Статті в журналах: "18F-NaF"

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Weinberg, Benjamin Adam, Maria Liza Lindenberg, Karen A. Kurdziel, Seth M. Steinberg, David J. Liewehr, Kattie Khadar, Yolanda McKinney, Peter L. Choyke, and Andrea Borghese Apolo. "Assessment of bone metastases in patients (pts) with urothelial carcinoma using 18F-sodium fluoride PET/CT (18F-NaF) versus 18F-fluorodeoxyglucose PET/CT (18F-FDG)." Journal of Clinical Oncology 32, no. 4_suppl (February 1, 2014): 329. http://dx.doi.org/10.1200/jco.2014.32.4_suppl.329.

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329 Background: 18F-NaF has shown improved sensitivity for bone imaging when compared to conventional planar imaging or SPECT/CT using 99mTc-MDP. We compared the number of bone lesions detected on 18F-NaF versus 18F-FDG in urothelial cancer pts with known bone metastases undergoing treatment. Methods: Pts enrolled in a prospective single-arm phase II study of cabozantinib underwent 18F-NaF and 18F-FDG scans at baseline and at 8 weeks of therapy. In a lesion-based analysis independently confirmed by a nuclear medicine physician, abnormal foci of radiotracer uptake were categorized by location (skull, spine, pelvis, thorax, or long bones) and by disease state (benign, malignant, or indeterminate). A patient-based analysis was performed to determine if findings indicated disease progression, stable disease, or improvement of disease, based on the number of lesions and standardized uptake values (SUVs). Results: 294 total bone lesions were identified at baseline in 10 pts (8 male and 2 female, ages 44-73). 18F-NaF identified more lesions than 18F-FDG at baseline, 294 vs. 119. In a paired analysis, the median difference was 11.5 more lesions detected per patient on 18F-NaF vs. 18F-FDG (by Wilcoxon signed-rank test, p = 0.023). More total thoracic bone lesions at baseline, 100 vs. 23, were also detected on 18F-NaF vs. 18F-FDG, median 6.5 vs. 1.0 with a median difference of 6 more lesions per patient on 18F-NaF (p = 0.016). 18F-NaF also detected more skull lesions at baseline, 19 vs. 1, which was clinically but not statistically significant (p = 0.250). There was general concordance in the patient-based analysis; only 1 18F-NaF scan demonstrated progressive disease while its corresponding 18F-FDG scan showed stable disease. Conclusions:18F-NaF identified more lesions than 18F-FDG at baseline, making it a good staging exam. However, there was agreement between 18F-NaF and 18F-FDG in terms of tumor response in almost all the follow-up scans. Therefore, although a greater number of bone lesions are seen in 18F-NaF compared with 18F-FDG, the clinical significance in assessing treatment response remains to be determined. Clinical trial information: NCT01688999.

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Wang, Dong, YiYang Yang, ZhenPei Zeng, Jing Ye, ChengMao Guo, ShiSang Huang, XuFeng Guo, and JingXing Xiao. "Comparison of Bone Metastases between 18F-NaF PET/CT, 18F-NaF PET, and Planar 99mTc-MDP Bone Scintigraphy in Patients with Newly Diagnosed Nasopharyngeal Carcinoma." Contrast Media & Molecular Imaging 2022 (April 13, 2022): 1–8. http://dx.doi.org/10.1155/2022/5975338.

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Purpose. Our study aims to compare the diagnostic value of 18F-NaF positron emission tomography-computed tomography (PET/CT), 18F-NaF PET, and planar 99mTc-MDP bone scintigraphy for detection of bone metastases in patients with newly diagnosed nasopharyngeal carcinoma (NPC). Methods. Our study retrospectively analyzed 58 patients with pathologically proven NPC. They all underwent both 18F-NaF PET/CT and planar 99mTc-MDP bone scintigraphy within a 7-day interval. Bone metastases were confirmed by follow-up using PET/CT, contrast-enhanced computed tomography (CT), and magnetic resonance imaging (MRI). These three examinations were compared using per-patient-based analysis and per-lesion-based analysis. Results. 19 patients (32.7%) were classified as having bone metastatic disease in their final diagnosis. The patient-based diagnostic performances (sensitivity, specificity, and overall accuracy) were as follows: 18F-NaF PET/CT (100%, 92.3%, and 94.8%), 18F-NaF PET (100%, 53.8%, and 69.0%), and planar 99mTc-MDP bone scintigraphy (78.9%, 74.4%, and 75.9%). The overall accuracy of 18F-NaF PET/CT was significantly more favorable compared to 18F-NaF PET ( p = 0.002 ) and to planar 99mTc-MDP bone scintigraphy ( p = 0.044 ). The lesion-based diagnostic performances (sensitivity, specificity, and overall accuracy) were as follows: 18F-NaF PET/CT (98.5%, 93.9%, and 96.6%), 18F-NaF PET (98.5%, 57.1%, and 81.1%), and planar 99mTc-MDP bone scintigraphy (69.9%, 85.7%, and 76.4%). Conclusion. 18F-NaF PET/CT outperforms 18F-NaF PET or planar 99mTc-MDP bone scintigraphy in detecting bone metastases with newly diagnosed NPC on a patient-based and lesion-based analysis.

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Kwiecinski, Jacek, Piotr J. Slomka, Marc R. Dweck, David E. Newby, and Daniel S. Berman. "Vulnerable plaque imaging using 18F-sodium fluoride positron emission tomography." British Journal of Radiology 93, no. 1113 (September 1, 2020): 20190797. http://dx.doi.org/10.1259/bjr.20190797.

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Positron emission tomography (PET) with 18F-sodium fluoride (18F-NaF) has emerged as a promising non-invasive imaging modality to identify high-risk and ruptured atherosclerotic plaques. By visualizing microcalcification, 18F-NaF PET holds clinical promise in refining how we evaluate coronary artery disease, shifting our focus from assessing disease burden to atherosclerosis activity. In this review, we provide an overview of studies that have utilized 18F-NaF PET for imaging atherosclerosis. We discuss the associations between traditional coronary artery disease measures (risk factors) and 18F-NaF plaque activity. We also present the data on the histological validation as well as show how 18F-NaF uptake is associated with plaque morphology on intravascular and CT imaging. Finally, we discuss the technical challenges associated with 18F-NaF coronary PET highlighting recent advances in this area.

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Sachpekidis, Christos, Annette Kopp-Schneider, Maximilian Merz, Anna Jauch, Marc-Steffen Raab, Hartmut Goldschmidt, and Antonia Dimitrakopoulou-Strauss. "Can 18F-NaF PET/CT before Autologous Stem Cell Transplantation Predict Survival in Multiple Myeloma?" Cancers 12, no. 5 (May 23, 2020): 1335. http://dx.doi.org/10.3390/cancers12051335.

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There is an unmet need for positron emission tomography (PET) radiotracers that can image bone disease in multiple myeloma (MM) in a more sensitive and specific way than the widely used 18F-fluorodeoxyglucose (18F-FDG). Sodium fluoride (18F-NaF) is a highly sensitive tracer of bone reconstruction, evolving as an important imaging agent for the assessment of malignant bone diseases. We attempted to investigate for the first time the prognostic significance of 18F-NaF PET/CT in newly diagnosed, symptomatic MM patients planned for autologous stem cell transplantation (ASCT). Forty-seven patients underwent dynamic and static PET/CT with 18F-NaF before treatment. After correlation with the respective findings on CT and 18F-FDG PET/CT that served as reference, the 18F-NaF PET findings were compared with established factors of high-risk disease, like cytogenetic abnormalities as well as bone marrow plasma cell infiltration rate. Furthermore, the impact of 18F-NaF PET/CT on progression-free survival (PFS) was analyzed. Correlation analysis revealed a moderate, significant correlation of the 18F-NaF parameters SUVaverage and K1 in reference tissue with bone marrow plasma cell infiltration rate. However, no significant correlation was observed regarding all other 18F-NaF PET parameters. Survival analysis revealed that patients with a pathologic 18F-NaF PET/CT have a shorter PFS (median = 36.2 months) than those with a physiologic scan (median = 55.6 months) (p = 0.02). Nevertheless, no quantitative 18F-NaF parameter could be shown to adversely affect PFS. In contrast, the respective analysis for quantitative dynamic 18F-FDG PET/CT revealed that the parameters SUVmax, fractional blood volume (VB), k3 and influx from reference tissue as well as SUVaverage from MM lesions had a significant negative impact on patient survival. The herein presented findings highlight the rather limited role of 18F-NaF PET/CT as a single PET approach in MM.

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Kim, Joseph W., Maria Liza Lindenberg, William L. Dahut, James L. Gulley, Ravi A. Madan, Lauren V. Wood, Yolanda McKinney, Peter L. Choyke, Karen A. Kurdziel, and Andrea Borghese Apolo. "A pilot study on the clinical value of 18F-sodium fluoride PET/CT in advanced prostate cancer." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 10589. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.10589.

