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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.
Both...
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... patients were suspicious of bone metastases during their regular follow-up and each of them, at the time of 1-128 months (mean: 34.0 ± 29.5 months) after the initial diagnosis of HCC, received both Tc-99m MDP BS and F-18 NaF PET-CT within a time span of 1 month (mean: 11.3 ± 10.4 days). The characteristics of the patients in the study are listed in Table 1. ...
Similar publications
Current nuclear imaging of the skeletal system is achieved using technetium-99m (Tc-99m) methylene diphosphonate (MDP), F-18 sodium fluoride (NaF), or F-18 fluorodeoxyglucose (FDG). However, comparisons of these are rare in the literature.
We present a case of a 51-year-old female with suspicious lung cancer due to main symptoms of dyspnea, nonprod...
Technetium-99m methylene diphosphonate (Tc-99m MDP) whole-body bone scintigraphy (BS) has been widely used for detecting bone metastases. The aim of this study is to investigate the diagnostic accuracy of BS in detecting skeletal metastases for hepatocellular carcinoma (HCC) patients. In addition, the anatomic distribution of the metastatic bone le...
Citations
... This results in delayed diagnosis and treatment of bone metastasis. [25][26][27] Therefore, there is an urgent need to establish a new early warning system to indicate the risk and presence of bone metastasis, so as to promote the prevention and treatment of lung cancer. We rank the features based on the differentiation performance of the average classifiers of the 4 machine learning algorithms. ...
Objective:
We tested the performance of general machine learning and joint machine learning algorithms in the classification of bone metastasis, in patients with lung adenocarcinoma.
Methods:
We used R version 3.5.3 for statistical analysis of the general information, and Python to construct machine learning models.
Results:
We first used the average classifiers of the 4 machine learning algorithms to rank the features and the results showed that race, sex, whether they had surgery and marriage were the first 4 factors affecting bone metastasis. Machine learning results in the training group: for area under the curve (AUC), except for RF and LR, the AUC values of all machine learning classifiers were greater than .8, but the joint algorithm did not improve the AUC for any single machine learning algorithm. Among the results related to accuracy and precision, the accuracy of other machine learning classifiers except the RF algorithm was higher than 70%, and only the precision of the LGBM algorithm was higher than 70%. Machine learning results in the test group: Similarly, for areas under the curve (AUC), except RF and LR, the AUC values for all machine learning classifiers were greater than .8, but the joint algorithm did not improve the AUC value for any single machine learning algorithm. For accuracy, except for the RF algorithm, the accuracy of other machine learning classifiers was higher than 70%. The highest precision for the LGBM algorithm was .675.
Conclusion:
The results of this concept verification study show that machine learning algorithm classifiers can distinguish the bone metastasis of patients with lung cancer. This will provide a new research idea for the future use of non-invasive technology to identify bone metastasis in lungcancer. However, more prospective multicenter cohort studies are needed.
... Due to its advantage of overall high sensitivity and easy evaluation of the entire skeleton at a relatively low cost in comparison to conventional radiographs, 99m Tc-MDP whole body bone scan (WBBS) has become the most common method for screening bone metastasis. But there are several disadvantages associated with this technique, such as low specificity, hard to distinguish between osteogenic and osteolytic lesions, and not showing the degree of bone destruction (7)(8)(9). In addition, there have been few improvements in radiopharmaceuticals for WBBS in the past few decades, and the supply of 99m Tc has become less predictable in recent years due to the decline in the number of active nuclear reactors for medical isotope production. ...
Objectives
⁶⁸ Ga-P15-041 ( ⁶⁸ Ga-HBED-CC-BP) is a novel bone-seeking PET radiotracer, which can be readily prepared by using a simple kit formulation and an in-house ⁶⁸ Ga/ ⁶⁸ Ge generator. The aim of this study is to assess the potential human application of ⁶⁸ Ga-P15-041 for clinical PET/CT imaging and to compare its efficacy to detect bone metastases of different cancers with ⁹⁹ mTc-MDP whole-body bone scintigraphy (WBBS).
Methods
Initial kinetic study using Patlak analysis and parametric maps were performed in five histopathologically proven cancer patients (three males, two females) using ⁶⁸ Ga-P15-041 PET/CT scan only. Another group of 51 histopathologically proven cancer patients (22 males, 29 females) underwent both ⁹⁹ mTc-MDP WBBS and ⁶⁸ Ga-P15-041 PET/CT scans within a week, sequentially. Using either pathology examination or follow-up CT or MRI scans as the gold standard, the diagnostic efficacy and receiver operating characteristic curve (ROC) of the two methods in identifying bone metastases were compared (p <0.05, statistically significant).
