Therapy-induced bone changes in oncology imaging with 18F-sodium fluoride (NaF) PET-CT

Najeeb Ahmed 1 2, Alyaa Sadeq 3, Fahad Marafi 3, Gopinath Gnanasegaran 4, Sharjeel Usmani 5 6


 

Affiliations

01 April 2022

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doi: 10.1007/s12149-022-01730-y

Abstract

18F-Sodium fluoride (18F-NaF) is a PET tracer that is mostly used in the evaluation of bone metastasis in oncology cases. Recently, 18F-NaF PET/CT is gaining wide popularity owing to its higher sensitivity over the other conventional bone tracer with higher and rapid single-pass extraction, negligible plasma protein binding, rapid blood, and renal clearance. In the era of constant evolution of cancer therapy regimens, considerable bone health impact is seen in the form of avascular necrosis, insufficiency fractures, among others. A significant number of these therapy-induced changes show high bone turnover and thereby 18F-NaF accumulation, mimicking metastatic lesions. This article summarizes and illustrates the pattern and morphological features of 18F-NaF PET/CT findings in these changes in the context of clinical and therapeutic history.

Keywords: 18F-NaF PET–CT; Bone metastases; Cancer; Therapy-induced changes.


 

References

 

  1. Czernin J, Satyamurthy N, Schiepers C. Molecular mechanisms of bone 18F-NaF deposition. J Nucl Med. 2010;51:1826–9. - PubMed
  2. Laverick S, Bounds G, Wong WL. [18F]-Fluoride positron emission tomography for imaging condylar hyperplasia. Br J Oral Maxillofac Surg. 2009;47:196–9. - PubMed
  3. Sachpekidis C, Hillengass J, Goldschmidt H, et al. Quantitative analysis of 18F-NaF dynamic PET/CT cannot differentiate malignant from benign lesions in multiple myeloma. Am J Nucl Med Mol Imaging. 2017;7:148–56. - PubMed - PMC
  4. Frost ML, Blake GM, Cook GJ, et al. Differences in regional bone perfusion and turnover between lumbar spine and distal humerus: 18F-fluoride PET study of treatment-naive and treated postmenopausal women. Bone. 2009;45:942–8. - PubMed
  5. Blake GM, Park-Holohan SJ, Cook GJ, et al. Quantitative studies of bone with the use of 18F-fluoride and 99mTc-methylene diphosphonate. Semin Nucl Med. 2001;31:28–49. - PubMed
  6. Beheshti M, Mottaghy FM, Payche F, et al. 18 F-NaF PET/CT: EANM procedure guidelines for bone imaging. Eur J Nucl Med Mol Imaging. 2015;42:1767–77. - PubMed
  7. Segall G, Delbeke D, Stabin MG, et al. SNM practice guideline for sodium 18F-fluoride PET/CT bone scans 1.0. J Nucl Med. 2010;51:1813–20. - PubMed
  8. Usmani S, Ahmed N, Gnanasegaran G, Musbah A, Al Kandari F, Van den Wyngaert T. 18F-Sodium Fluoride (NaF) PET/CT in obese patients on LYSO PET/CT system: patient dosimetry, optimization of injected activity and acquisition time. J Nucl Med Technol. 2020. https://doi.org/10.2967/jnmt.120.258137 . - DOI - PubMed
  9. D’Oronzo S, Stucci S, Tucci M, Silvestris F. Cancer treatment-induced bone loss (CTIBL): pathogenesis and clinical implications. Cancer Treat Rev. 2015;41(9):798–808. - PubMed
  10. Kwak JJ, Tirumani SH, Van den Abbeele AD, et al. Cancer immunotherapy: imaging assessment of novel treatment response patterns and immune-related adverse events. Radiographics. 2015;35:424–37. - PubMed
  11. Bronstein Y, Ng CS, Hwu P, et al. Radiologic manifestations of immune-related adverse events in patients with metastatic melanoma undergoing anti-CTLA-4 antibody therapy. AJR Am J Roentgenol. 2011;197:W992–1000. - PubMed
  12. Wissing MD. Chemotherapy- and irradiation-induced bone loss in adults with solid tumors. Curr Osteoporos Rep. 2015;13:140–5. - PubMed - PMC
  13. Haworth AE, Webb J. Skeletal complications of bisphosphonate use: what the radiologist should know. Br J Radiol. 2012;85:1333–42. - PubMed - PMC
  14. Nicolatou-Galitis O, Schiødt M, Mendes RA, et al. Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment. Oral Surg Oral Med Oral Pathol Oral Radiol. 2019;127:117–35. - PubMed
  15. Kim Y, Lee HY, Yoon HJ, et al. Utility of 18F-fluorodeoxy glucose and 18F-sodium fluoride positron emission tomography/computed tomography in the diagnosis of medication-related osteonecrosis of the jaw: a preclinical study in a rat model. J Craniomaxillofac Surg. 2016;44:357–63. - PubMed
  16. Wilde F, Steinhoff K, Frerich B, et al. Positron-emission tomography imaging in the diagnosis of bisphosphonate-related osteonecrosis of the jaw. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:412–9. - PubMed
  17. Raje N, Woo SB, Hande K, et al. Clinical, radiographic, and biochemical characterization of multiple myeloma patients with osteonecrosis of the jaw. Clin Cancer Res. 2008;14:2387–95. - PubMed
  18. Tile L, Cheung AM. Atypical femur fractures: current understanding and approach to management. Ther Adv Musculoskelet Dis. 2020. https://doi.org/10.1177/1759720X20916983 . - DOI - PubMed - PMC