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10589 Background: We evaluated the clinical utility of 18F-sodium fluoride PET/CT bone scan (18F-NaF) in the detection of bone metastases in patients (pts) with prostate cancer in comparison with Technetium-99m MDP bone scan (TcBS). Methods: In a prospective study, from October 2010-December 2011, 30 prostate cancer pts (ages 51-79), 21 with known bone metastases and 9 without known bone metastases, had18F-NaF and a TcBS performed. Abnormal foci of uptake on both TcBS and 18F-NaFwere classified as benign, malignant or indeterminate. Benign lesions included uptake in the joints and linear uptake at the endplates of the vertebral bodies consistent with degenerative changes. Malignant uptake on 18F-NaF scans was confirmed by characteristic osteoblastic features on CT. All TcBS and 18F-NaF were reviewed by an experienced nuclear medicine physician. For the patient-based analysis, scan results were categorized as positive (POS) = any malignant lesion; indeterminate (IND) = not distinctly malignant or benign; negative (NEG) = benign lesions only. Results: In the lesion-based analysis, 21 of 30 (70%) pts had more malignant lesions identified on 18F-NaF than on TcBS. The mean number of additional malignant lesions per patient on 18F-NaF vs TcBS was 4. Eight of the 30 pts had same number of malignant lesions identified in both studies. One of 30 pts had one less malignant lesion identified on 18F-NaF than on TcBS. CT correlation by 18F-NaF PET/CT of this particular lesion did not confirm osteoblastic feature. Malignant lesion distribution on 18F-NaF included: spine (28%), thorax (26%), pelvis (24%), long bones (13%) and skull (10%). In the patient-based analysis, 24 pts (80%) were POS by 18F-NaF, of whom 14 pts were POS, 8 were IND, and 2 were NEG by corresponding TcBS; in the 4 pts with NEG 18F-NaF, zero were POS, 2 were IND and 2 were NEG by corresponding TcBS. Conclusions: 18F-NaF identified more malignant lesions than TcBS. 18F-NaF may also add useful information in the management of advanced prostate cancer pts with and without known bone metastases.

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Zhang, Yin, Yue Chen, Zhanwen Huang, Li Zhang, Qiang Wan, and Lei Lei. "Comparison of 18F-NaF PET/CT and 18F-FDG PET/CT for Detection of Skull-Base Invasion and Osseous Metastases in Nasopharyngeal Carcinoma." Contrast Media & Molecular Imaging 2018 (September 5, 2018): 1–7. http://dx.doi.org/10.1155/2018/8271313.

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Our study aimed at comparing the diagnostic value of 18F-NaF positron emission tomography-computed tomography (PET/CT) and 18F-fluorodeoxyglucose (FDG) PET/CT for detection of skull-base invasion and osseous metastases in patients with nasopharyngeal carcinoma (NPC). Our study retrospectively analyzed 45 patients with pathologically proven NPC. They all underwent both 18F-NaF PET/CT and 18F-FDG PET/CT within a 7-day interval. Bone metastases were confirmed by follow-up using PET/CT, enhance-contrast computed tomography (CT), and magnetic resonance image (MRI). These two examinations were compared using per-patient-based analysis and per-lesion-based analysis. 18F-NaF PET/CT detected 27 patients with skull-base invasion, whereas 18F-FDG PET/CT detected 17 patients. 18F-NaF PET/CT and 18F-FDG PET/CT differed significantly in diagnosing skull-base invasion (p=0.02) and sensitivity (p=0.008). The sensitivity, specificity, and agreement rate of 18F-NaF PET/CT for detecting bone metastatic lesions were 98.3%, 65.7%, and 92.9%, respectively; these values were 42.9%, 97.1%, and 51.9%, respectively, for 18F-FDG PET/CT. 18F-NaF PET/CT and 18F-FDG PET/CT differed significantly in the number of osseous metastases detected (t=2.45, p=0.18) sensitivity (p<0.0001) and specificity (p=0.003). In patients with nasopharyngeal carcinoma, 18F-NaF PET/CT assessed invasion of the skull base better and detected more osseous metastases than 18F-FDG PET/CT.

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Lapa, Paula, Tiago Saraiva, Rodolfo Silva, Margarida Marques, Gracinda Costa, and João Pedroso Lima. "Superioridade da PET/CT com FNa-F18 na Deteção de Metástases Ósseas quando Comparada com Outros Métodos de Diagnóstico por Imagem." Acta Médica Portuguesa 30, no. 1 (January 31, 2017): 53. http://dx.doi.org/10.20344/amp.7818.

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Introduction: The 18F-NaF positron emission tomography/computed tomography is being considered as an excellent imaging modalityfor bone metastases detection. This ability was compared with other imaging techniques.Material and Methods: We retrospectively evaluated 114 patients who underwent 18F-NaF positron emission tomography/ computed tomography. Of these, 49 patients also had bone scintigraphy, 61 18F-FDG positron emission tomography/computed tomography and 10 18F-FCH positron emission tomography/computed tomography. We identified the technique that detected the largest number of bone metastases. For the detection of skeletal metastases with the 18F-NaF positron emission tomography/computed tomography study,the contribution of the positron emission tomography component was compared with the contribution of the computed tomography component. Cases in which 18F-NaF positron emission tomography/computed tomography and bone scintigraphy required further additional tests for diagnosis clarification were registered.Results: The 18F-NaF positron emission tomography/computed tomography was superior to bone scintigraphy in 49% of the patients(p < 0.001); it was superior to 18F-FDG positron emission tomography/computed tomography in 59% of the patients (p < 0.001) and it was superior to 18F-FCH positron emission tomography/computed tomography in 40% of the patients (p < 0.001). None of the compared imaging techniques were superior to 18F-NaF positron emission tomography/computed tomography. The positron emission tomography component was superior to computed tomography in 35% of the cases (p < 0.001). Further investigation was suggested in only 3.5% of patients who underwent 18F-NaF positron emission tomography/computed tomography (45% for bone scintigraphy) (p < 0.001).Discussion: As with other authors, our experience also confirms that 18F-NaF positron emission tomography/computed tomography is an excellent imaging modality for the detection of bone metastases, detecting lesions in more patients and more lesions per patient.Conclusion: The 18F-NaF positron emission tomography/computed tomography showed a superior ability for the detection of bone metastases when compared with bone scintigraphy, 18F-FDG positron emission tomography/computed tomography and 18F-FCH positron emission tomography/computed tomography.

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Kwiecinski, Jacek, Damini Dey, Sebastien Cadet, Sang-Eun Lee, Balaji Tamarappoo, Yuka Otaki, Phi T. Huynh, et al. "Predictors of 18F-sodium fluoride uptake in patients with stable coronary artery disease and adverse plaque features on computed tomography angiography." European Heart Journal - Cardiovascular Imaging 21, no. 1 (June 18, 2019): 58–66. http://dx.doi.org/10.1093/ehjci/jez152.

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Abstract Aims In patients with stable coronary artery disease (CAD) and high-risk plaques (HRPs) on coronary computed tomography angiography (CTA), we sought to define qualitative and quantitative CTA predictors of abnormal coronary 18F-sodium fluoride uptake (18F-NaF) by positron emission tomography (PET). Methods and results Patients undergoing coronary CTA were screened for HRP. Those who presented with ≥3 CTA adverse plaque features (APFs) including positive remodelling; low attenuation plaque (LAP, <30 HU), spotty calcification; obstructive coronary stenosis ≥50%; plaque volume >100 mm3 were recruited for 18F-NaF PET. In lesions with stenosis ≥25%, quantitative plaque analysis and maximum 18F-NaF target to background ratios (TBRs) were measured. Of 55 patients, 35 (64%) manifested coronary 18F-NaF uptake. Of 68 high-risk lesions 49 (70%) had increased PET tracer activity. Of the APFs, LAP had the highest sensitivity (39.4%) and specificity (98.3%) for predicting 18F-NaF uptake. TBR values were higher in lesions with LAP compared to those without [1.6 (1.3–1.8) vs. 1.1 (1.0–1.3), P = 0.01]. On adjusted multivariable regression analysis, LAP (both qualitative and quantitative) was independently associated with plaque TBR [LAP qualitative: β = 0.47, 95% confidence interval (CI) 0.30–0.65; P < 0.001] and (LAP volume: β = 0.20 per 10 mm3, 95% CI 0.13–0.27; P < 0.001). Conclusion In stable CAD patients with HRP, LAP is predictive of 18F-NaF coronary uptake, but 18F-NaF is often seen in the absence of LAP. If 18F-NaF uptake is shown to be associated with adverse outcomes and becomes clinically used, the presence of LAP may define patients who would not benefit from the added testing.

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Kwiecinski, Jacek, Martin Lyngby Lassen, and Piotr J. Slomka. "Advances in Quantitative Analysis of 18F-Sodium Fluoride Coronary Imaging." Molecular Imaging 2021 (January 13, 2021): 1–9. http://dx.doi.org/10.1155/2021/8849429.

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18F-sodium fluoride (18F-NaF) positron emission tomography (PET) has emerged as a promising noninvasive imaging tool for the assessment of active calcification processes in coronary artery disease. 18F-NaF uptake colocalizes to high-risk and ruptured atherosclerotic plaques. Most recently, 18F-NaF coronary uptake was shown to be a robust and independent predictor of myocardial infarction in patients with advanced coronary artery disease. In this review, we provide an overview of the advances in coronary 18F-NaF imaging. In particular, we discuss the recently developed and validated motion correction techniques which address heart contractions, tidal breathing, and patient repositioning during the prolonged PET acquisitions. Additionally, we discuss a novel quantification approach—the coronary microcalcification activity (which has been inspired by the widely employed method in oncology total active tumor volume measurement). This new method provides a single number encompassing 18F-NaF activity within the entire coronary vasculature rather than just information regarding a single area of most intense tracer uptake.

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Glasgow, Krystle W. "18F-NaF PET/CT." Journal of Nuclear Medicine Technology 49, no. 2 (June 2021): 105–6. http://dx.doi.org/10.2967/jnmt.121.262379.

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Avanesov, M., M. Karul, and T. Derlin. "18F-NaF-PET-CT." Der Radiologe 54, no. 9 (August 10, 2014): 856–58. http://dx.doi.org/10.1007/s00117-014-2724-5.

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Huang, Franklin W., Brian Trinh, Sunny Wang, and Thomas A. Hope. "Combined 18F-naf and fluciclovine administration for PET imaging of prostate cancer." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e17533-e17533. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e17533.

