淋巴瘤PET/CT最大标准摄取值与临床分期、病理分型及Ki-67表达相关性

目的探讨淋巴瘤18F-FDG PET/CT中最大标准摄取值(SUVmax)与临床分期、病理分型及Ki-67表达的相关性。方法回顾性分析135例经病理证实、18F-FDG PET/CT和Ki-67免疫组化资料完整的淋巴瘤患者,分析SUVmax与临床分期和Ki-67表达的相关性,比较不同病理分型淋巴瘤SUVmax差异,绘制ROC曲线,获得SUVmax诊断侵袭性淋巴瘤的界值。结果 SUVmax与淋巴瘤临床分期无相关(r=0.04,P=0.544)。霍奇金淋巴瘤和非霍奇金淋巴瘤SUVmax分别为11.53±5.58和11.84±6.82(Z=-0.256,P=0.798);侵袭性淋巴瘤SUVmax(13.02±6.53)高于惰性淋巴瘤(6.81±5.71,Z=-4.226,P0.001);以SUVmax=8.4为预测侵袭性淋巴瘤的界值,其灵敏度和特异度分别为75.5%和77.3%。早期和晚期淋巴瘤SUVmax与Ki-67指数均呈正相关(r=0.44,P0.001;r=0.43,P=0.002)。结论淋巴瘤18F-FDG PET/CT SUVmax与临床分期不相关,与Ki-67表达呈正相关,可预测侵袭性淋巴瘤。     

[18F]‐Sodium Fluoride PET/MR Imaging for Bone–Cartilage Interactions in Hip Osteoarthritis: A Feasibility Study

This study characterized the distribution of [¹⁸F]‐sodium fluoride (NaF) uptake and blood flow in the femur and acetabulum in hip osteoarthritis (OA) patients to find associations between bone remodeling and cartilage composition in the presence of morphological abnormalities using simultaneous positron emission tomography and magnetic resonance imaging (PET/MR), quantitative magnetic resonance imaging (MRI) and femur shape modeling. Ten patients underwent a [¹⁸F]‐NaF PET/MR dynamic scan of the hip simultaneously with: (i) fast spin‐echo CUBE for morphology grading and (ii) T_1ρ/T₂ magnetization‐prepared angle‐modulated partitioned k‐space spoiled gradient echo snapshots for cartilage, bone segmentation, bone shape modeling, and T_1ρ/T₂ quantification. The standardized uptake values (SUVs) and Patlak kinetic parameter (K_pat) were calculated for each patient as PET outcomes, using an automated post‐processing pipeline. Shape modeling was performed to extract the variations in bone shapes in the patients. Pearson's correlation coefficients were used to study the associations between bone shapes, PET outcomes, and patient reported pain. Direct associations between quantitative MR and PET evidence of bone remodeling were established in the acetabulum and femur. Associations of shaft thickness with SUV in the femur (p = 0.07) and K_pat in the acetabulum (p = 0.02), cam deformity with acetabular score (p = 0.09), osteophytic growth on the femur head with K_pat (p = 0.01) were observed. Pain had increased correlations with SUV in the acetabulum (p = 0.14) and femur (p = 0.09) when shaft thickness was accounted for. This study demonstrated the ability of [¹⁸F]‐NaF PET‐MRI, 3D shape modeling, and quantitative MRI to investigate cartilage‐bone interactions and bone shape features in hip OA, providing potential investigative tools to diagnose OA. © 2019 The Authors. Journal of Orthopaedic Research^® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 37:2671–2680, 2019     

18F-FDG PET/CT评价初诊T细胞淋巴瘤代谢活性与免疫表型的相关性

目的观察初诊T细胞淋巴瘤~(18)F-FDG代谢活性与淋巴瘤免疫表型的关系。方法回顾性分析64例初诊T细胞淋巴瘤患者,均于治疗前接受~(18)F-FDG PET/CT检查且经病理学确诊。测量活检部位PET/CT最大标准摄取值(SUV_(max)),分析其与免疫表型之间的相关性。结果 64例活检部位SUV_(max)为2.23～24.42,中位SUV_(max)为8.02,与Ki-67、CD5表达呈正相关(r_s=0.31、P=0.02,r_s=0.81、P0.01),而与其他免疫学指标均无相关性(P均0.05)。结论 T细胞淋巴瘤代谢活性与Ki-67和CD5表达呈正相关;~(18)F-FDG PET/CT可作为无创评估Ki-67和CD5免疫表达的影像学手段。     

