title: Can we achieve a radionuclide radiation dose equal to or less than that of 99mTc-hydroxymethane diphosphonate bone scintigraphy with a low-dose 18F-sodium fluoride time-of-flight PET of diagnostic quality?
abstract: OBJECTIVE
  18F-Sodium fluoride is a bone tracer with a high signal-to-noise ratio, but its dosimetry is higher than that of 99mTc-labeled phosphonates at the recommended activities. The study's purpose was to determine whether the reduction by half of F-sodium fluoride-injected activity, mimicked by a short-timed reconstruction image, simulating a total dose less than or equal to that of 99mTc-hydroxymethane diphosphonate scintigraphy, had an impact on the accuracy of PET semiquantitative measurements and image quality.
  
  
  METHODS
  Whole-body time-of-flight 18F-sodium fluoride PET/computed tomography (CT) images were acquired prospectively from 40 adult patients for detection of bone metastases. 18F-Sodium fluoride was administered according to the European Association of Nuclear Medicine (EANM) and Society of Nuclear Medicine (SNM) practice guidelines. From the acquired 1 min/bed position list-mode data, 30-s reconstructions were extracted. Measurements of maximum standard uptake value were recorded with a region of interest applied to the same location on the 1-min and 30-s images, which were displayed side by side, and were analyzed using Bland-Altman plots. A masked reading was performed by two senior nuclear medicine physicians who counted the foci of visually increased uptake.
  
  
  RESULTS
  Bland-Altman plots showed an excellent agreement between the maximum standard uptake value measurements of the 60- and 30-s images. The paired Wilcoxon test results between the corresponding 60- and 30-s images read by masked readers A and B were not significant (P=0.15 and 0.19, respectively).
  
  
  CONCLUSIONS
  Reducing acquisition duration by half or injecting half of the activity recommended by the EANM and SNM practice guidelines can lead to 18F-sodium fluoride time-of-flight PET images of diagnostic quality, achieving a radiation dose less than or equal to that of 99mTc-labeled phosphonates.
authors.affiliation: Nuclear Medicine Department, University Hospitals Eastern Paris, AP-HP TENON Hospital, Pierre et Marie Curie Paris 06 University, Paris, France.
authors.forename: Jessica
authors.initials: J
authors.lastname: Ohnona
authors.forename: Laure
authors.initials: L
authors.lastname: Michaud
authors.forename: Sona
authors.initials: S
authors.lastname: Balogova
authors.forename: Frédéric
authors.initials: F
authors.lastname: Paycha
authors.forename: Valérie
authors.initials: V
authors.lastname: Nataf
authors.forename: Paul
authors.initials: P
authors.lastname: Chauchat
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Talbot
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Kerrou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D004164:Diphosphonates; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D012969:Sodium Fluoride; D013667:Technetium; D013997:Time Factors
chemical_list: D004164:Diphosphonates; D005462:Fluorine Radioisotopes; C029285:hydroxymethanediphosphonic acid; D013667:Technetium; D012969:Sodium Fluoride