title: The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: a comparison with FDG PET/CT and 99mTc-MDP bone scan.
abstract: OBJECTIVE
  We aimed to compare the role of (18)F-fluoride PET/CT, FDG PET/CT and (99m)Tc-MDP bone scans in the detection of bone metastases in patients with lung, breast and prostate carcinoma.
  
  
  METHODS
  This was a prospective study including patients for staging (S) and restaging (R). Seventy-two patients (23S, 49R) with infiltrating ductal breast carcinoma, 49 patients (25S, 24R) with prostate adenocarcinoma and 30 patients (17S, 13R) with non-small-cell lung carcinoma (NSCLC), without known bone metastases but with high risk/clinical suspicion for the same, underwent a (99m)Tc-MDP bone scan, FDG PET/CT and (18)F-fluoride PET/CT within 2 weeks. All scans were reviewed by two experienced nuclear medicine physicians, and the findings were correlated with MRI/thin-slice CT/skeletal survey. Histological verification was done wherever feasible.
  
  
  RESULTS
  Sensitivity and negative predictive value (NPV) of (18)F-fluoride PET/CT was 100 % in all three malignancies, while that of FDG PET/CT was 79 % and 73 % in NSCLC, 73 % and 80 % in breast cancer and 72 and 65 % in prostate cancer. Specificity and positive predictive value (PPV) of FDG PET/CT were 100 % in NSCLC and prostate and 97 % and 96 % in breast cancer. As compared to the (99m)Tc-MDP bone scan, all parameters were superior for (18)F-fluoride PET/CT in prostate and breast cancer, but sensitivity and NPV were equal in NSCLC. The MDP bone scan had superior sensitivity and NPV compared to FDG PET/CT but had low specificity and PPV.
  
  
  CONCLUSIONS
  To rule out bone metastases in cases where there is a high index of suspicion, (18)F-fluoride PET/CT is the most reliable investigation. (18)F-fluoride PET/CT has the potential to replace the (99m)Tc-MDP bone scan for the detection of bone metastases.
authors: Department of Nuclear Medicine, All India Institute of Medical Sciences, Room no. 59 A, New Delhi, 110029, India. nkantdamle@gmail.com
authors: Nishikant Avinash
authors: NA
authors: Damle
authors: Chandrasekhar
authors: C
authors: Bal
authors: G P
authors: GP
authors: Bandopadhyaya
authors: Lalit
authors: L
authors: Kumar
authors: Praveen
authors: P
authors: Kumar
authors: Arun
authors: A
authors: Malhotra
authors: Sneh
authors: S
authors: Lata
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000473:pathology; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate; D014057:Tomography, X-Ray Computed
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D013669:Technetium Tc 99m Medronate
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