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e17533 Background: 18F-fluciclovine is FDA approved for the detection of recurrent and metastatic prostate cancer. At our institution, 18F-fluciclovine PET had replaced 18F-NaF PET, but fluciclovine has mild to no uptake in dense sclerotic bony lesions. F18-NaF offers increased sensitivity and specificity in detection of osseous metastases and therefore we converted to using a combination of 18F-NaF and 18F-fluciclovine in patients with biochemical recurrence. In this study, we assessed the feasibility of performing a combined F18- fluciclovine and F18-NaF study, and evaluated the biodistribution of the combined radiotracers in patients with prostate cancer. Methods: We retrospectively reviewed 16 consecutive patients over a period of 3 months. 5 mCi of F18-NaF was injected, followed 45 minutes later by a 10 mCi injection of F18-fluciclovine. Patients were asked to hydrate after NaF injection and empty their bladder immediately prior to scanning. A non-diagnostic CT for attenuation correction and an emission PET scan were acquired on a time of flight Discovery 690 PET/CT (GE Healthcare) within 5 minutes of fluciclovine injection. We characterized the extent of soft tissue and osseous disease, as well as assessed the image quality, taking note for F18-NaF excretion in the bladder and the potential scatter artifact limiting evaluation of the prostate bed. Results: On average patients received 5.5 +/- 0.5 mCi of F18-NaF and 10.4 +/- 0.8 mCi of F18-fluciclovine. All 16 patients had diagnostic quality scans. None had limited evaluation of the prostate bed secondary to artifacts from bladder scatter. 10 patients (62.5%) had residual or recurrent prostate cancer within the prostate bed, of which 3 (18.8%) had distant nodal disease in the perirectal, pelvis, retroperitoneal, or periaortic lymph node regions. 7 patients (43.8%) demonstrated osseous metastatic lesions within the clavicle, sternum, iliac wing, vertebra, coccyx, or sacrum. Conclusions: Combined 18F-NaF and 18F-fluciclovine scans in patients with prostate cancer is a feasible method for detecting soft tissue recurrence and osseous disease. Bladder excretion from F18-NaF does not obscure the prostate bed nor degrades the diagnostic quality of the exam. The combined use of 18F-fluciclovine and F18-NaF in one PET/CT acquisition has the potential to increase the sensitivity for detecting prostate cancer and limit the time and radiation dose delivered compared to the conventional, separate acquisitions of the two radiotracers.

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Omarjee, Loukman, Pierre-Jean Mention, Anne Janin, Gilles Kauffenstein, Estelle Le Pabic, Olivier Meilhac, Simon Blanchard, et al. "Assessment of Inflammation and Calcification in Pseudoxanthoma Elasticum Arteries and Skin with 18F-FluroDeoxyGlucose and 18F-Sodium Fluoride Positron Emission Tomography/Computed Tomography Imaging: The GOCAPXE Trial." Journal of Clinical Medicine 9, no. 11 (October 27, 2020): 3448. http://dx.doi.org/10.3390/jcm9113448.

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Background: Pseudoxanthoma elasticum (PXE) is an inherited metabolic disease characterized by elastic fiber fragmentation and ectopic calcification. There is growing evidence that vascular calcification is associated with inflammatory status and is enhanced by inflammatory cytokines. Since PXE has never been considered as an inflammatory condition, no incidence of chronic inflammation leading to calcification in PXE has been reported and should be investigated. In atherosclerosis and aortic stenosis, positron emission tomography combined with computed tomographic (PET-CT) imaging has demonstrated a correlation between inflammation and calcification. The purpose of this study was to assess skin/artery inflammation and calcification in PXE patients. Methods: 18F-FluroDeoxyGlucose (18F-FDG) and 18F-Sodium Fluoride (18F-NaF) PET-CT, CT-imaging and Pulse wave velocity (PWV) were used to determine skin/vascular inflammation, tissue calcification, arterial calcium score (CS) and stiffness, respectively. In addition, inorganic pyrophosphate, high-sensitive C-reactive protein and cytokines plasma levels were monitored. Results: In 23 PXE patients, assessment of inflammation revealed significant 18F-FDG uptake in diseased skin areas contrary to normal regions, and exclusively in the proximal aorta contrary to the popliteal arteries. There was no correlation between 18F-FDG uptake and PWV in the aortic wall. Assessment of calcification demonstrated significant 18F-NaF uptake in diseased skin regions and in the proximal aorta and femoral arteries. 18F-NaF wall uptake correlated with CS in the femoral arteries, and aortic wall PWV. Multivariate analysis indicated that aortic wall 18F-NaF uptake is associated with diastolic blood pressure. There was no significant correlation between 18F-FDG and 18F-NaF uptake in any of the artery walls. Conclusion: In the present cross-sectional study, inflammation and calcification were not correlated. PXE would appear to more closely resemble a chronic disease model of ectopic calcification than an inflammatory condition. To assess early ectopic calcification in PXE patients, 18F-NaF-PET-CT may be more relevant than CT imaging. It potentially constitutes a biomarker for disease-modifying anti-calcifying drug assessment in PXE.

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Mogensen, Anna Winther, Lars J. Petersen, Christian Torp-Pedersen, Mette Nørgaard, Marie T. Pank, and Helle D. Zacho. "Use of ¹⁸F-NaF PET in the staging of skeletal metastases of newly diagnosed, high-risk prostate cancer patients: a nationwide cohort study." BMJ Open 12, no. 6 (June 2022): e058898. http://dx.doi.org/10.1136/bmjopen-2021-058898.

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ObjectiveTo determine whether preoperative staging of high-risk prostate cancer with 18F-sodium-fluoride (18F-NaF) positron emission tomography (PET) reduces the risk of skeletal metastases.DesignNationwide, population-based cohort study using real-world data.SettingThe study used national health registries, including all sites in Denmark from 2011 to 2018.ParticipantsNewly diagnosed high-risk prostate cancer patients who underwent radical prostatectomy from 2011 to 2018. Patients were stratified into two groups according to the preoperative imaging modality of either 18F-NaF PET or bone scintigraphy.Main outcome measuresThe risk of skeletal-related events (SREs) as a proxy for skeletal metastases following radical prostatectomy. The secondary endpoint was overall survival.ResultsBetween 1 January 2011 and 31 December 2018, 4183 high-risk patients underwent radical prostatectomy. Of these patients, 807 (19.3%) underwent 18F-NaF PET and 2161 (51.7%) underwent bone scintigraphy. The remaining 30% were examined by a different imaging method or did not undergo imaging. Using the inverse probability of treatment weighting to control potential confounding, the HR of experiencing an SRE for patients in the 18F-NaF PET group versus the bone scintigraphy group was 1.15 (95% CI 0.86 to 1.54). The 3-year survival rates were 97.4% (95% CI 96.1 to 98.7) and 97.1% (95% CI 96.4 to 97.9) for patients receiving 18F-NaF PET and bone scintigraphy, respectively.ConclusionPatients with high-risk prostate cancer undergoing preoperative staging with 18F-NaF PET did not display a lower risk of developing SREs after prostatectomy compared with patients undergoing bone scintigraphy. The survival rates were similar between the two groups.

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Park, Peter Sang Uk, William Y. Raynor, Yusha Sun, Thomas J. Werner, Chamith S. Rajapakse, and Abass Alavi. "18F-Sodium Fluoride PET as a Diagnostic Modality for Metabolic, Autoimmune, and Osteogenic Bone Disorders: Cellular Mechanisms and Clinical Applications." International Journal of Molecular Sciences 22, no. 12 (June 17, 2021): 6504. http://dx.doi.org/10.3390/ijms22126504.

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In a healthy body, homeostatic actions of osteoclasts and osteoblasts maintain the integrity of the skeletal system. When cellular activities of osteoclasts and osteoblasts become abnormal, pathological bone conditions, such as osteoporosis, can occur. Traditional imaging modalities, such as radiographs, are insensitive to the early cellular changes that precede gross pathological findings, often leading to delayed disease diagnoses and suboptimal therapeutic strategies. 18F-sodium fluoride (18F-NaF)-positron emission tomography (PET) is an emerging imaging modality with the potential for early diagnosis and monitoring of bone diseases through the detection of subtle metabolic changes. Specifically, the dissociated 18F- is incorporated into hydroxyapatite, and its uptake reflects osteoblastic activity and bone perfusion, allowing for the quantification of bone turnover. While 18F-NaF-PET has traditionally been used to detect metastatic bone disease, recent literature corroborates the use of 18F-NaF-PET in benign osseous conditions as well. In this review, we discuss the cellular mechanisms of 18F-NaF-PET and examine recent findings on its clinical application in diverse metabolic, autoimmune, and osteogenic bone disorders.

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Atanasova Lazareva, Marija, Katerina Kolevska, Maja Chochevska, Maja Velickovska, Filip Jolevski, Ana Ugrinska, and Emilija Janevik-Ivanovska. "Aseptic process validation of [18F]Sodium Fluoride radiopharmaceutical in-house production." Macedonian Pharmaceutical Bulletin 68, no. 1 (January 25, 2023): 27–32. http://dx.doi.org/10.33320/maced.pharm.bull.2022.68.01.003.

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Sodium fluoride ([18F]NaF) is a PET radiopharmaceutical for vizualization of the skeletal system and microcalcification. In the originally designed in-house method, [18F]NaF is recovered in aqueous solution after cyclotron irradiation, sterilized by passage through a 0.22 µm sterile filter and dispensed under aseptic conditions. To ensure the microbiological safety of drugs produced under aseptic conditions, validation of aseptic procedures is always recommended. This is essential for radiopharmaceuticals because most of them are released for administration before any sterility test can be completed due to their radioactive nature. This study reports the validation of the aseptic process applied to the internal production of [18F]NaF carried out in two phases: testing the number of viable microorganisms in radiopharmaceutical product prior to sterilization and process simulation studies (media fill tests). We found that all samples were sterile and the endotoxin concentration was well below the maximum acceptable level reported in the Ph Eur. monograph on [18F]NaF. The results confirmed that the entire production process of [18F]NaF can be carried out under strictly aseptic conditions following the validated procedures preserving the sterility of the final product.