18F-FDG-PET uptake in non-infected total hip prostheses

Background and purpose — ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used in the diagnostic work-up of a patient with suspected periprosthetic joint infection (PJI) but, due to a lack of accurate interpretation criteria, this technique is not routinely applied. Since the physiological uptake pattern of FDG around a joint prosthesis is not fully elucidated, we determined the physiological FDG uptake in non-infected total hip prostheses.

Patients and methods — Patients treated with primary total hip arthroplasty (1995–2016) who underwent a FDG-PET/CT for an indication other than a suspected PJI were retrospectively evaluated. Scans were both visually and quantitatively analyzed. Semi-quantitative analysis was performed by calculating maximum and peak standardized uptake values (SUV_max and SUV_peak) by volume of interests (VOIs) at 8 different locations around the prosthesis.

Results — 58 scans from 30 patients were analyzed. In most hips, a diffuse heterogeneous uptake pattern around the prosthesis was observed (in 32/38 of the cemented prostheses, and in 16/20 of the uncemented prostheses) and most uptake was located around the neck of the prosthesis. The median SUV_max in the cemented group was 2.66 (95% CI 2.51–3.10) and in the uncemented group 2.87 (CI 2.65–4.63) (Median difference = –0.36 [CI –1.2 to 0.34]). In uncemented prostheses, there was a positive correlation in time between the age of the prosthesis and the FDG uptake (r_s = 0.63 [CI 0.26–0.84]).

Interpretation — Our study provides key data to develop accurate interpretation criteria to differentiate between physiological uptake and infection in patients with a prosthetic joint.     

Multimodal [18F]FDG PET/CT Is a Direct Readout for Inflammatory Bone Repair: A Longitudinal Study in TNFα Transgenic Mice

In rheumatoid arthritis (RA), chronic joint inflammation leading to bone and cartilage damage is the major cause of functional impairment. Whereas reduction of synovitis and blockade of joint damage can be successfully achieved by disease modifying antirheumatic therapies, bone repair upon therapeutic interventions has only been rarely reported. The aim of this study was to use fluorodeoxyglucose ([¹⁸F]FDG) and [¹⁸F]fluoride µPET/CT imaging to monitor systemic inflammatory and destructive bone remodeling processes as well as potential bone repair in an established mouse model of chronic inflammatory, erosive polyarthritis. Therefore, human tumor necrosis factor transgenic (hTNFtg) mice were treated with infliximab, an anti-TNF antibody, for 4 weeks. Before and after treatment period, mice received either [¹⁸F]FDG, for detecting inflammatory processes, or [¹⁸F]fluoride, for monitoring bone remodeling processes, for PET scans followed by CT scans. Standardized uptake values (SUV_mean) were analyzed in various joints and histopathological signs of arthritis, joint damage, and repair were assessed. Longitudinal PET/CT scans revealed a significant decrease in [¹⁸F]FDG SUVs in affected joints demonstrating complete remission of inflammatory processes due to TNF blockade. In contrast, [¹⁸F]fluoride SUVs could not discriminate between different severities of bone damage in hTNFtg mice. Repeated in vivo CT images proved a structural reversal of preexisting bone erosions after anti-TNF therapy. Accordingly, histological analysis showed complete resolution of synovial inflammation and healing of bone at sites of former bone erosion. We conclude that in vivo multimodal [¹⁸F]FDG µPET/CT imaging allows to quantify and monitor inflammation-mediated bone damage and reveals not only reversal of synovitis but also bone repair upon TNF blockade in experimental arthritis. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.     

