-based analysis, [99mTc]MDP WBBS identified skeletal lesions in 37 patients and PET/MRI in 45 patients. On a lesion-based analysis, WBBS identified a total of 81 skeletal lesions, whereas PET/MRI identified 140 lesions. Additionally, PET/MRI showed extra-skeletal lesions in 19 patients, including lymph nodes (16), prostate (4) lung (3), and liver (2) lesions.

Conclusions: The ability of Na[18F]F/[18F]FDG PET/MRI to identify more skeletal lesions than 99mTc-MDP WBBS and to additionally identify extra-skeletal disease may be beneficial for patient care and represent an alternative to the single modalities performed separately. Na[18F]F/[18F]FDG PET/MRI is a promising approach for evaluation of skeletal and extra-skeletal lesions in a selected population of breast and prostate cancer patients.

Keywords: Breast and prostate cancer; Magnetic resonance imaging; Na[18F]F/[18F]FDG PET/MRI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / diagnostic imaging*
  • Bone Neoplasms / secondary
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / pathology
  • Female
  • Fluorodeoxyglucose F18*
  • Humans
  • Image Processing, Computer-Assisted
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Multimodal Imaging / methods
  • Positron-Emission Tomography*
  • Prospective Studies
  • Prostatic Neoplasms / diagnostic imaging*
  • Prostatic Neoplasms / pathology
  • Radionuclide Imaging
  • Radiopharmaceuticals
  • Sodium
  • Sodium Fluoride*
  • Technetium Tc 99m Medronate
  • Whole Body Imaging


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Sodium Fluoride
  • Sodium
  • Technetium Tc 99m Medronate