Results
Fifty-one patients were imaged, and 174 bone metastatic sites were identified. ⁶⁸ Ga-P15-041 PET/CT and ⁹⁹ mTc-MDP WBBS detected 162 and 81 metastases, respectively. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ⁶⁸ Ga-P15-041 PET/CT and ⁹⁹ mTc-MDP WBBS were 93.1% vs 81.8%, 89.8% vs 90.7%, 77.5% vs 69.2%, 97.2% vs 93.4% and 90.7% vs 88.4%, respectively. Our results showed that the mean of SUVmax was significantly higher in metastases than that in benign lesions, 15.1 ± 6.9 vs . 5.6 ± 1.3 (P <0.001). Using SUVmax = 7.6 as the cut-off value by PET/CT, it was possible to predict the occurrence of metastases (AUC = 0.976; P <0.001; 95% CI: 0.946–0.999). However, it was impossible to distinguish osteoblastic bone metastases from osteolytic bone lesions. Parametric maps based on Patlak analysis provided excellent images and highly valuable quantitative information.
Conclusions
⁶⁸ Ga-P15-041 PET/CT, offering a rapid bone scan and high contrast images in minutes, is superior to the current method of choice in detecting bone metastases. It is reasonable to suggest that ⁶⁸ Ga-P15-041 PET/CT could become a valuable routine nuclear medicine procedure in providing excellent images for detecting bone metastases in cancer patients. ⁶⁸ Ga-P15-041 could become a valuable addition expanding the collection of ⁶⁸ Ga-based routine nuclear medicine procedures where ¹⁸ F fluoride is not currently available.
... The main clinical indications of 18 F-NaF PET/CT are identification of bone metastases, correct determination of the extent of disease, and localization of the malignant bony lesions [24,35,37,[41][42][43][44][45][46]. However, based on current data, the following indications have been suggested to be appropriate in certain cases: & Bone Trauma, child abuse [63] & Back pain [48,64] & Osteochondrosis and condylar hyperplasia [65] & Osteoid osteoma [46] & Langerhans cell histiocytosis [46] Necessary data for requesting 18 ...
The aim of this guideline is to provide minimum standards for the performance and interpretation of (18)F-NaF PET/CT scans. Standard acquisition and interpretation of nuclear imaging modalities will help to provide consistent data acquisition and numeric values between different platforms and institutes and to promote the use of PET/CT modality as an established diagnostic modality in routine clinical practice. This will also improve the value of scientific work and its contribution to evidence-based medicine.
... As the availability of PET systems was increasing, 18 Ffluoride has been used for skeletal PET imaging since 1990s. PET or PET/CT with 18 F-fluoride have been shown to be more sensitive than planar 99m Tc bone scintigraphy for the detection of bone metastases of lung, 9 breast, 10,11 hepatocellular, 12 prostate, 11,13,14 colon and bladder 11 cancers. However, to the best of our knowledge, there have been no systematic comparative studies on the efficacies of 18 F-fluoride PET/CT, 18 F-FDG PET/CT and 99m Tc bone scintigraphy (planar and SPECT) for the detection of bone metastases of DTC. ...
... In the present study, 18 F-fluoride PET/CT showed significantly higher sensitivity than 99m Tc bone scintigraphy (planar) in detecting bone metastases of DTC (Table 3); the results agree with those of the earlier studies on 18 F-fluoride PET or PET/CT with bone metastases of lung, 9 breast, 10,11 hepatocellular, 12 prostate, 11,13,14 colon and bladder 11 cancers. In the present study, however, the specificities of both 18 F-fluoride PET/CT and 99m Tc bone scintigraphy (SPECT) in detecting bone metastases of DTC were similarly high and did not differ significantly from one another ( Table 3), indicating that the sensitivity of 99m Tc bone scintigraphy (planar) was improved when SPECT was added to a planar scan. ...
Objective:
We compared the efficacies of ¹⁸F-fluoride positron emission tomography (¹⁸F-fluoride PET)/CT, ¹⁸F-fludeoxyglucose PET (¹⁸F-FDG PET)/CT, and ⁹⁹mTc bone scintigraphy [planar and single photon emission CT (SPECT)] for the detection of bone metastases in patients with differentiated thyroid carcinoma (DTC).
Methods:
We examined 11 patients (8 females and 3 males; mean age 6 standard deviation, 61.968.7 years) with DTC who had been suspected of having bone metastases after total thyroidectomy and were hospitalized to be given ¹³¹I therapy. Bone metastases were verified either when positive findings were obtained on both ¹³¹I scintigraphy and CT or when MRI findings were positive if MRI was performed.
Results:
Metastases were confirmed in 24 (13.6%) of 176 bone segments in 9 (81.8%) of the 11 patients. The sensitivities of ¹⁸F-fluoride PET/CT and ⁹⁹mTc bone scintigraphy (SPECT) were significantly higher than those of ¹⁸F-FDG PET/CT and ⁹⁹mTc bone scintigraphy (planar) (p,0.05). The accuracies of ¹⁸F-fluoride PET/CT and mTc bone scintigraphy (SPECT) were significantly higher than that of ⁹⁹mTc bone scintigraphy (planar) (p,0.05).