18F‐fluoride PET as a noninvasive imaging biomarker for determining treatment efficacy of bone active agents at the hip: A prospective,randomized, controlled clinical study

The functional imaging technique of ¹⁸F‐fluoride positron emission tomography (¹⁸F‐PET) allows the noninvasive quantitative assessment of regional bone formation at any skeletal site, including the spine and hip. The aim of this study was to determine if ¹⁸F‐PET can be used as an early biomarker of treatment efficacy at the hip. Twenty‐seven treatment‐naive postmenopausal women with osteopenia were randomized to receive teriparatide and calcium and vitamin D (TPT group, n = 13) or calcium and vitamin D only (control group, n = 14). Subjects in the TPT group were treated with 20 µg/day teriparatide for 12 weeks. ¹⁸F‐PET scans of the proximal femur, pelvis, and lumbar spine were performed at baseline and 12 weeks. The plasma clearance of ¹⁸F‐fluoride to bone, K_i, a validated measurement of bone formation, was measured at four regions of the hip, lumbar spine, and pelvis. A significant increase in K_i was observed at all regions of interest (ROIs), including the total hip (+27%, p = 0.002), femoral neck (+25%, p = 0.040), hip trabecular ROI (+21%, p = 0.017), and hip cortical ROI (+51%, p = 0.001) in the TPT group. Significant increases in K_i in response to TPT were also observed at the lumbar spine (+18%, p = 0.001) and pelvis (+42%, p = 0.001). No significant changes in K_i were observed for the control group. Changes in BMD and bone turnover markers were consistent with previous trials of teriparatide. In conclusion, this is the first study to our knowledge to demonstrate that ¹⁸F‐PET can be used as an imaging biomarker for determining treatment efficacy at the hip as early as 12 weeks after initiation of therapy.     

Overexpression of hexokinase-2 in giant cell tumor of bone is associated with false positive in bone tumor on FDG-PET/CT

Introduction

The aim of the current study was to evaluate the usefulness of maximum standardized uptake value (SUV_max) in 2-deoxy-2-F¹⁸-fluoro-d-glucose positron emission tomography combined with computed tomography (18F-FDG-PET/CT) for preoperative differential diagnosis between benign and malignant bone tumors.

Materials and methods

Seventy-nine patients with bone tumors were examined by FDG-PET prior to histopathological diagnosis. The SUV_max was calculated and compared between benign and malignant lesions, and among different histopathological subgroups, to identify false-positive histological subtypes.

Results

There was a statistically significant difference in the SUV_max of benign (3.7?±?3.3; n?=?17) and malignant (5.3?±?3.3; n?=?62) bone tumors. However, receiver operating characteristic curve analysis revealed the poor accuracy of this distinction. The cut-off value was determined to be 2.6, while the value of sensitivity and specificity was calculated to be 74.2 and 64.7?%, respectively. Giant cell tumor of bone (9.0?±?2.0; n?=?5) displayed a higher SUV_max than osteosarcoma (4.2?±?2.3; n?=?18). Immunohistochemical analysis demonstrated that markers of these cancers, hexokinase-2 (HK-2) and glucose transporter type 1 (GLUT-1), supported our findings.

Conclusion

The poor accuracy of SUV_max in 18F-FDG-PET/CT in distinguishing malignant from benign bone tumors was confirmed; some benign bone tumors showed high FDG uptake. Giant cell tumor of bone was a major false-positive histopathological subtype of bone tumors, showing high FDG accumulation. HK-2 contributed significantly to FDG uptake, whereas GLUT-1 appeared to play no role in FDG uptake in giant cell tumor of bone.     

Patients with patellofemoral pain exhibit elevated bone metabolic activity at the patellofemoral joint

Patellofemoral pain is characterized by pain behind the kneecap and is often thought to be due to high stress at the patellofemoral joint. While we cannot measure bone stress in vivo, we can visualize bone metabolic activity using ¹⁸F NaF PET/CT, which may be related to bone stress. Our goals were to use ¹⁸F NaF PET/CT to evaluate whether subjects with patellofemoral pain exhibit elevated bone metabolic activity and to determine whether bone metabolic activity correlates with pain intensity. We examined 20 subjects diagnosed with patellofemoral pain. All subjects received an ¹⁸F NaF PET/CT scan of their knees. Uptake of ¹⁸F NaF in the patella and trochlea was quantified by computing the standardized uptake value and normalizing by the background tracer uptake in bone. We detected increased tracer uptake in 85% of the painful knees examined. We found that the painful knees exhibited increased tracer uptake compared to the pain‐free knees of four subjects with unilateral pain (P = 0.0006). We also found a correlation between increasing tracer uptake and increasing pain intensity (r² = 0.55; P = 0.0005). The implication of these results is that patellofemoral pain may be related to bone metabolic activity at the patellofemoral joint. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:209–213, 2012     

