J Nucl Med. 2012; 53 (Supplement 1):586
General Clinical Specialties
Musculoskeletal: Bone Malignancy and More
Evaluation of NaF PET/CT, FDG PET/CT, combined NaF/FDG PET/CT and CT alone for detection of bone metastases
Sanjiv Gambhir1 and
1 Radiology, Nuclear Medicine, Stanford University Medical Center, Stanford, CA
2 Radiology, MSK Imaging, Stanford University Medical Center, Stanford, CA
3 Radiology, Body Imaging, Stanford University Medical Center, Stanford, CA
Abstract No. 586
Objectives: FDG PET/CT is established in clinical practice for the initial cancer staging and the subsequent monitoring of response to therapy. NaF can be used as a PET/CT tracer for the detection of sclerotic skeletal metastases. The combined administration of NaF and FDG in a single PET/CT scan may improve patient convenience and reduce healthcare costs in selected patients. However, it has not been compared to CT alone for the detection of bone metastases.
Methods: This is a retrospective review of 51 patients with biopsy-proven cancer who underwent separate NaF PET/CT, FDG PET/CT and combined NaF/FDG PET/CT scans (3 scans per patient) at our institution. There were 39 men and 12 women, 19-84 year-old (average 53.9 ± 16.3). The 3 PET/CT scans were performed within a 2-week period for each patient. A direct comparison for detected bone metastases was performed between the 3 PET/CT scans and CT alone for each patient.
Results: The sensitivities, specificities, PPV and NPV for CT alone, 18F NaF PET/CT, 18F FDG PET/CT and combined 18F NaF/18F FDG PET/CT scans are presented in the attached table below. Overall, the combined scan performed better than any of the separate scans or the CT alone for identification of bone metastases.
Conclusions: We showed that combined NaF/FDG PET/CT detects more bone metastases than CT alone, and without loss of sensitivity in comparison to standard FDG PET/CT. The simultaneous use of NaF/FDG PET contributed greatly to the degree of concordance between scintigraphy and radiography, as the majority of CT-detected lesions missed on FDG PET were subsequently detected by NaF PET. These findings provide a strong clinical rationale for the use of combined NaF/FDG PET/CT in the management of selected oncologic patients, and should be further validated in larger cohorts