title: Combined 18F-fluoride and 18F-FDG PET/CT scanning for evaluation of malignancy: results of an international multicenter trial.
abstract: (18)F-FDG PET/CT is used in a variety of cancers, but because of variable rates of glucose metabolism, not all cancers are reliably identified. (18)F(-) PET/CT allows for the acquisition of highly sensitive and specific images of the skeleton. We prospectively evaluated combined (18)F(-)/(18)F-FDG as a single PET/CT examination for evaluation of cancer patients and compared it with separate (18)F(-) PET/CT and (18)F-FDG PET/CT scans.
  
  
  METHODS
  One hundred fifteen participants with cancer were prospectively enrolled in an international multicenter trial evaluating (18)F(-) PET/CT, (18)F-FDG PET/CT, and combined (18)F(-)/(18)F-FDG PET/CT. The 3 PET/CT scans were performed sequentially within 4 wk of one another for each patient.
  
  
  RESULTS
  (18)F(-)/(18)F-FDG PET/CT allowed for accurate interpretation of radiotracer uptake outside the skeleton, with findings similar to those of (18)F-FDG PET/CT. In 19 participants, skeletal disease was more extensive on (18)F(-) PET/CT and (18)F(-)/(18)F-FDG PET/CT than on (18)F-FDG PET/CT. In another 29 participants, (18)F(-) PET/CT and (18)F(-)/(18)F-FDG PET/CT showed osseous metastases where (18)F-FDG PET/CT was negative. The extent of skeletal lesions was similar in 18 participants on all 3 scans.
  
  
  CONCLUSIONS
  This trial demonstrated that combined (18)F(-)/(18)F-FDG PET/CT shows promising results when compared with separate (18)F(-) PET/CT and (18)F-FDG PET/CT for evaluation of cancer patients. This result opens the possibility for improved patient care and reduction in health-care costs, as will be further evaluated in future trials.
authors.affiliation: Division of Nuclear Medicine, Stanford University Medical Center, Stanford, California 94305, USA. aiagaru@stanford.edu
authors.forename: Andrei
authors.initials: A
authors.lastname: Iagaru
authors.forename: Erik
authors.initials: E
authors.lastname: Mittra
authors.forename: Camila
authors.initials: C
authors.lastname: Mosci
authors.forename: David W
authors.initials: DW
authors.lastname: Dick
authors.forename: Mike
authors.initials: M
authors.lastname: Sathekge
authors.forename: Vineet
authors.initials: V
authors.lastname: Prakash
authors.forename: Victor
authors.initials: V
authors.lastname: Iyer
authors.forename: Paula
authors.initials: P
authors.lastname: Lapa
authors.forename: Jorge
authors.initials: J
authors.lastname: Isidoro
authors.forename: Joao M
authors.initials: JM
authors.lastname: de Lima
authors.forename: Sanjiv Sam
authors.initials: SS
authors.lastname: Gambhir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging; D001842:Bone and Bones / Q000378:metabolism; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007391:International Cooperation; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D009683:Nuclear Medicine / Q000379:methods; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D005947:Glucose