Conclusion:
The sensitivity and accuracy of ¹⁸F-fluoride PET/CT for the detection of bone metastases of DTC are significantly higher than those of ⁹⁹mTc bone scintigraphy (planar). However, the sensitivity and accuracy of ⁹⁹mTc bone scintigraphy (planar) are improved near to those of ¹⁸F-fluoride PET/CT when SPECT is added to a planar scan. The sensitivity of ¹⁸F-FDG PET/CT is significantly lower than that of 18F-fluoride PET/CT or ⁹⁹mTc bone scintigraphy (SPECT).
... and is more accurate than 99m Tc-MDP scintigraphy when compared to SPECT/CT [7] [8] [9]. Although the original role of CT in 18 F-fluoride PET/CT is for identifying anatomic landmarks, it also provides a large amount of diagnostic information. ...
Objective. Due to the frequently interrupted supply of 99mTc-methylene diphosphonate, the use of 18F-fluoride positron emission tomography (PET)/computed tomography (CT) has become more popular. The study aims to determine the percentage of extraosseous findings from the unenhanced CT portion of 18F-fluoride PET/CT scans.
Materials and Methods. We retrospectively collected 18F-fluoride PET/CT studies between March 2010 and February 2011. The unenhanced CT portions of 18F-fluoride PET/CT were reviewed for each patient. Significant extraosseous findings related to malignancy from the unenhanced CT were recorded. Results. A total of 158 patients (110 females, 48 males) were included in the study. Clinically significant extraosseous findings from the unenhanced CT were found in 43 patients (27.2%). Previously unknown extraosseous findings were identified in 17 patients (10.8%) after a review of the 18F-fluoride PET/CT scan results. Most of the extraosseous findings were small pulmonary metastases or enlarged metastatic lymph nodes. Conclusion. It is not rare to identify new clinically significant extraosseous findings from the unenhanced CT of 18F-fluoride PET/CT studies. Therefore the clinical management of patients may be altered by the results, and a careful review of the unenhanced CT portion of 18F-fluoride PET/CT is mandatory.
... However, X-ray images merely detect bone density and relatively large changes in the bone shape and structure, whereas a nuclear-based procedure can detect functional changes in the bone that occur prior to structural changes. In particular, 18F-fluoride positron emission computerized-tomography (PET) has received much attention in detecting bone diseases such as bone metastases because of its high image quality [3–5]. The functional imaging technique of 18F-fluoride PET allows a quantitative assessment of bone metabolism at specific sites of the skeleton in man [6–16], suggesting that the technique could be used to quantify the magnitude of the localized response to pressure induced by wearing dentures. ...
Objective
Excessive pressure due to wearing mal-adapting dentures is well known to cause residual bone resorption beneath the denture. X-rays have been commonly utilized to evaluate the changes in the bone beneath the denture. However, X-ray images merely detect bone density and relatively large changes in the bone shape and structure, whereas nuclear medicine imaging can detect functional changes, which occur prior to structural changes. This article aimed to describe the time course of the bone metabolism at the residual ridge beneath the denture following denture use by 18F-fluoride positron emission computerized-tomography (PET)/computed tomography (CT) scanning.
Methods
Three subjects, who had a free-end edentulous mandible, were treated with a denture replacing the edentulous region of the dental arch. The metabolic changes in the residual bone beneath the denture were assessed by 18F-fluoride PET/CT imaging. 18F-fluoride PET/CT scanning was performed at baseline, and 4–6 and 13 weeks after denture use. A volume of interest (VOI) was placed on their mandibles at the edentulous region beneath the denture on the PET/CT image. CT value and mean standardized uptake value (SUV) of the VOI were calculated. The difference in the time variation between the CT value and SUV was analyzed.
Results
The adaptation of the denture base to the residual ridge was successful, and there was no trouble such as pain at the residual ridge beneath the denture. The SUVs of each VOI significantly increased at 4–6 weeks after denture use and then decreased at 13 weeks in all three subjects (P < 0.05; two-way ANOVA, Dunnett test). On the other hand, the CT images showed no obvious changes in the bone shape or structure beneath the dentures, and the CT values of each VOI remained static after denture use in all three subjects.
Conclusions
This study indicates that in the present first-time removable partial denture (RPD) users, wearing of a well-adapted RPD initially increased bone metabolism beneath the denture and then decreased it at around 13 weeks after RPD use without any bone structural changes detectable by clinical X-rays. These metabolic changes are a mechanobiological reaction to the pressure induced by RPD use.