18F-NaF PET/CT IMAGING IN FIBROUS DYSPLASIA OF BONE

Fibrous dysplasia (FD) is a mosaic skeletal disorder resulting in fractures, deformity, and functional impairment. Clinical evaluation has been limited by a lack of surrogate endpoints capable of quantitating disease activity. The purpose of this study was to investigate the utility of ¹⁸F-NaF PET/CT imaging in quantifying disease activity in patients with FD. Fifteen consecutively evaluated subjects underwent whole-body ¹⁸F-NaF PET/CT scans, and FD burden was assessed by quantifying FD-related ¹⁸F-NaF activity. ¹⁸F-NaF PET/CT parameters obtained included (i) SUV_max (standardized uptake value [SUV] of the FD lesion with the highest uptake); (ii) SUV_mean (average SUV of all ¹⁸F-NaF–positive FD lesions); (iii) total volume of all ¹⁸F-NaF–positive FD lesions (TV); and (iv) total FD lesion activity determined as the product of TV multiplied by SUV_mean (TA = TV × SUV_mean) (TA). Skeletal outcomes, functional outcomes, and bone turnover markers were correlated with ¹⁸F-NaF PET/CT parameters. TV and TA of extracranial FD lesions correlated strongly with skeletal outcomes including fractures and surgeries (p values ≤ 0.003). Subjects with impaired ambulation and scoliosis had significantly higher TV and TA values (P < 0.05), obtained from extracranial and spinal lesions, respectively. Craniofacial surgeries correlated with TV and TA of skull FD lesions (P < 0.001). Bone turnover markers, including alkaline phosphatase, N-telopeptides, and osteocalcin, were strongly correlated with TV and TA (P < 0.05) extracted from FD lesions in the entire skeleton. No associations were identified with SUV_max or SUV_mean. Bone pain and age did not correlate with ¹⁸F-NaF PET/CT parameters. FD burden evaluated by ¹⁸F-NaF-PET/CT facilitates accurate assessment of FD activity, and correlates quantitatively with clinically-relevant skeletal outcomes. © 2019 American Society for Bone and Mineral Research.     

[18F]‐fluorocholine positron‐emission/computed tomography for lymph node staging of patients with prostate cancer: preliminary results of a prospective study

Study Type – Diagnostic (case series)
Level of Evidence 4

OBJECTIVES

To evaluate prospectively [¹⁸F]‐fluorocholine positron‐emission/computed tomography (FCH PET/CT) for lymph node staging of prostate cancer before intended curative therapy, and to determine whether imaging 15 or 60 min after radiotracer injection is preferable.

PATIENTS AND METHODS

In all, 25 consecutive patients with newly diagnosed prostate cancer (Gleason score >6, and/or a prostate‐specific antigen level of >10 ng/mL, and/or T3 cancer) were scanned before lymphadenectomy. Each patient was assessed twice with imaging, at 15 and 60 min after the injection with FCH. Images were compared with the results of histopathological examination of the surgically removed lymph nodes. Maximum standardized uptake values (SUV_max) at 15 and 60 min were also compared.

RESULTS

Histopathologically, metastases were present in removed lymph nodes from three patients. FCH PET/CT showed a high radiotracer uptake in four patients, the former three and a fourth. The sensitivity, specificity, positive and negative predictive value of FCH PET/CT for patient based lymph node staging of prostate cancer were 100%, 95%, 75% and 100%, respectively; the corresponding 95% confidence intervals were 29.2–100%, 77.2–99.9%, 19.4–99.4% and 83.9–100%, respectively. Values of SUV_max at early and late imaging were not significantly different.

CONCLUSIONS

This small series supports the use of FCH PET/CT as a tool for lymph node staging of patients with prostate cancer. Values of SUV_max at early and late imaging did not differ. However, larger prospective studies are needed to validate these findings.     

