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Correcting 18F-fluoride PET static scan measurements of skeletal plasma clearance for tracer efflux from bone

Siddique, Musib; Frost, Michelle L.; Moore, Amelia E.B.; Fogelman, Ignac; Blake, Glen M.

Nuclear Medicine Communications: March 2014 - Volume 35 - Issue 3 - p 303–310
doi: 10.1097/MNM.0000000000000047
Original Articles

Objective The aim of the study was to examine whether 18F-fluoride PET (18F-PET) static scan measurements of bone plasma clearance (K i) can be corrected for tracer efflux from bone from the time of injection.

Materials and methods The efflux of tracer from bone mineral to plasma was described by a first-order rate constant k loss. A modified Patlak analysis was applied to 60-min dynamic 18F-PET scans of the spine and hip acquired during trials on the bone anabolic agent teriparatide to find the best-fit values of k loss at the lumbar spine, total hip and femoral shaft. The resulting values of k loss were used to extrapolate the modified Patlak plots to 120 min after injection and derive a sequence of static scan estimates of K i at 4-min intervals that were compared with the Patlak K i values from the 60-min dynamic scans. A comparison was made with the results of the standard static scan analysis, which assumes k loss=0.

Results The best-fit values of k loss for the spine and hip regions of interest averaged 0.006/min and did not change when patients were treated with teriparatide. Static scan values of K i calculated using the modified analysis with k loss=0.006/min were independent of time between 10 and 120 min after injection and were in close agreement with findings from the dynamic scans. In contrast, by 2 h after injection the static scan K i values calculated using the standard analysis underestimated the dynamic scan results by 20%.

Conclusion Using a modified analysis that corrects for 18F efflux from bone, estimates of K i from static PET scans can be corrected for time up to 2 h after injection. This simplified approach may obviate the need to perform dynamic scans and hence shorten the scanning procedure for the patient and reduce the cost of studies. It also enables reliable estimates of K i to be obtained from multiple skeletal sites with a single injection of tracer.

King’s College London, Osteoporosis Screening and Research Unit, King’s College Academic Health Partners, Guy’s Campus, London, UK

Correspondence to Glen M. Blake, PhD, Osteoporosis Research Unit, 1st Floor, Tower Wing, Guy’s Hospital, London SE1 9RT, UK Tel: +44 207 188 4117; fax: +44 207 188 0103; e-mail:

Received July 10, 2013

Accepted October 21, 2013

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins