title: Prospective Comparison of 99mTc-MDP Scintigraphy, Combined 18F-NaF and 18F-FDG PET/CT, and Whole-Body MRI in Patients with Breast and Prostate Cancer.
abstract: We prospectively evaluated the use of combined (18)F-NaF/(18)F-FDG PET/CT in patients with breast and prostate cancer and compared the results with those for (99m)Tc-MDP bone scintigraphy and whole-body MRI.
  
  
  METHODS
  Thirty patients (15 women with breast cancer and 15 men with prostate cancer) referred for standard-of-care bone scintigraphy were prospectively enrolled in this study. (18)F-NaF/(18)F-FDG PET/CT and whole-body MRI were performed after bone scintigraphy. The whole-body MRI protocol consisted of both unenhanced and contrast-enhanced sequences. Lesions detected with each test were tabulated, and the results were compared.
  
  
  RESULTS
  For extraskeletal lesions, (18)F-NaF/(18)F-FDG PET/CT and whole-body MRI had no statistically significant differences in sensitivity (92.9% vs. 92.9%, P = 1.00), positive predictive value (81.3% vs. 86.7%, P = 0.68), or accuracy (76.5% vs. 82.4%, P = 0.56). However, (18)F-NaF/(18)F-FDG PET/CT showed significantly higher sensitivity and accuracy than whole-body MRI (96.2% vs. 81.4%, P < 0.001, 89.8% vs. 74.7%, P = 0.01) and bone scintigraphy (96.2% vs. 64.6%, P < 0.001, 89.8% vs. 65.9%, P < 0.001) for the detection of skeletal lesions. Overall, (18)F-NaF/(18)F-FDG PET/CT showed higher sensitivity and accuracy than whole-body MRI (95.7% vs. 83.3%, P < 0.002, 87.6% vs. 76.0%, P < 0.02) but not statistically significantly so when compared with a combination of whole-body MRI and bone scintigraphy (95.7% vs. 91.6%, P = 0.17, 87.6% vs. 83.0%, P = 0.53). (18)F-NaF/(18)F-FDG PET/CT showed no significant difference from a combination of (18)F-NaF/(18)F-FDG PET/CT and whole-body MRI. No statistically significant differences in positive predictive value were noted among the 3 examinations.
  
  
  CONCLUSIONS
  (18)F-NaF/(18)F-FDG PET/CT is superior to whole-body MRI and (99m)Tc-MDP scintigraphy for evaluation of skeletal disease extent. Further, (18)F-NaF/(18)F-FDG PET/CT and whole-body MRI detected extraskeletal disease that may change the management of these patients. (18)F-NaF/(18)F-FDG PET/CT provides diagnostic ability similar to that of a combination of whole-body MRI and bone scintigraphy in patients with breast and prostate cancer. Larger cohorts are needed to confirm these preliminary findings, ideally using the newly introduced simultaneous PET/MRI scanners.
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, California Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, Stanford, California; and.
authors.forename: Ryogo
authors.initials: R
authors.lastname: Minamimoto
authors.affiliation: Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California.
authors.forename: Andreas
authors.initials: A
authors.lastname: Loening
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, California Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, Stanford, California; and.
authors.forename: Mehran
authors.initials: M
authors.lastname: Jamali
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, California.
authors.forename: Amir
authors.initials: A
authors.lastname: Barkhodari
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, California.
authors.forename: Camila
authors.initials: C
authors.lastname: Mosci
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, California.
authors.forename: Tatianie
authors.initials: T
authors.lastname: Jackson
authors.affiliation: Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California.
authors.forename: Piotr
authors.initials: P
authors.lastname: Obara
authors.affiliation: Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California.
authors.forename: Valentina
authors.initials: V
authors.lastname: Taviani
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, California Molecular Imaging Program at Stanford, Department of Radiology, Stanford University, Stanford, California; and.
authors.forename: Sanjiv Sam
authors.initials: SS
authors.lastname: Gambhir
authors.affiliation: Radiological Sciences Laboratory, Department of Radiology, Stanford University, Stanford, California.
authors.forename: Shreyas
authors.initials: S
authors.lastname: Vasanawala
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University, Stanford, California aiagaru@stanford.edu.
authors.forename: Andrei
authors.initials: A
authors.lastname: Iagaru
mesh_terms: D000328:Adult; D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D019275:Radiopharmaceuticals; D012969:Sodium Fluoride; D013669:Technetium Tc 99m Medronate; D051598:Whole Body Imaging / Q000379:methods*
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D012969:Sodium Fluoride; D013669:Technetium Tc 99m Medronate
keywords: 18F-FDG; 18F-NaF; 99mTc-MDP; breast cancer; prostate cancer; whole-body MRI