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Madsen, Claus, Peter Østergren, and Christian Haarmark. "The Value of 68Ga-PSMA PET/CT Following Equivocal 18F-NaF PET/CT in Prostate Cancer Patients." Diagnostics 10, no. 6 (May 28, 2020): 352. http://dx.doi.org/10.3390/diagnostics10060352.

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Background: Inconclusive bone scans are a challenge but there is no consensus about follow-up imaging. We evaluated the use of 68gallium-labelled prostate-specific membrane antigen (68Ga-PSMA) PET/CT if 18F-sodium fluoride (18F-NaF) PET/CT was inconclusive. Methods: This retrospective study included patients with no previously known bone metastases who had one or more equivocal bone lesions on 18F-NaF PET/CT and underwent additional 68Ga-PSMA PET/CT. The bone lesions were deemed as true metastases or not based on follow-up by surveying supplemental imaging modalities and hospital records. A subgroup of patients with “most valid follow-up” was created, which included patients with unmeasurable PSA after prostatectomy or subsequent imaging (additional 18F-NaF PET/CT, 68Ga-PSMA PET/CT, CT, or MRI). Results: Of the 2918 patients referred for 18F-NaF PET/CT from the department of urology in the inclusion period, 51 (1.7%) were inconclusive regarding bone metastases and underwent additional 68Ga-PSMA PET/CT. Thirteen of these patients (25%) were ultimately diagnosed with bone metastases. Patient-based sensitivity, specificity, and accuracy of additional 68Ga-PSMA PET/CT were 100%, 95%, and 96%, respectively. In patients with “most valid follow-up”, the same parameters were 100%, 93%, and 94%, respectively. Conclusion: 68Ga-PSMA PET/CT is an excellent complementary modality in when 18F-NaF PET/CT is equivocal.

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Tran, Manh Thang, Van Vinh Mai, Thi Tam Dam, Quang Anh Nguyen, Thi Thu Hien Le, Minh Duc Pham, Tuan Anh Nguyen, et al. "Preparation of ¹⁸F-NaF radiopharmaceuticals using home-made automatic synthesis module at Hanoi Irradiation Center." Nuclear Science and Technology 9, no. 1 (March 15, 2019): 41–49. http://dx.doi.org/10.53747/jnst.v9i1.59.

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The aim of this study is to prepare 18F-NaF radiopharmaceutical using a home-madeautomatic synthesis module consisting of hardware and software which was made by a researcherteam of Hanoi Irradiation Center, HIC, Hanoi, Vietnam. Fluorine-18 isotopes produced in cyclotron KOTRON13 were transferred to the module and radioactive cation impurities were first removed by cation exchange on a carboxymethyl cation exchange (CM) cartridge, and then 18F- ion were trapped by a quaternary methyl ammonium anion exchange (QMA) cartridge. Finally, 18F- was eluated from the cartridge by isotonic saline water (NaCl 0,9% in water) in the form of 18F-NaF. Time of the preparation process was about 13 minutes. Radiochemical yield of the preparation was as high as 95.5%, in average. The qualities of the product were satisfied the criteria of the United StatesPharmacopoeia (USP38). PET/CT bone scaner (skeletal scintigraphy) pre-clinical tests using of the 18 F-NaF product showed good quality of imaging for the entire skeletal and distribution of the 18F-NaF in the kidney and the bladder agreed with it’s natural distribution.

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Hassan, Hishar, Muhamad Faiz Othman, Hairil Rashmizal Abdul Razak, Zainul Amiruddin Zakaria, Fathinul Fikri Ahmad Saad, Mohd Azuraidi Osman, Loh Hui Yi, et al. "Preparation, Optimisation, and In Vitro Evaluation of [18F]AlF-NOTA-Pamidronic Acid for Bone Imaging PET." Molecules 27, no. 22 (November 17, 2022): 7969. http://dx.doi.org/10.3390/molecules27227969.

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[18F]sodium fluoride ([18F]NaF) is recognised to be superior to [99mTc]-methyl diphosphate ([99mTc]Tc-MDP) and 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) in bone imaging. However, there is concern that [18F]NaF uptake is not cancer-specific, leading to a higher number of false-positive interpretations. Therefore, in this work, [18F]AlF-NOTA-pamidronic acid was prepared, optimised, and tested for its in vitro uptake. NOTA-pamidronic acid was prepared by an N-Hydroxysuccinimide (NHS) ester strategy and validated by liquid chromatography-mass spectrometry analysis (LC-MS/MS). Radiolabeling of [18F]AlF-NOTA-pamidronic acid was optimised, and it was ensured that all quality control analysis requirements for the radiopharmaceuticals were met prior to the in vitro cell uptake studies. NOTA-pamidronic acid was successfully prepared and radiolabeled with 18F. The radiolabel was prepared in a 1:1 molar ratio of aluminium chloride (AlCl3) to NOTA-pamidronic acid and heated at 100 °C for 15 min in the presence of 50% ethanol (v/v), which proved to be optimal. The preliminary in vitro results of the binding of the hydroxyapatite showed that [18F]AlF-NOTA-pamidronic acid was as sensitive as [18F]sodium fluoride ([18F]NaF). Normal human osteoblast cell lines (hFOB 1.19) and human osteosarcoma cell lines (Saos-2) were used for the in vitro cellular uptake studies. It was found that [18F]NaF was higher in both cell lines, but [18F]AlF-NOTA-pamidronic acid showed promising cellular uptake in Saos-2. The preliminary results suggest that further preclinical studies of [18F]AlF-NOTA-pamidronic acid are needed before it is transferred to clinical research.

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Sorysz, Danuta, Rafał Januszek, Anna Sowa-Staszczak, Anna Grochowska, Marta Opalińska, Maciej Bagieński, Barbara Zawiślak, et al. "The Usefulness of [18F]F-Fluorodeoxyglucose and [18F]F-Sodium Fluoride Positron Emission Tomography Imaging in the Assessment of Early-Stage Aortic Valve Degeneration after Transcatheter Aortic Valve Implantation (TAVI)—Protocol Description and Preliminary Results." Journal of Clinical Medicine 10, no. 3 (January 22, 2021): 431. http://dx.doi.org/10.3390/jcm10030431.

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Transcatheter aortic valve implantation (TAVI) is now a well-established treatment for severe aortic stenosis. As the number of procedures and indications increase, the age of patients decreases. However, their durability and factors accelerating the process of degeneration are not well-known. The aim of the study was to verify the possibility of using [18F]F-sodium fluoride ([18F]F-NaF) and [18F]F-fluorodeoxyglucose ([18F]F-FDG) positron emission tomography/computed tomography (PET/CT) in assessing the intensity of TAVI valve degenerative processes. In 73 TAVI patients, transthoracic echocardiography (TTE) at initial (before TAVI), baseline (after TAVI), and during follow-up, as well as transesophageal echocardiography (TEE) and PET/CT, were performed using [18F]F-NaF and [18F]F-FDG at the six-month follow-up (FU) visit as a part of a two-year FU period. The morphology of TAVI valve leaflets were assessed in TEE, transvalvular gradients and effective orifice area (EOA) in TTE. Calcium scores and PET tracer activity were counted. We assessed the relationship between [18F]F-NaF and [18F]F-FDG PET/CT uptake at the 6 = month FU with selected indices e.g.,: transvalvular gradient, valve type, EOA and insufficiency grade at following time points after the TAVI procedure. We present the preliminary PET/CT ([18F]F-NaF, [18F]F-FDG) results at the six-month follow-up period as are part of an ongoing study, which will last two years FU. We enrolled 73 TAVI patients with the mean age of 82.49 ± 7.11 years. A significant decrease in transvalvular gradient and increase of effective orifice area and left ventricle ejection fraction were observed. At six months, FU valve thrombosis was diagnosed in four patients, while 7.6% of patients refused planned controls due to the COVID-19 pandemic. We noticed significant correlations between valve types, EOA and transaortic valve gradients, as well as [18F]F-NaF and [18F]F-FDG uptake in PET/CT. PET/CT imaging with the use of [18F]F-FDG and [18F]F-NaF is intended to be feasible, and it practically allows the standardized uptake value (SUV) to differentiate the area containing the TAVI leaflets from the SUV directly adjacent to the ring calcifications and the calcified native leaflets. This could become the seed for future detection and evaluation capabilities regarding the progression of even early degenerative lesions to the TAVI valve, expressed as local leaflet inflammation and microcalcifications.

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Piccardo, A., M. Puntoni, S. Morbelli, F. Bongioanni, F. Paparo, V. Altrinetti, R. Gonella, et al. "18F-FDG PET/CT is a prognostic biomarker in patients affected by bone metastases from breast cancer in comparison with 18F-NaF PET/CT." Nuklearmedizin 54, no. 04 (2015): 163–72. http://dx.doi.org/10.3413/nukmed-0727-15-02.

