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Pilot Prospective Evaluation of 99mTc-MDP Scintigraphy, 18F NaF PET/CT, 18F FDG PET/CT and Whole-Body MRI for Detection of Skeletal Metastases

Iagaru, Andrei MD*; Young, Phillip MD; Mittra, Erik MD, PhD; Dick, David W. PhD§; Herfkens, Robert MD; Gambhir, Sanjiv Sam MD, PhD

doi: 10.1097/RLU.0b013e3182815f64
Original Articles

Objective The aim of this study was to compare 99mTc-MDP bone scanning, 18F NaF PET/CT, 18F FDG PET/CT, and whole-body MRI (WBMRI) for detection of known osseous metastases.

Patients and Methods This prospective pilot trial (September 2007-April 2009) enrolled 10 participants (5 men, 5 women, 47–81 years old) diagnosed with cancer and known osseous metastases. 18F NaF PET/CT, 18F FDG PET/CT, and WBMRI were performed within 1 month for each participant.

Results The image quality and evaluation of extent of disease were superior by 18F NaF PET/CT compared to 99mTc-MDP scintigraphy in all patients with skeletal lesions and compared to 18F FDG PET/CT in 3 of the patients with skeletal metastases. 18F NaF PET/CT showed osseous metastases where 18F FDG PET/CT was negative in another 3 participants. Extraskeletal metastases were identified by 18F FDG PET/CT in 6 participants. WBMRI with the combination of iterative decomposition of water and fat with echo asymmetry and least-squares estimation, short tau inversion recovery, and diffusion-weighted imaging pulse sequences showed fewer lesions than 18F NaF PET/CT in 5 patients, same number of lesions in 2 patients, and more lesions in 1 patient. WBMRI showed fewer lesions than 18F FDG in 3 patients and same lesions in 6 patients.

Conclusions Our pilot phase prospective trial demonstrated superior image quality and evaluation of skeletal disease extent with 18F NaF PET/CT compared to 99mTc-MDP scintigraphy and 18F FDG PET/CT, as well as the feasibility of multisequence WBMRI. In addition, 18F FDG PET/CT provided valuable soft-tissue information that can change disease management. Further evaluation of these findings using the recently introduced PET/MRI scanners is warranted.

From the *Division of Nuclear Medicine, Stanford University Medical Center, Stanford, CA; †Mayo Clinic, Rochester, MN; ‡Stanford University Medical Center, Stanford, CA; §University of Iowa Hospitals & Clinics, Iowa City, IA; ¶Stanford University Medical Center, Stanford, CA; and ∥Departments of Radiology, Bioengineering, Materials Science and Engineering, Molecular Imaging Program at Stanford (MIPS), Stanford University Medical Center, Stanford, CA.

Received for publication August 27, 2012; and revision accepted October 25, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Andrei Iagaru, MD, Division of Nuclear Medicine, Stanford University Medical Center, 300 Pasteur Dr, Room H-2200, Stanford, CA. E-mail: aiagaru@stanford.edu.

© 2013 by Lippincott Williams & Wilkins