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Can we achieve a radionuclide radiation dose equal to or less than that of 99mTc-hydroxymethane diphosphonate bone scintigraphy with a low-dose 18F-sodium fluoride time-of-flight PET of diagnostic quality?

Ohnona, Jessicaa; Michaud, Laurea; Balogova, Sonaa; Paycha, Frédérica,b; Nataf, Valériea; Chauchat, Paula; Talbot, Jean-Noëla; Kerrou, Khaldouna

Nuclear Medicine Communications: May 2013 - Volume 34 - Issue 5 - p 417–425
doi: 10.1097/MNM.0b013e32835fcd9d
Original Articles

Purpose: 18F-Sodium fluoride is a bone tracer with a high signal-to-noise ratio, but its dosimetry is higher than that of 99mTc-labeled phosphonates at the recommended activities. The study’s purpose was to determine whether the reduction by half of 18F-sodium fluoride-injected activity, mimicked by a short-timed reconstruction image, simulating a total dose less than or equal to that of 99mTc-hydroxymethane diphosphonate scintigraphy, had an impact on the accuracy of PET semiquantitative measurements and image quality.

Methods: Whole-body time-of-flight 18F-sodium fluoride PET/computed tomography (CT) images were acquired prospectively from 40 adult patients for detection of bone metastases. 18F-Sodium fluoride was administered according to the European Association of Nuclear Medicine (EANM) and Society of Nuclear Medicine (SNM) practice guidelines. From the acquired 1 min/bed position list-mode data, 30-s reconstructions were extracted. Measurements of maximum standard uptake value were recorded with a region of interest applied to the same location on the 1-min and 30-s images, which were displayed side by side, and were analyzed using Bland–Altman plots. A masked reading was performed by two senior nuclear medicine physicians who counted the foci of visually increased uptake.

Results: Bland–Altman plots showed an excellent agreement between the maximum standard uptake value measurements of the 60- and 30-s images. The paired Wilcoxon test results between the corresponding 60- and 30-s images read by masked readers A and B were not significant (P=0.15 and 0.19, respectively).

Conclusion: Reducing acquisition duration by half or injecting half of the activity recommended by the EANM and SNM practice guidelines can lead to 18F-sodium fluoride time-of-flight PET images of diagnostic quality, achieving a radiation dose less than or equal to that of 99mTc-labeled phosphonates.

aNuclear Medicine Department, University Hospitals Eastern Paris, AP-HP TENON Hospital, Pierre et Marie Curie Paris 06 University

bNuclear Medicine Department, University Hospitals Northern Paris, AP-HP TENON Lariboisière Hospital, Paris-Diderot Paris 07 University, Paris, France

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Correspondence to Khaldoun Kerrou, MD, Nuclear Medicine Department, University Hospitals Eastern Paris, AP-HP TENON Hospital, 4, rue de la Chine, 75020 Paris, France Tel: +33 1 56 01 65 56; fax: +33 1 56 01 61 71; e-mail:

Received October 16, 2012

Accepted February 4, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins