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18F-Fluoride PET/CT Scan for Quantification of Bone Metabolism in the Inner Ear in Patients With Otosclerosis—A Pilot Study

Waterval, Jérôme J. MD*; Vallinga, Maud MD*; Brans, Boudewijn MD, PhD; Winkens, Bjorn MSc, PhD; Stokroos, Robert J. MD, PhD*

doi: 10.1097/RLU.0b013e31829a013e
Original Articles

Background In otosclerosis, CT of the temporal bone is used to confirm the diagnosis. Whereas CT is a static diagnostic tool displaying the demineralization caused by otosclerosis, imaging of bone metabolism by 18F-fluoride PET may provide quantitative information. This could be useful for prognosis and stratification of patients. The aim of this study was to assess 18F-fluoride activity in patients with otosclerosis and to evaluate its use as a complementary diagnostic tool.

Methods All patients with otosclerosis underwent a PET/CT scan. Audiometric data were collected. The severity of otosclerosis was assessed using a recognized radiological classification. The control group consisted of patients who had undergone 18F-fluoride PET/CT scan for orthopedic purpose. Regions of interest were drawn on PET scans which corresponded to standardized anatomical sites as defined on CT, to measure bone metabolism using standardized uptake values (SUVmax and SUVmean).

Results Group 1 consisted of 11 otosclerosis patients (16 eligible temporal bones) and group 2 consisted of 5 control patients (10 temporal bones). On PET scan, visual assessment of temporal bones with otosclerosis showed increased metabolic activity in the otic capsule in 11/16 cases. The SUVmax in the entire otic capsule was significantly higher in otosclerosis patients compared to control subjects. Significant differences in SUVmean were found between otosclerosis and control subjects in the fenestral and saccule area. Moreover, metabolic activity in these regions significantly correlated with hearing loss and CT classification.

Conclusions 18F-Fluoride PET scanning using SUV measurements has the potential to be a diagnostic tool in otosclerosis.

From the Departments of *Otorhinolaryngology—Head & Neck Surgery, †Nuclear Medicine, and ‡Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands.

Received for publication October 25, 2012; revision accepted April 14, 2013.

Conflicts of interest and sources of funding: none declared.

J.J.W. and M.V. share first authorship.

Reprints: Jérôme J. Waterval, MD, Department of Otorhinolaryngology, Maastricht University Medical Center, P.O. Box 5800, 6202AZ Maastricht, The Netherlands. E-mail:

© 2013 by Lippincott Williams & Wilkins