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SummaryAim: To compare 18F-FDG PET/CT and 18F-NaF PET/CT with respect to disease prognostication and outcome in patients affected by bone metastases from breast cancer (BC). Patients, methods: We retrospectively investigated 32 women with BC and documented bone metastases. Semi-quantitative parameters were applied to 18F-FDG PET/CT and 18F-Na PET/CT in order to evaluate disease extent and tumour metabolism. We used time-to-event analyses (Kaplan Meier and COX proportional hazard methods) to estimate progression-free (PFS) and overall survival (OS) in order to assess the independent prognostic value of 18F-FDG PET/CT and 18F-Na PET/CT. Results: The sensitivity of 18F-NaF PET/CT (100%) was higher (p < 0.05) than that of 18F-FDG PET/CT (72% and 72%). None of the 18F-FDG PET/CT-negative patients showed disease progression at the end of follow-up. After adjustment for age, Ki-67 levels, presence of visceral metastases, hormone therapy, duration of bone disease and response to first-line therapy, only 18F-FDG SUV mean [HR 15.7, 95% confidence interval (CI) 1.15-214.5] and 18F-FDG whole-body bone metabolic burden (WB-B-MB) (HR 16.9; 95%CI 1.87-152.2) were independently and significantly associated with OS. None of the 18F-NaF PET/CT parameters were associated with OS. None of the conventional clinical prognostic parameters remained significantly associated with OS after the inclusion of PET/ CT parameters in the model. Conclusion: 18F-FDG PET/CT is independently associated with OS in BC patients with bone metastases and its prognostic impact seems to be higher than conventional clinical and biological prognostic factors. Although 18F-NaF PET/CT has a higher diagnostic sensitivity than 18F-FDG PET/ CT, it is not independently associated with OS.

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Murtazalieva, P. M., D. V. Ryzhkova, O. B. Irtyuga, E. G. Malev, S. A. Kukushkina, E. V. Zhiduleva, and O. M. Moiseeva. "¹⁸F-sodium fluoride and ¹⁸F-fluorodeoxyglucose positron emission tomography for assessment of aortic valve inflammation and calcification in patients with aortic stenosis." Russian Journal of Cardiology, no. 12 (December 28, 2019): 33–38. http://dx.doi.org/10.15829/1560-4071-2019-12-33-38.

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Aim. To determine the inflammation and calcification activity in aortic stenosis (AS) by assessing the accumulation of 18F-FDG and 18F-NaF in the aortic valve; to study the relationship of the AS severity, aortic calcification and the accumulation of 18F-FDG and 18F-NaF. Material and methods. The study included 62 patients with asymptomatic AS (29 patients with tricuspid (TAV) and 33 with bicuspid (BAV) aortic valve), aged 40 to 70 years. The maximum flow rate at the aortic valve (Vmax) differs from 2,4 m/s to 4,5 m/s. The mean age of patients was 59,44±7,33 years, M:W 1:1. Patients with infective endocarditis and chronic rheumatic heart disease were excluded. The AS severity was assessed according to the standard protocol of transthoracic echocardiography with the use of Vivid 7 ultrasound system (GE,USA). All patients underwent combined positron emission tomography/computed tomography (PET/CT) of the aortic valve using the Discovery 710 system. Evaluation of calcification and inflammation activity of the aortic valve was performed using 8F-NaF and 18F-FDG PET/CT. A quantitative assessment of radiopharmaceuticals accumulation was carried out using uptake ratio indices. The calcium score was calculated using SmartScore 4.0 software.Results. Patients with TAV and BAV were comparable in severity of AS, the median Vmax was 2,9 [2,6; 3,4] m/s and 2,9 [2,3; 3,3] m/s, respectively. Also, TAV and BAV patients did not differ in calcification values (Agatston score 1088 [465; 2192] and 1128 [442; 2391] HU, respectively). The association of 18F-FDG accumulation and AS severity has not been established. At the same time, the association was found between the aortic valve peak velocity and the calcium score (r=0,57, p< 0,0001), as well as the 18F-NaF accumulation values — maximum, mean and maximum to mean (r=0,37, p=0,002; r=0,46, p=0,0001 and r=0,41, p=0,0008, respectively). No association between the accumulation of 18F-FDG and 18F-NaF (r=0,098, p=0,49) was found.Conclusion. It was found that the inflammation according to 18F-FDG PET/CT does not play a significant role in AS pathogenesis. At this time, 18F-NaF PET/CT is a reliable method for the AS diagnosis and valve calcification assessment. It can be used to evaluate the prognosis and effectiveness of therapy in TAV and BAV patients.

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Kaiser, Yannick, Nick S. Nurmohamed, Jeffrey Kroon, Hein J. Verberne, Evangelos Tzolos, Marc R. Dweck, Aernout G. Somsen, et al. "Lipoprotein(a) has no major impact on calcification activity in patients with mild to moderate aortic valve stenosis." Heart 108, no. 1 (September 30, 2021): 61–66. http://dx.doi.org/10.1136/heartjnl-2021-319804.

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ObjectiveTo assess whether patients with aortic valve stenosis (AS) with elevated lipoprotein(a) (Lp(a)) are characterised by increased valvular calcification activity compared with those with low Lp(a).MethodsWe performed 18F-sodium fluoride (18F-NaF) positron emission tomography/CT in patients with mild to moderate AS (peak aortic jet velocity between 2 and 4 m/s) and high versus low Lp(a) (>50 mg/dL vs <50 mg/dL, respectively). Subjects were matched according to age, gender, peak aortic jet velocity and valve morphology. We used a target to background ratio with the most diseased segment approach to compare 18F-NaF uptake.Results52 individuals (26 matched pairs) were included in the analysis. The mean age was 66.4±5.5 years, 44 (84.6%) were men, and the mean aortic valve velocity was 2.80±0.49 m/s. The median Lp(a) was 79 (64–117) mg/dL and 7 (5–11) mg/dL in the high and low Lp(a) groups, respectively. Systolic blood pressure and low-density-lipoprotein cholesterol (corrected for Lp(a)) were significantly higher in the low Lp(a) group (141±12 mm Hg vs 128±12 mm Hg, 2.5±1.1 mmol/L vs 1.9±0.8 mmol/L). We found no difference in valvular 18F-NaF uptake between the high and low Lp(a) groups (3.02±1.26 vs 3.05±0.96, p=0.902). Linear regression analysis showed valvular calcium score to be the only significant determinant of valvular 18F-NaF uptake (β=0.63; 95% CI 0.38 to 0.88 per 1000 Agatston unit increase, p<0.001). Lp(a) was not associated with 18F-NaF uptake (β=0.17; 95% CI −0.44 to 0.88, p=0.305 for the high Lp(a) group).ConclusionAmong patients with mild to moderate AS, calcification activity is predominantly determined by established calcium burden. The results do not support our hypothesis that Lp(a) is associated with valvular 18F-NaF uptake.

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Usmani, Sharjeel, Najeeb Ahmed, Gopinath Gnanasegaran, Rashid Rasheed, Fahad Marafi, Mashari Alnaaimi, Mohammad Omar, et al. "The clinical effectiveness of reconstructing 18F-sodium fluoride PET/CT bone using Bayesian penalized likelihood algorithm for evaluation of metastatic bone disease in obese patients." British Journal of Radiology 94, no. 1120 (April 1, 2021): 20210043. http://dx.doi.org/10.1259/bjr.20210043.

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Objective: A new Bayesian penalized likelihood reconstruction algorithm for positron emission tomography (PET) (Q.Clear) is now in clinical use for fludeoxyglucose (FDG) PET/CT. However, experience with non-FDG tracers and in special patient populations is limited. This pilot study aims to compare Q.Clear to standard PET reconstructions for 18F sodium fluoride (18F-NaF) PET in obese patients. Methods: 30 whole body 18F-NaF PET/CT scans (10 patients with BMI 30–40 Kg/m2 and 20 patients with BMI >40 Kg/m2) and a NEMA image quality phantom scans were analyzed using ordered subset expectation maximization (OSEM) and Q.Clear reconstructions methods with B400, 600, 800 and 1000. The images were assessed for overall image quality (IQ), noise level, background soft tissue, and lesion detectability, contrast recovery (CR), background variability (BV) and contrast-to-noise ratio (CNR) for both algorithms. Results: CNR for clinical cases was higher for Q.Clear than OSEM (p < 0.05). Mean CNR for OSEM was (21.62 ± 8.9), and for Q.Clear B400 (31.82 ± 14.6), B600 (35.54 ± 14.9), B800 (39.81 ± 16.1), and B1000 (40.9 ± 17.8). As the β value increased the CNR increased in all clinical cases. B600 was the preferred β value for reconstruction in obese patients. The phantom study showed Q.Clear reconstructions gave lower CR and lower BV than OSEM. The CNR for all spheres was significantly higher for Q.Clear (independent of β) than OSEM (p < 0.05), suggesting superiority of Q.Clear. Conclusion: This pilot clinical study shows that Q.Clear reconstruction algorithm improves overall IQ of 18F-NaF PET in obese patients. Our clinical and phantom measurement results demonstrate improved CNR and reduced BV when using Q.Clear. A β value of 600 is preferred for reconstructing 18F-NaF PET/CT with Q.Clear in obese patients. Advances in knowledge: 18F-NaF PET/CT is less susceptible to artifacts induced by body habitus. Bayesian penalized likelihood reconstruction with18F-NaF PET improves overall IQ in obese patients.

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Fakhrejahani, Farhad, Maria Liza Lindenberg, Ethan S. Bargvall, Esther Mena, Baris Turkbey, Stephen Adler, James L. Gulley, et al. "Imaging metastatic prostate cancer with 18F-DCFBC PET/CT (DCFBC) and 18F-NaF PET/CT (NaF)." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 231. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.231.

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231 Background: Conventional imaging of advanced prostate cancer (computerized tomography and nuclear bone scintigraphy) is limited and indicates a need for a more specific molecular imaging probe. DCFBC is a radiolabeled PET agent that binds with high affinity to prostate specific membrane antigen (PSMA), which is overexpressed in almost all prostate cancers and through whole-body non-invasive functional imaging, may provide new information on the expression of PSMA. We compare the uptake of DCFBC in bone with respect to NaF PET/CT in metastatic prostate cancer patients. DCFBC has added capability to detect soft tissue metastasis whereas NaF is confined to secondary effects of bone disease. Methods: Subjects with known or suspected prostate cancer metastasis underwent DCFBC PET/CT imaging performed at 1 hour and 2 hours after IV bolus injection of 8 mCi of DCFBC. Patients also underwent a whole body NaF PET/CT scan within 3 weeks of DCFBC PET/CT to assess for bone metastases. Patients received 3 mCi of NaF IV bolus and then were imaged 1hour post injection. PSA levels and antiandrogen therapy status were obtained at the time of DCFBC imaging. Results: Fifteen patients have been preliminarily analyzed. PSA ranged from < .01 to 4379 ng/mL. NaF identified bone lesions in 10 patients but matching focal DCFBC uptake was only seen in 3 patients. DCFBC additionally showed lymph node metastasis in 1of these 3 patient. There were 5 patients without focal abnormal bone uptake on NaF or DCFBC. In this group, 4 of 5 patients had focal DCFBC uptake in lymph nodes or soft tissue lesions. Ten patients were on some form of androgen deprivation therapy (ADT). For those on ADT, 7 of 10 patients had positive findings on NaF, compared to 2 of 10 patients on DCFBC. Conclusions: DCFBC uptake in bone metastasis does not routinely correspond to focal NaF uptake which could be due to distinct mechanisms of tracer uptake and tumor biology. There is an inverse association in focal bone findings when comparing each tracer on antiandrogen therapy. Through whole-body non-invasive functional imaging and further study, DCFBC may prove useful in characterizing prostate cancer based on PSMA expression. Clinical trial information: NCT02190279.

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Liu, Huipan, Lin Liu, Wenhui Fu, and Yue Chen. "18F-NaF Uptake in Breast Cancer." Clinical Nuclear Medicine 45, no. 11 (June 10, 2020): 878–79. http://dx.doi.org/10.1097/rlu.0000000000003114.

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Tan, Esther, Liza Lindenberg, Neha Korde, Alexandra Berg, Esther Mena, Baris Turkbey, Omer Aras, et al. "Novel Molecular Imaging Detects Evidence of Altered Bone Marrow Biology in Myeloma Precursor Disease (MGUS and smoldering myeloma): A Prospective Clinical Study." Blood 118, no. 21 (November 18, 2011): 2888. http://dx.doi.org/10.1182/blood.v118.21.2888.2888.

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Abstract Abstract 2888 Despite its poor sensitivity to detect bone lesions, its inability to define focal disease in the bone marrow, and its incapacity to identify extramedullary disease; skeletal survey remains the gold standard in multiple myeloma (MM). We conducted a prospective clinical study to evaluate novel molecular imaging in MM and its precursors (monoclonal gammopathy of undetermined significance, MGUS; smoldering myeloma, SMM). We included 10 MGUS, 10 SMM, and 10 MM (2/8; untreated/treated) patients. To define evidence of osteolytic lesions and extramedullary disease, all patients were assessed by skeletal survey, fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), 18F-sodium fluoride (18F-NaF) PET/CT. To assess bone marrow vascularity we conducted dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI). Using DCE-MRI, we compared exchange rate constants (contrast agent transit from the extravascular compartment to the intravascular compartment, kep ; movement of contrast agent from plasma to extravascular extracellular space, ktrans) with bone marrow biopsies immunostained with CD34 as measures of microvessel density (MVD). All but one MGUS patients were negative by 18F-FDG. One had indeterminate uptake in possible early myelomatous lesions but was negative on 18F-NaF. Two MGUS patients had unexplained focal uptake in bone (one in the left orbital sphenoid and another in the left temporal bone) without CT abnormalities. Two SMM patients had abnormalities by PET/CT. One SMM patient had subtle increased 18F-NaF PET uptake in T12 which corresponded to CT, MRI and DCE-MRI abnormalities in this region; 18F-FDG PET and skeletal survey were negative. Another SMM patient had increased 18F-FDG PET uptake in the left clavicle with negative 18F-NaF that was biopsy proven to be consistent with disease. In 8 MM patients, both 18F-FDG and 18F-NaF PET/CT showed mild to moderate positive PET uptake corresponding with CT abnormalities; the remaining 2 MM patients had CT abnormalities, which were 18F-NaF positive, corresponding with skeletal survey, while 18F-FDG PET was negative. Immunohistochemistry and kep were correlated (r=0.64 and p=0.0003), and DCE-MRI showed higher kep levels in MM versus MGUS patients (mean kep 9.4 vs. 5.0; p<0.05); suggesting that increased MVD may be associated with transformation from early precursor disease to frank malignancy. In 2 MGUS patients and 1 SMM patient, DCE-MRI showed focal disease in the bone marrow. Novel molecular imaging techniques detected evidence of altered bone marrow biology in myeloma precursor disease, which was not found on skeletal survey. Our results emphasize the broad biological and clinical heterogeneity in myeloma precursor disease, and the need for molecularly defined phenotypes. This study provides new avenues for future investigations designed to (1) initiate/monitor early treatment in high-risk myeloma precursor disease and (2) to monitor minimal residual disease and/or to detect early relapse. Detailed imaging, clinical, and molecular data will be presented at the meeting. Disclosures: No relevant conflicts of interest to declare.

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Puri, Tanuj, Michelle L. Frost, Gary J. Cook, and Glen M. Blake. "[18F] Sodium Fluoride PET Kinetic Parameters in Bone Imaging." Tomography 7, no. 4 (December 1, 2021): 843–54. http://dx.doi.org/10.3390/tomography7040071.

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This report describes the significance of the kinetic parameters (k-values) obtained from the analysis of dynamic positron emission tomography (PET) scans using the Hawkins model describing the pharmacokinetics of sodium fluoride ([18F]NaF) to understand bone physiology. Dynamic [18F]NaF PET scans may be useful as an imaging biomarker in early phase clinical trials of novel drugs in development by permitting early detection of treatment-response signals that may help avoid late-stage attrition.

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Atanasova Lazareva, Marija, Ana Ugrinska, and Emilija Janevik-Ivanovska. "RESEARCH ON THE INFLUENCE OF DIFFERENT TYPES OF ANION-EXCHANGE CARTRIDGES ON THE QUALITY OF [18F]NAF RADIOPHARMACEUTICAL AS PART OF PRODUCTION PROCESS DEVELOPMENT." KNOWLEDGE - International Journal 54, no. 4 (September 30, 2022): 661–67. http://dx.doi.org/10.35120/kij5404661a.

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[18F]Sodium Fluoride radiopharmaceutical is a sterile solution for intravenous administration, intendedfor skeletal visualization by positron emission tomography (PET). [18F]Sodium Fluoride for bone imaging wasintroduced in early 1960's, but with the increased availability of PET scanners in the last two decades, thisradiopharmaceutical has growing use in clinical practice for the detection of bone metastases. The productionprocess of [18F]NaF includes production of the radioisotope [18F]F- and purification and formulation of the [18F]NaFradiopharmaceutical. The radioisotope [18F]F- is produced by a cyclotron via the 18O(p,n)18F nuclear reaction,followed by recovery of [18F]F- from [18O] proton-irradiated water by adsorption and desorption from anionexchangeresins. The fluoride anions are trapped on the anion-exchange SPE (solid-phase extraction) cartridge, andall other cationic and water-soluble radionuclide impurities present in irradiated enriched water are collected in thewaste vial. Next step is desorption of the fluoride anions from the cartridge by elution with saline solution (0.9%NaCl). This study aimed to define the most appropriate type of anion-exchange SPE cartridge which could be usedfor routine production [18F]Sodium fluoride radiopharmaceutical which meets the quality requirements defined inEuropean pharmacopeia monograph. For that purpose, as part of development of in-house production method,manual productions with four different types of anion-exchange cartridges were performed. The influence of sorbentsubstrate and counter-ion of the cartridge on the final yield and the quality of the produced radiopharmaceutical wasinvestigated. The study also aimed to define the minimum volume of physiological solution required for the pHparameter to be within limits.The results have shown that the quality parameters: appearance, chemical purity, radiochemical purity andradionuclide purity were in defined acceptance criteria and did not differ when using different anion-exchangecartridges. The pH analyses have demonstrated that the type of cartridge and counter-ion influence the final pH of[18F]NaF solution. This study confirmed that the three types of anion-exchange resins (QMA-Cl-, QMA-CO32- andPS-OH-) could be used for production. In the experiments where QMA-Cl- was used, the required pH level wasobtained even without dilution. The other cartridges could be used in the [18F]NaF production process, but furtherdilution is necessary in order to obtain the pH value in acceptance criteria. On the basis of this study, the QMA-Cl- ischosen as a cartridge to be used in the further development of the in-house method for [18F]NaF radiopharmaceuticalproduction.

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Cecelja, Marina, Amelia Moore, Ignac Fogelman, Michelle L. Frost, Glen M. Blake, and Phil Chowienczyk. "Evaluation of aortic 18F-NaF tracer uptake using PET/CT as a predictor of aortic calcification in postmenopausal women: A longitudinal study." JRSM Cardiovascular Disease 8 (January 2019): 204800401984887. http://dx.doi.org/10.1177/2048004019848870.

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Introduction Aortic calcification as detected by computed tomography is associated with arterial stiffening and is an important predictor of cardiovascular morbidity and mortality. Uptake of 18F-sodium fluoride (18F-NaF) in the aortic wall reflects metabolically active areas of calcification. The aim of this study was to determine if 18F-NaF uptake in the aorta is associated with calcification and progression of calcification as detected by computed tomography. Methods Twenty-one postmenopausal women (mean age 62 ± 6 years) underwent assessment of aortic 18F-NaF uptake using positron emission tomography/computer tomography at baseline and a repeat computed tomography scan after a mean follow-up of 3.8 ± 1.3 years. Tracer uptake was quantified by calculating the target-to-background (TBR) ratios at baseline and follow-up. Calcification was assessed at baseline and follow-up using computed tomography. Results Over the follow-up period, aortic calcium volume increased from 0.46 ± 0.62 to 0.71 ± 0.93 cm3 ( P < 0.05). However, the change in calcium volume did not correlate with baseline TBR either unadjusted ( r = 0.00, P = 1.00) or adjusted for age and baseline calcium volume (beta coefficient = −0.18, P = 0.42). TBR at baseline did not differ between participants with ( n = 16) compared to those without ( n = 5) progression in calcium volume (2.43 ± 0.46 vs. 2.31 ± 0.38, P = 0.58). In aortic segments identified to have the highest tracer uptake at baseline, calcium volume did not significantly change over the follow-up period ( P = 0.41). Conclusion In a cohort of postmenopausal women, 18F-NaF uptake as measured by TBR in the lumbar aorta did not predict progression of aortic calcification as detected by computed tomography over a four-year follow-up.

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Lillo, Eugenia, Antonio Gutierrez-Cardo, Belén Murcia-Casas, Juan Luis Carrillo-Linares, Francisco Garcia-Argüello, Reinaldo Chicharo de Freitas, Isabel Baquero-Aranda, Pedro Valdivielso, María García-Fernández, and Miguel Ángel Sánchez-Chaparro. "Cutaneous and Vascular Deposits of 18F-NaF by PET/CT in the Follow-Up of Patients with Pseudoxanthoma Elasticum." Journal of Clinical Medicine 10, no. 12 (June 11, 2021): 2588. http://dx.doi.org/10.3390/jcm10122588.

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Active microcalcification of elastic fibers is a hallmark of pseudoxanthoma elasticum and it can be measured with the assessment of deposition of 18F-NaF using a PET/CT scan at the skin and vascular levels. It is not known whether this deposition changes over time in absence of specific therapy. We repeated in two years a PET/CT scan using 18F-NaF as a radiopharmaceutical in patients with the disease and compared the deposition at skin and vessel. Furthermore, calcium score values at the vessel wall were also assessed. Main results indicate in the vessel walls that calcification progressed in each patient; by contrast, the active microcalcification, measured and target-to-background ratio showed reduced active deposition. By contrast, at skin levels (neck and axillae) the uptake of the pharmaceutical remains unchanged. In conclusion, because calcification in the arterial wall is not specific for pseudoxanthoma elasticum condition, the measurement of the deposition of 18F-NaF in the neck might be potentially used as a surrogate marker in future trials for the disease.

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Czernin, J., N. Satyamurthy, and C. Schiepers. "Molecular Mechanisms of Bone 18F-NaF Deposition." Journal of Nuclear Medicine 51, no. 12 (November 15, 2010): 1826–29. http://dx.doi.org/10.2967/jnumed.110.077933.

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33

Raynor, William Y., Abdullah Al-Zaghal, Thomas J. Werner, Poul F. Høilund-Carlsen, and Abass Alavi. "18F-NaF PET/CT in Prostatic Calculi." Clinical Nuclear Medicine 43, no. 12 (December 2018): e484-e485. http://dx.doi.org/10.1097/rlu.0000000000002317.

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Kothekar, Esha, William Y. Raynor, Thomas J. Werner, Abass Alavi, and Joshua F. Baker. "18F-NaF Uptake in Calcified Uterine Leiomyoma." Clinical Nuclear Medicine 44, no. 11 (November 2019): e620-e621. http://dx.doi.org/10.1097/rlu.0000000000002628.

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Kothekar, Esha, Siavash Mehdizadeh Seraj, Fatemeh Kaghazchi, Thomas J. Werner, and Abass Alavi. "18F-NaF Uptake in Ocular Prosthesis (Implant)." Clinical Nuclear Medicine 45, no. 1 (January 2020): e59-e60. http://dx.doi.org/10.1097/rlu.0000000000002700.

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Papadakis, Georgios Z., Corina Millo, Ulas Bagci, Jenny Blau, and Michael T. Collins. "18F-NaF and 18F-FDG PET/CT in Gorham-Stout Disease." Clinical Nuclear Medicine 41, no. 11 (November 2016): 884–85. http://dx.doi.org/10.1097/rlu.0000000000001369.

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37

Barragan-Campos, Hector Manuel, Anne Laurence Le Faou, Martín Burgos-Jaramillo, Fernando Lopez-Soto, Javier Altamirano Ley, and Roberto De la Peña-Lopez. "Detection of bone metastases through diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) compared with PET/CT 18F-NaF." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e23086-e23086. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e23086.

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e23086 Background: To evaluate a diagnostic test which can allow the comparison between Diffusion-weighted imaging with background suppression (DWIBS) the novel diagnostic modality versus PET/CT 18F-NaF, the gold standard for the diagnosis of bone metastases (BM). Methods: University bioethics committee authorized the protocol. Patients with solid cancer and suspicion of BM (by clinical findings, imaging, and tumor biomarkers), who met inclusion criteria were included and provided their signed informed consent. The DWIBS in a MR 3.0 T was performed first and then the PET/CT 18F-NaF. Each study was interpreted blinded. Statistics to evaluate a diagnostic test were performed. Results: From April 2014 to April 2016, 91 patients (100%) were interviewed, 88 (93.4%) met the inclusion criteria. Nine patients (8%) were excluded: death 3, respiratory failure 2, refused participating 2, pacemaker 1, claustrophobia 1. Seventy-nine patients (86.8%) were included, of which 81.0% (64/79) were women. Primary cancer was: a) breast 73.4 b) prostate 15.2%; c) Non-Hodgkin lymphoma 2.5%; d) cervical 2.5%; e) thyroid 2.5%; f) lung 1.3%; g) colon 1.3%; and h) testicular 1.3%. Diagnostic performance of DWIBS compared to PET/CT 18F-NaF, sensitivity 88.1% (Confidence Interval [CI95%, 73.3-96.0), specificity of 48.7% (CI 95%, 31.9-65.6), PPV of 66.0% (CI 95%, 58.2-73.1), NPV of 78.3% (CI 95%, 59.7-89.7), PLR 1.7 (CI 95%, 1.2-2-4), NLR 0.2 (CI 95%, 0.1-0.6) and prevalence of 53.1% (CI 95%, 41.6-54.5). Results were stratified in quartiles (excellent, good, fair, and poor). Conclusions: DWIBS has excelent sensibility, fair specificity, good PPV, and excellent NPV. These data suggest DWIBS could be used as a proxy of PET/CT 18F-NaF.

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Dadgar, Habibollah, Nasim Norouzbeigi, Narges Jokar, Jafar Zareizadeh, Ali Gholamrezanezhad, Hojjat Ahmadzadehfar, Moloud Abbaszadeh, and Majid Assadi. "Comparison of 18F-NaF Imaging, 99mTc-MDP Scintigraphy, and 18F-FDG for Detecting Bone Metastases." World Journal of Nuclear Medicine 21, no. 01 (March 2022): 001–8. http://dx.doi.org/10.1055/s-0042-1748154.

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AbstractBone is a common metastasis site in several malignancies, most importantly prostate and breast cancers. Given the significance of the early and accurate diagnosis of bone metastases for preliminary staging, treatment planning and monitoring, restaging, and survival prediction in patients with malignancy, it is critical to compare and contrast the strengths and weaknesses of imaging modalities. Although technetium-99m-labeled diphosphonates [99mTc-MDP] scintigraphy has been used for assessing skeletal involvement, there is a renewed interest in fluorine-18-labeled sodium fluoride [18F-NaF] bone imaging with positron emission tomography or positron emission tomography/computed tomography, since this approach provides essential advantages in bone metastases evaluation. This review study aimed to discuss the basic and technical aspects of 18F-NaF imaging and its mechanism of action, and compare this modality with the 99mTc-MDP bone scan and 18F-fluorodeoxyglucose using current evidence from the pertinent literature and case examples of the center in the study.

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Gutierrez-Cardo, Antonio, Eugenia Lillo, Belén Murcia-Casas, Juan Luis Carrillo-Linares, Francisco García-Argüello, Purificación Sánchez-Sánchez, Alejandro Rodriguez-Morata, et al. "Skin and Arterial Wall Deposits of 18F-NaF and Severity of Disease in Patients with Pseudoxanthoma Elasticum." Journal of Clinical Medicine 9, no. 5 (May 8, 2020): 1393. http://dx.doi.org/10.3390/jcm9051393.

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Pseudoxanthoma elasticum (PXE) is a genetic disease characterized by the calcification of elastin fibers. Our aim was to quantify vascular calcification in the arteries and the deposition of 18F-sodium-fluoride (18F-NaF) in the skin and vessel walls with positron emission tomography/computed tomography. This was an observational study including 18 patients with PXE. Vascular calcification was measured in Agatston units, and deposition in the skin and vessel walls was shown using target-to-background ratio (TBR). Severity of the disease was scored by Phenodex. We found higher vascular calcification in the popliteal, femoral, and aortic arch vessels compared to other vascular regions; however, the uptake of radiotracer was the highest in the aorta and femoral arteries. In the skin, the highest uptake was observed in the neck and the axillae. There was no significant association between 18F-NaF deposition in the arteries or skin and the global Phenodex score. In contrast, the Phenodex score was significantly associated in univariate analyses with the averaged vascular calcium score (p < 0.01). In the neck, patients with higher skin Phenodex scores exhibited higher radiotracer uptake. As a conclusion, because vascular calcification is physiological, our data suggested that the detection of cutaneous (neck) 18F-NaF deposits might serve to monitor the calcification process in the short-term for patients with PXE.