... respectively, P=0.0001) and a significant correlation between prognosis and bony lesions found on 18 F scan; such a relationship was not found with 99m Tc-MDP. [48] Similar results were found in patients with non-small cell lung cancer. [49] This increased accuracy, along with the current availability of PET/CT technology in a range of clinical settings and the relative ease at producing 18 F, indicate this technology will become increasingly incorporated into routine clinical use. ...
Patient management in oncology increasingly relies on imaging for diagnosis, response assessment, and follow-up. The clinical availability of combined functional/anatomical imaging modalities, which integrate the benefits of visualizing tumor biology with those of high-resolution structural imaging, revolutionized clinical management of oncologic patients. Conventional high-resolution anatomical imaging modalities such as computed tomography (CT) and MRI excel at providing details on lesion location, size, morphology, and structural changes to adjacent tissues; however, these modalities provide little insight into tumor physiology. With the increasing focus on molecularly targeted therapies, imaging radiolabeled compounds with PET and single-photon emission tomography (SPECT) is often carried out to provide insight into a tumor's biological functions and its surrounding microenvironment. Despite their high sensitivity and specificity, PET and SPECT alone are substantially limited by low spatial resolution and inability to provide anatomical detail. Integrating SPECT or PET with a modality capable of providing these (i.e. CT or MR) maximizes their separate strengths and provides anatomical localization of physiological processes with detailed visualization of a tumor's structure. The availability of multimodality (hybrid) imaging with PET/CT, SPECT/CT, and PET/MR improves our ability to characterize lesions and affect treatment decisions and patient management. We have just begun to exploit the truly synergistic capabilities of multimodality imaging. Continued advances in the development of instrumentation and imaging agents will improve our ability to noninvasively characterize disease processes. This review will discuss the evolution of hybrid imaging technology and provide examples of its current and potential future clinical uses.
Benign and malignant primary bone tumors are rare, while metastatic disease is a common occurrence. The efficacy of the several currently available imaging modalities in the detection, staging, and follow-up of patients with skeletal neoplasia varies. Evaluation of bone tumors involves a multimodality approach. Standard radiographs play an important role in the diagnosis of both primary and metastatic tumors. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are often complementary and are particularly useful in primary bone tumors. CT scan is especially useful in evaluating the cortex. MRI is superior in evaluating the extent of several primary tumors and detecting bone marrow lesions. The role of bone scintigraphy in the preoperative evaluation of primary tumors is limited. Bone scintigraphy, on the other hand, is an excellent cost-effective screening modality in detecting metastatic disease in patients with skeletal (tumors?) as in the case of extraskeletal malignancies. In breast, lung, and head and neck tumors, bone scans are rarely positive for metastasis in patients with low-stage disease. Positron emission tomography (PET) using F-18 sodium fluoride and FDG, or combined, is more sensitive in detecting metastases. Metaiodobenzylguanidine (MIBG) scintigraphy is valuable in children with neuroblastoma. Conventional bone scan and other radionuclide modalities are valuable in the long-term follow-up of several cancers, and in estimating the prognosis. The therapeutic response of malignant bone disease can particularly be assessed using PET and alternatively, Tl-201 and Tc-99m methoxyisobutylisonitrile (MIBI) in case PET is unavailable.
Although the use of SPECT/CT, PET/CT, and PET/MR in different bone diseases was discussed in several chapters of this book, a separate chapter putting together the clinical uses and impacts of such important modalities in the diagnosis and follow-up of bone diseases is thought to be warranted given the importance of such modern imaging modalities.
The clinical utility and effectiveness of bone scan, planar scan, and SPECT have been proven without CT. In most patients, a bone scan without CT provides sufficient information for the diagnosis. Accordingly, adding CT should only be in select situations when bone scans show lesions of indeterminate nature and/or location. In such situations, CT is added for a limited region of interest to improve the specificity of bone scintigraphy. PET/CT and PET/MR have revolutionized the impact of nuclear medicine in the diagnosis and follow-up of diseases, including bone pathologies, particularly in neoplastic disease.
The use of 18F sodium fluoride (18F-NaF) in positron emission tomography (PET/CT) is increasing. This resurgence of an old tracer has been driven by several factors, including its superior diagnostic performance over standard 99mTc-based bone scintigraphy (BS), availability of PET/CT imaging systems, a shortened examination time and an increase in the number of regional commercial PET radiotracer distribution. In this special article, we aimed to highlight the current place of the 18F-NaF PET/CT in the imaging of bone metastases (BM) in a variety of malignancies. A special focus is given to the following ones: breast cancer (BC), prostate cancer (PCa). Also, other malignancies such as bladder cancer, lung cancer, thyroid cancer, multiple myeloma, head and neck cancer, hepatocellular carcinoma have been addressed. At last, we summarize the advantages and limits of the 18F-NaF PET/CT compared to other imaging modalities in these settings.