18F-FDG PET/CT半定量参数在非小细胞肺癌预后判断中的研究进展

肺癌是目前世界上发病率最高的恶性肿瘤,非小细胞肺癌(NSCLC)约占其中的80%～85%,手术切除仍是首选治疗方法,因此,术前的准确分期和预后评估至关重要。~(18)F-FDG PET/CT检查相关的葡萄糖代谢半定量参数,包括最大标准化摄取值(SUV_(max))、最大标准化摄取峰值(SUV_(peak))、平均标准化摄取值(SUV_(mean))、肿瘤代谢体积(MTV)、总糖酵解量(TLG)等,可为判断肿瘤预后提供重要信息。本文对以上葡萄糖代谢半定量参数判断NSCLC预后的临床进展进行综述。     

Diagnostic value of fusion of metabolic and structural images for stereotactic biopsy of brain tumors without enhancement after contrast medium injection

BackgroundThe heterogeneous nature of glioma makes it difficult to select a target for stereotactic biopsy that will be representative of grade severity on non-contrast-enhanced lesion imaging. The objective of this study was to evaluate the benefit of fusion of metabolic images (PET 18F-DOPA) with magnetic resonance imaging (MRI) morphological images for cerebral biopsy under stereotactic conditions of glioma without contrast enhancement.Patients and methodsThis single-center prospective observational study conducted between January 2016 and April 2018 included 20 consecutive patients (mean age: 45 ± 19.5 years; range, 9–80 years) who underwent cerebral biopsy for a tumor without MRI enhancement but with hypermetabolism on ¹⁸F-FDOPA PET (positron emission tomography). Standard ¹⁸F-FDOPA uptake value (SUV_max) was determined for diagnosis of high-grade glioma, with comparison to histomolecular results.ResultsHistological diagnosis was made in all patients (100%). Samples from hypermetabolism areas revealed high-grade glial tumor in 16 patients (80%). For a SUV_max threshold of 1.75, sensitivity was 81.2%, specificity 50%, PPV 86.7% and VPN 40% for diagnosis of high-grade glioma. No significant association between SUV_max and histomolecular mutation was found.Conclusion¹⁸F-FDOPA metabolic imaging is an aid in choosing the target to be biopsied under stereotactic conditions in tumors without MR enhancement. Nevertheless, despite good sensitivity, ¹⁸F-FDOPA PET is insufficient for definitive diagnosis of high-grade tumor.     

Highly variable biodistribution of 68Ga labeled somatostatin analogues 68Ga-DOTA-NOC and 68Ga-DOTA-TATE in neuroendocrine tumors: clinical implications for somatostatin receptor directed PET/CT

BackgroundSomatostatin receptor (SSTR)-targeted positron emission tomography/computed tomography (PET/CT) imaging has risen to the forefront for neuroendocrine tumor (NET) detection and management, yet the variability of significant uptake variability (SUV) as a semiquantitative measure of disease detection and tumor response to treatment has not been fully explored.MethodsWe assess the reproducibility and interscan variability of SUV metrics of normal tissue and NET in serial ⁶⁸Ga-DOTA-NOC and ⁶⁸Ga-DOTA-TATE PET imaging to clinically monitor disease state. Eighty-one patients were enrolled in this retrospective study.ResultsBoth primary and metastatic hepatic lesions demonstrated SUV (SUV_mean 16.5±8.0). The median SUV_mean was 16 for the spleen, 9.7 for the pituitary, 12.6 for the adrenal glands, and 4.8 for the liver. The normal pituitary gland demonstrates focal homogenous uptake with SUV_max range of 4.5–23. The adrenal gland showed uptake with SUV_max range of 4.1–29.4, which is more than two times greater than liver uptake (SUV_mean range, 2.3–12.4). Highest physiological uptake seen in the spleen (average SUV_mean of 17.3, range of 5.4–34.4).ConclusionsThe highly variable nature of regional SUV_mean and SUV_max in both physiologic tissue and lesions suggests the need for incorporation of more reliable quantitative measures for clinical decision making.     

18F-FDG PET/CT动态评价单纯125I粒子植入或联合顺铂化学治疗兔VX2肺癌效果

目的 分析¹⁸F-FDG PET/CT动态观察单纯¹²⁵I粒子植入术及联合化学治疗（化疗）对兔VX2肺癌的干预效果的价值。方法 将VX2肿瘤组织接种于3~4月龄新西兰大耳白兔右肺下叶,制成兔VX2肺癌模型。将30只模型兔随机分为3组,每组10只。对A组通过治疗计划系统（TPS）植入25.9 MBq（0.7 mCi）¹²⁵I粒子,B组经耳缘静脉注射顺铂7 mg/kg体质量,C组予以上2种干预。分别于治疗前及治疗后第3、7、14天对实验兔行全身PET/CT扫描,于右肺肿瘤部位及肝右叶勾画ROI,检测其最大标准摄取值（SUV_max）,计算肿瘤SUV_max/肝脏SUV_max（SUV_T/L）;于治疗前及治疗后第3、7天完成PET/CT检查后分别处死2只,治疗后第14天PET/CT检查后处死4只动物,取肿瘤组织进行病理学检查。结果 3组间及A、B组内治疗前及治疗后不同时间点肿瘤最大径差异均无统计学意义（P均>0.05）。C组治疗后第14天肿瘤最大径较治疗前缩小（P<0.05）。治疗后第7、14天,C组SUV_T/L值较A、B组均降低（P均<0.05）;A、B组治疗后第7、14天SUV_T/L值均较治疗前降低,C组治疗后第3、7、14天SUV_T/L值均较治疗前降低（P均<0.05）。病理学检查发现3组治疗后肿瘤细胞均逐渐减少,A、C组炎症细胞及肿瘤坏死区较B组更多;C组治疗后第14天仅见少量肿瘤细胞,炎症细胞及纤维组织增多。结论 ¹⁸F-FDG PET/CT可动态监测并早期评价单纯¹²⁵I粒子植入术及联合化疗对兔VX2肺癌的干预效果。     

Shining dead bone—cause for cautious interpretation of [18F]NaF PET scans

Background and purpose — [¹⁸F]Fluoride ([¹⁸F]NaF) PET scan is frequently used for estimation of bone healing rate and extent in cases of bone allografting and fracture healing. Some authors claim that [¹⁸F]NaF uptake is a measure of osteoblastic activity, calcium metabolism, or bone turnover. Based on the known affinity of fluoride to hydroxyapatite, we challenged this view.

Methods — 10 male rats received crushed, frozen allogeneic cortical bone fragments in a pouch in the abdominal wall on the right side, and hydroxyapatite granules on left side. [¹⁸F]NaF was injected intravenously after 7 days. 60?minutes later, the rats were killed and [¹⁸F]NaF uptake was visualized in a PET/CT scanner. Specimens were retrieved for micro CT and histology.

Results — MicroCT and histology showed no signs of new bone at the implant sites. Still, the implants showed a very high [¹⁸F]NaF uptake, on a par with the most actively growing and remodeling sites around the knee joint.

Interpretation — [¹⁸F]NaF binds with high affinity to dead bone and calcium phosphate materials. Hence, an [¹⁸F]NaF PET/CT scan does not allow for sound conclusions about new bone ingrowth into bone allograft, healing activity in long bone shaft fractures with necrotic fragments, or remodeling around calcium phosphate coated prostheses     

Accuracy of PET-CT in Predicting Survival in Patients with Esophageal Cancer

Background  

Positron emission tomography (PET) is an integral part of tumor staging for patients with esophageal cancer. Recent studies suggest a role for PET scan in predicting survival in these patients, but this relationship is unclear in the setting of neoadjuvant therapy. We examined pretreatment maximum standard uptake value (SUV_max) of the primary tumor in patients treated with and without neoadjuvant therapy.     

18F-FDG PET/CT诊断腹膜后纤维化

目的探讨~(18 )F-FDG PET/CT诊断腹膜后纤维化(RPF)的价值。方法回顾性分析因RPF接受~(18 )F-FDG PET/CT检查的12例患者,分析其病灶形态、分布范围和葡萄糖代谢活性最大标准摄取比值(SUV_(max))。结果 12例患者中,7例为初诊患者,5例为治疗后患者。7例初诊RPF患者中4例为继发性,病因分别为IgG4相关疾病、乳腺癌和前列腺癌。12例患者均可见腹主动脉和/或髂血管旁软组织密度病灶,91.67%(11/12)患者可见输尿管受累。初诊RPF患者腹膜后病灶SUV_(max)(4.21±1.76)显著高于治疗后患者(1.46±0.25;P0.05)。依据PET/CT检查结果,3例有代谢活性病灶的特发RPF患者接受激素和/或他莫昔芬等免疫抑制治疗,4例具有活性病灶的继发RPF患者接受针对病因治疗;5例治疗后患者,3例继续当前激素维持剂量治疗,2例未接受其他治疗。结论 PET/CT可用于评价RPF病灶活性和分布范围。     

Clinical utility of (18)F-fluoride PET/CT in benign and malignant bone diseases

¹⁸F labeled sodium fluoride is a positron-emitting, bone seeking agent with more favorable skeletal kinetics than conventional phosphate and diphosphonate compounds. With the expanding clinical usage of PET/CT, there is renewed interest in using ¹⁸F-fluoride PET/CT for imaging bone diseases. Growing evidence indicates that ¹⁸F fluoride PET/CT offers increased sensitivity, specificity, and diagnostic accuracy in evaluating metastatic bone disease compared to ^99mTc based bone scintigraphy. National Oncologic PET Registry (NOPR) has expanded coverage for ¹⁸F sodium fluoride PET scans since February 2011 for the evaluation of osseous metastatic disease. In this article, we reviewed the pharmacological characteristics of sodium fluoride, as well as the clinical utility of PET/CT using ¹⁸F-fluoride in both benign and malignant bone disorders.     

Combined 18F‐fluorocholine and 18F‐fluoride positron emission tomography/computed tomography imaging for staging of high‐risk prostate cancer

Study Type – Diagnosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? Positron emission tomography/computed tomography (PET/CT) with choline and fluoride for the detection of metastases in patients with prostate cancer have each been evaluated, with mixed results. Choline PET/CT has been evaluated against pelvic lymphadenectomy, generally with a low sensitivity but a high specificity; however, the study populations have been heterogenous. Fluoride PET/CT has been evaluated against other imaging methods, such as bone scan, single photon emission CT and MRI, and has been shown to have high specificity as well as sensitivity for bone metastases, but there are no studies with biopsy verification. This is the first study that evaluates the clinical use of both choline and fluoride PET/CT on the same patients in a well‐defined population of patients with high‐risk prostate cancer.

OBJECTIVE

• ? To investigate how often positron emission tomography/computed tomography (PET/CT) scans, with both ¹⁸F‐fluorocholine and ¹⁸F‐fluoride as markers, add clinically relevant information for patients with prostate cancer who have high‐risk tumours and a normal or inconclusive planar bone scan.

PATIENTS AND METHODS

• ? Patients with prostate cancer with prostate specific antigen (PSA) levels between 20 and 99 ng/mL and/or Gleason score 8–10 tumours, planned for treatment with curative intent based on routine staging with a negative or inconclusive bone scan, were further investigated with a ¹⁸F‐fluorocholine and a ¹⁸F‐fluoride PET/CT.
• ? None of the patients received hormonal therapy before the staging procedures were completed.

RESULTS

• ? For 50 of the 90 included patients (56%) one or both PET/CT scans indicated metastases.
• ? ¹⁸F‐fluorocholine PET/CT indicated lymph node metastases and/or bone metastases in 35 patients (39%).
• ? ¹⁸F‐fluoride PET/CT was suggestive for bone metastases in 37 patients (41%).
• ? In 18 patients (20%) the PET/CT scans indicated widespread metastases, leading to a change in therapy intent from curative to non‐curative.
• ? Of the patients with positive scans, 74% had Gleason score 8–10 tumours. Of the patients with Gleason score 8–10 tumours, 64% had positive scans.

CONCLUSIONS

• ? PET/CT scans with ¹⁸F‐fluorocholine and ¹⁸F‐fluoride commonly detect metastases in patients with high‐risk prostate cancer and a negative or inconclusive bone scan.
• ? For 20% of the patients the results of the PET/CT scans changed the treatment plan.