  19. Laarschot DM, Somford MP, Jager A, et al. “Atypical” atypical femur fractures and use of bisphosphonates. Clin Cases Miner Bone Metab. 2016;13:204–8. - PubMed
  20. Roca-Ayats N, Balcells S, Garcia-Giralt N, et al. GGPS1 mutation and atypical femoral fractures with bisphosphonates. N Engl J Med. 2017;376:1794–5. - PubMed
  21. Spyridonidis TJ, Mousafiris KV, Rapti EK, et al. Bone scintigraphy depicts bilateral atypical femoral stress fractures with metachronous presentation, long before a complete fracture occurs. Hell J Nucl Med. 2014;17:54–7. - PubMed
  22. D’Oronzo S, Stucci S, Tucci M, Silvestris F. Cancer treatment-induced bone loss (CTIBL): pathogenesis and clinical implications. Cancer Treat Rev. 2015;41:798–808. - PubMed
  23. Brufsky AM. Cancer treatment-induced bone loss: pathophysiology and clinical perspectives. Oncologist. 2008;13:187–95. - PubMed
  24. Bjarnason NH, Hitz M, Jorgensen NR, et al. Adverse bone effects during pharmacological breast cancer therapy. Acta Oncol. 2008;47:747–54. - PubMed
  25. Agrawal K, Tripathy SK, Sen RK, et al. Nuclear medicine imaging in osteonecrosis of hip: old and current concepts. World J Orthop. 2017;8:747–53. - PubMed - PMC
  26. Dasa V, Adbel-Nabi H, Anders MJ, Mihalko WM. F-18 fluoride positron emission tomography of the hip for osteonecrosis. Clin Orthop Relat Res. 2008;466(5):1081–6. - PubMed - PMC
  27. Gayana S, Bhattacharya A, Sen RK, Singh P, Prakash M, Mittal BR. F-18 fluoride positron emission tomography/computed tomography in the diagnosis of avascular necrosis of the femoral head: comparison with magnetic resonance imaging. Indian J Nucl Med. 2016;31:3–8. - PubMed - PMC
  28. Huh SJ, Kim B, Kang MK, et al. Pelvic insufficiency fracture after pelvic irradiation in uterine cervix cancer. Gynecol Oncol. 2002;86:264–8. - PubMed
  29. Chung YK, Lee YK, Yoon BH, Suh DH, Koo KH. Pelvic insufficiency fractures in cervical cancer after radiation therapy: a meta-analysis and review. In Vivo. 2021;35:1109–15. - PubMed - PMC
  30. Peh WC, Khong PL, Yin Y, et al. Imaging of pelvic insufficiency fractures. Radiographics. 1996;16:335–48. - PubMed
  31. Lapina O, Tiškevičius S. Sacral insufficiency fracture after pelvic radiotherapy: a diagnostic challenge for a radiologist. Medicina (Kaunas). 2014;50:249–54.
  32. Soares PBF, Soares CJ, Limirio PHJO, et al. Effect of ionizing radiation after-therapy interval on bone: histomorphometric and biomechanical characteristics. Clin Oral Investig. 2019;23:2785–93. - PubMed
  33. Israel O, Gorenberg M, Frenkel A, et al. Local and systemic effects of radiation on bone metabolism measured by quantitative SPECT. J Nucl Med. 1992;33:1774–80. - PubMed
  34. Lloyd S, Decker RH, Evans SB. Bone scan findings of chest wall pain syndrome after stereotactic body radiation therapy: implications for the pathophysiology of the syndrome. J Thorac Dis. 2013;5:E41–4. - PubMed - PMC
  35. Park W, Huh SJ, Yang JH, et al. The implication of hot spots on bone scans within the irradiated field of breast cancer patients treated with mastectomy followed by radiotherapy. Ann Nucl Med. 2008;22:685–91. - PubMed
  36. Benfaremo D, Manfredi L, Luchetti MM, et al. Musculoskeletal and rheumatic diseases induced by immune checkpoint inhibitors: a review of the literature. Curr Drug Saf. 2018;13:150–64. - PubMed - PMC
  37. Naidoo J, Cappelli LC, Forde PM, et al. Inflammatory arthritis: a newly recognized adverse event of immune checkpoint blockade. Oncologist. 2017;22:627–30. - PubMed - PMC
  38. Smith MH, Bass AR. Arthritis after cancer immunotherapy: symptom duration and treatment response. Arthritis Care Res (Hoboken). 2019;71:362–6.
  39. Belkhir R, Burel SL, Dunogeant L, et al. Rheumatoid arthritis and polymyalgia rheumatica occurring after immune checkpoint inhibitor treatment. Ann Rheum Dis. 2017;76:1747–50. - PubMed
  40. Nobashi T, Mittra E. PD-1 blockade–induced inflammatory arthritis. Radiology. 2018;289:616. - PubMed
  41. Jiang W, Rixiati Y, Zhao B, Li Y, Tang C, Liu J. Incidence, prevalence, and outcomes of systemic malignancy with bone metastases. J Orthop Surg (Hong Kong). 2020;28:2309499020915989.
  42. Vaz S, Usmani S, Gnanasegaran G, et al. Molecular imaging of bone metastases using bone targeted tracers. Q J Nucl Med Mol Imaging. 2019;63:112–28. - PubMed
  43. Hillner BE, Siegel BA, Hanna L, et al. Impact of 18F-fluoride PET in patients with known prostate cancer: initial results from the National Oncologic PET Registry. J Nucl Med. 2014;55:574–81. - PubMed
  44. Drubach LA. Clinical utility of 18F NaF PET/CT in benign and malignant disorders. Pet Clin. 2012;7:293–301. - PubMed
  45. Usmani S, Ahmed N, Muzaffar S, et al. Spectrum of false positive 18F-sodium fluoride (NaF) bone PET/CT findings in oncology imaging; a narrative pictorial review of cases from a single institution. Hell J Nucl Med. 2020;23:67–75. - PubMed

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