Nathanael Sabbah MD, Presenter: Nothing to Disclose

Tatianie Jackson MD, Abstract Co-Author: Nothing to Disclose

Camila Mosci MD, Abstract Co-Author: Nothing to Disclose

Mehran Jamali, Abstract Co-Author: Nothing to Disclose

Ryogo Minamimoto MD, PhD, Abstract Co-Author: Nothing to Disclose

Andrew Quon MD, Abstract Co-Author: Nothing to Disclose

Andrei Iagaru MD, Abstract Co-Author: Advisory Board, Cytogen Corporation Advisory Board, Spectrum Pharmaceuticals, Inc Researcher, General Electric Company

The purpose of this study is to analyze using semi-quantitative standardized uptake values (SUV) measurements the distribution of Sodium 18F-Fluoride (18F NaF) uptake in the normal skeleton, benign and malignant lesions, and extra-skeletal tissues. 

We retrospectively analyzed data from 129 patients who had 18F NaF PET/CT between 2007 and 2014. There were 99 men and 30 women, 19-90 year-old (average: 61.5±15.5). We measured maximum and mean SUV from normal bones, metastases, degenerative changes and extra-skeletal tissues in cancer patients. For the normal bone analysis, we excluded structures with any known history of bone tumor infiltration or degenerative changes clinically, radiographically or scintigraphically apparent. 

The PET/CT images were acquired on average at 30-169 minutes (average: 76.5±22.8) after injection of 3.9-13.6 mCi (average: 7.3±2.4) of 18F NaF. The range, average and SD of SUVmax were measured for normal bone and extra-skeletal tissues uptake for the entire patient population. A separate statistical analysis was performed to compare Group A which correspond to the population of patient with negative scans (no NaF avid metastatic lesions) and Group B which correspond to the population of patient with positive scans (NaF avid metastatic lesions). No statistical difference was found between the two groups. The average and SD of SUVmax were also measured for 18F NaF avid metastasis (4.50−103.3, 25.93±16.61) and for 18F NaF avid degenerative changes (3.30−52.0, 16.54±7.96). When comparing SUV max values from axial skeleton versus appendicular skeleton, we found that the SUVmax in the axial skeleton was 7.84±2.03 compared to the SUVmax in the appendicular skeleton of 3.04±1.12. There was a statistically significant difference (p<0.0001) when comparing SUVmax in the normal axial skeleton (7.84±2.03) vs bone metastases in the axial skeleton (24.04±4.95), as well as when comparing SUVmax in the normal appendicular skeleton (3.04±1.12) vs bone metastases in the appendicular skeleton (27.82±9.8).

According to our study, various skeletal sites have different normal SUVmax values. In order to improve interpretation accuracy and allow SUV value comparison between studies, a better understanding of physiological uptake throughout the body is necessary. 

To improved interpretive accuracy and may be useful for future semi-automated comparisons to a normal SUVmax database.

Sabbah, N, Jackson, T, Mosci, C, Jamali, M, Minamimoto, R, Quon, A, Iagaru, A, Characterization of 18F-NaF Uptake in Normal Bone, Bone Metastases, Degenerative Changes and Extra-Skeletal Tissues: An Atlas of Standardized Uptake Values.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003668.html