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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.

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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