Abstract

18F-NaF PET/CT has a rapid single-pass extraction and fast clearance from soft tissues, resulting in a good target-to-background ratio. This study aimed to establish the optimum acquisition time and dosimetry for 18F-NaF PET/CT to evaluate bone metastases in obese patients. A secondary objective was to evaluate the impact of acquisition time on image quality, lesion detection rate, noise level, and radiation burden in this patient group. Methods: In total, 60 patients were included in the study (20 patients with a body mass index (BMI) of 30.0-34.9 kg/m2, 20 with a BMI of 35-39.9 kg/m2, and 20 with a BMI of >40 kg/m2). Images were acquired after intravenous injection of a 2.2 MBq/kg (0.06 mCi/kg) dose of 18F-NaF. Data were acquired in list mode using ordered-subset expectation maximization reconstruction. The raw data were rebinned to simulate scans with acquisition times of 2, 2.5, and 3 min per bed position. The scans were visually analyzed by 2 observers and scored by rank against a panel of parameters (overall image quality, noise level, background soft tissue, and lesion detectability), and the contrast-to-noise ratio (CNR) was calculated. Results: The mean CNR was 20.19 ± 8.39 for a 2-min acquisition, 21.03 ± 8.35 for 2.5 min, and 22.16 ± 8.37 for 3 min. There were no statistically significant differences in CNR among the 3 different acquisition durations (P > 0.05). Lesion delineation was excellent and independent of the acquisition time. All relevant lesions could be identified with all 3 acquisition times. A mean activity of 215.4 ± 31.3 MBq was injected, with estimated mean effective absorbed doses of 4.09 ± 0.59 mSv for 18F-NaF PET and 7.88 ± 1.66 mSv for CT alone. Conclusion: 18F-NaF PET/CT can be beneficial in obese patients because of its good pharmacokinetics. Optimal osseous staging can be achieved with relatively low doses and radiation burden. Lesion delineation was excellent regardless of acquisition time. However, it is recommended that an acquisition of 3 min per bed position be used in patients with a BMI of more than 40.

Keywords: 18F-NaF PET/CT; bone metastasis; obesity; radiation dosimetry.