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Kothekar, Esha, William Y. Raynor, Abdullah Al-Zaghal, Thomas J. Werner, and Abass Alavi. "Incidental 18F-NaF Uptake in Drug-Induced Gynecomastia." Clinical Nuclear Medicine 44, no. 4 (April 2019): e303-e304. http://dx.doi.org/10.1097/rlu.0000000000002401.

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Van Der Gucht, Axel, Arnault Galat, Jean Rosso, Aziz Guellich, Jérôme Garot, Diane Bodez, Violaine Plante-Bordeneuve, et al. "[18F]-NaF PET/CT imaging in cardiac amyloidosis." Journal of Nuclear Cardiology 23, no. 4 (September 24, 2015): 846–49. http://dx.doi.org/10.1007/s12350-015-0287-0.

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Tawakol, Ahmed, Michael T. Osborne, and Francis J. McGovern. "Penile Artery 18F-NaF Uptake and Erectile Dysfunction." Journal of the American College of Cardiology 73, no. 12 (April 2019): 1395–97. http://dx.doi.org/10.1016/j.jacc.2018.10.073.

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Lee, Hyunjong, Kyu Sang Lee, and Won Woo Lee. "18F-NaF PET/CT Findings in Fibrous Dysplasia." Clinical Nuclear Medicine 40, no. 11 (November 2015): 912–14. http://dx.doi.org/10.1097/rlu.0000000000000948.

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Shao, Fuqiang, Yue Chen, Zhanwen Huang, Liang Cai, and Yin Zhang. "Unexpected Pregnancy Revealed on 18F-NaF PET/CT." Clinical Nuclear Medicine 41, no. 4 (April 2016): e202-e203. http://dx.doi.org/10.1097/rlu.0000000000000984.

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Salgarello, Matteo, Gianluigi Lunardi, Alessandro Inno, Stefano Pasetto, Fabrizia Severi, Giancarlo Gorgoni, and Stefania Gori. "18F-NaF PET/CT Imaging of Brain Metastases." Clinical Nuclear Medicine 41, no. 7 (July 2016): 564–65. http://dx.doi.org/10.1097/rlu.0000000000001186.

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Usmani, Sharjeel, Fahad Marafi, Najeeb Ahmed, and Fareeda Al Kandari. "18F-NaF PET-CT in Symptomatic Fabella Syndrome." Clinical Nuclear Medicine 42, no. 4 (April 2017): e199-e201. http://dx.doi.org/10.1097/rlu.0000000000001547.

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Usmani, Sharjeel, Najeeb Ahmed, Fahad Marafi, and Fareeda Al Kandari. "Bertolotti Syndrome Demonstrated on 18F-NaF PET/CT." Clinical Nuclear Medicine 42, no. 6 (June 2017): 480–82. http://dx.doi.org/10.1097/rlu.0000000000001632.

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Kyriakopoulos, Christos, Elisabeth I. Heath, Anna C. Ferrari, Scott Perlman, Tina M. Mayer, Mark N. Stein, Katharina Modelska, William Duggan, Robert Jeraj, and Glenn Liu. "Interlesional response assessment with 18F-sodium fluoride (18F-NaF) PET/CT in men with chemotherapy-naive bone metastatic castration-resistant prostate cancer (mCRPC) treated with enzalutamide (ENZA)." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 5036. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.5036.

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5036 Background: 18F-NaF PET/CT provides spatial and quantitative information on osteoblastic activity in men with bone mCRPC; thus, it can be used to assess interlesional response heterogeneity, a critical clinical issue. Here we assess the proportion of men treated with ENZA with responding lesions by 18F-NaF PET/CT at the time of prostate-specific antigen (PSA), standard radiographic, or clinical progression. Methods: Men with progressive mCRPC with ≥ 2 lesions on bone scintigraphy were enrolled and treated with ENZA 160 mg daily at 3 US sites. 18F-NaF PET/CT scans were obtained at baseline (PET1), week 13 (PET2), and at the time of PSA progression (increase of ≥ 25% and ≥ 2.0 ng/mL above nadir), standard radiographic or clinical progression, or at 2 years without progression (PET3) using Quantitative Total Bone Imaging (QTBI). The primary endpoint was the proportion of men with ≥ 1 responding bone lesion (defined as a lesion with a total NaF standardized uptake value [SUV] less than baseline) on PET3. Evaluable men had scans at PET1 and PET3. Results: A total of 23 men (median age, 72 years [range, 51-93]; median PSA, 20.5 ng/mL [range, 3.9-133.6]) were enrolled. The study met its primary objective; 22 of 22 (100%) evaluable men had ≥ 1 responding bone lesion on QTBI at PET3. Total disease burden changed from a mean baseline SUV of 5700 (range, 507-22,850) to 5590 (range, 213-17,090) at PET2 and 6020 (range, 118-16,650) at PET3. The proportion of progressive lesions increased from a mean 7.8% (range, 0-29) at PET2 to 9.4% (range, 0-32) at PET3. Conclusions: Although PSA response with ENZA is high, many men experience a mixed response to treatment. While overall functional disease burden improves during treatment, an eventual increase in global burden is seen at the time of progression as measured by 18F-NaF PET/CT. At the primary endpoint analysis the proportion of progressing lesions is low, supporting both the hypothesis that a substantial number of lesions continue to benefit from treatment and the concept of treating beyond progression and selectively targeting nonresponding lesions while keeping patients on ENZA. Clinical trial information: NCT02384382.

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Park, Jong Chul, Karen A. Kurdziel, Liza Lindenberg, James L. Gulley, Ravi Amrit Madan, Lauren V. Wood, Yolanda McKinney, Peter L. Choyke, William L. Dahut, and Andrea Borghese Apolo. "Preliminary results of a prospective study of 18F-NAF PET/CT in prostate cancer." Journal of Clinical Oncology 31, no. 6_suppl (February 20, 2013): 103. http://dx.doi.org/10.1200/jco.2013.31.6_suppl.103.

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103 Background: We performed a prospective study of 18F-NaF PET/CT bone scan (NaF) in the detection of bone metastases in men with prostate cancer. We previously reported that NaF identified more malignant lesions than Technetium-99m MDP bone scan (TcBS) (ASCO 2012 10589). This study evaluates the ability of NaF to detect bone metastasis in men with normal TcBS and also explores the change in NaF over 6 and 12 months compared to PSA changes. Methods: In a prospective 2-arm study, 60 men with prostate cancer (30 with and 30 without bone metastases by TcBS) were studied (ages 51-79). All had NaF and TcBS at baseline, followed by repeat NaF at 6 and 12 months. TcBS and NaF were reviewed by experienced nuclear medicine physicians. Abnormal foci of uptake on TcBS and NaF were classified as benign, malignant or indeterminate. Malignant uptake on NaF was confirmed by characteristic osteoblastic features on CT. Scan results were categorized as “positive” if any malignant lesion was present. In the 6 and 12 months follow up NaF, results were categorized as progression of disease (PD) = any new lesions or SUV increase > 30% in known lesions; stable disease (SD) = no new lesions or SUV changes < 30% in known lesions; and improvement of disease (ID) = resolution of known lesions or decrease SUV > 30% in known lesions. Results: 60 men have enrolled on study, 58 and 34 completed 6 and 12 month follow-up respectively. At baseline, 14 of 30 (47%) men with negative TcBS showed evidence of bone metastases in NaF (PSA mean 45); 7/14 had 2 baseline NaF and showed positive results in both, demonstrating reproducibility; 13/14 and 7/14 had follow up NaF at 6 and 12 months, respectively, all of which remained positive. In follow-up, 13/58 men at 6 months and 8/34 men at 12 months had PD from baseline on NaF, of whom 5/13 (38%) at 6 months and 5/8 (63%) at 12 months also had a PSA increase > 50%. All men who had PD on NaF at 6 months and had a follow-up scan at 12 months remained positive. 15 men at 6 months and 7 men at 12 months had ID on follow-up NaF, of which 11/15 (73%) and 6/7 (86%) had PSA decrease > 50% at 6 and 12 months, respectively. Conclusions: Early results of this ongoing NaF study are encouraging and suggest NaF identifies metastatic bone disease earlier than TcBS and correlates with changes in PSA. Clinical trial information: NCT01240551.

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Raynor, William Y., Peter Sang Uk Park, Austin J. Borja, Yusha Sun, Thomas J. Werner, Sze Jia Ng, Hui Chong Lau, Poul Flemming Høilund-Carlsen, Abass Alavi, and Mona-Elisabeth Revheim. "PET-Based Imaging with 18F-FDG and 18F-NaF to Assess Inflammation and Microcalcification in Atherosclerosis and Other Vascular and Thrombotic Disorders." Diagnostics 11, no. 12 (November 29, 2021): 2234. http://dx.doi.org/10.3390/diagnostics11122234.

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Positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose (FDG) represents a method of detecting and characterizing arterial wall inflammation, with potential applications in the early assessment of vascular disorders such as atherosclerosis. By portraying early-stage molecular changes, FDG-PET findings have previously been shown to correlate with atherosclerosis progression. In addition, recent studies have suggested that microcalcification revealed by 18F-sodium fluoride (NaF) may be more sensitive at detecting atherogenic changes compared to FDG-PET. In this review, we summarize the roles of FDG and NaF in the assessment of atherosclerosis and discuss the role of global assessment in quantification of the vascular disease burden. Furthermore, we will review the emerging applications of FDG-PET in various vascular disorders, including pulmonary embolism, as well as inflammatory and infectious vascular diseases.

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