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Changing of the Guard (The Sodium Fluoride Bone Scan). By Karen Wiki Sponsored by Cyclotek. What is 18 F-Sodium Fluoride (NaF). Half Life = 109mins Energy = 511 keV Highly sensitive bone seeking tracer Uptake mechanism resembles 99m Tc MDP Excellent pharmacokinetic characteristics.
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Changing of the Guard(The Sodium Fluoride Bone Scan) By Karen Wiki Sponsored by Cyclotek
What is18F-Sodium Fluoride (NaF) • Half Life = 109mins • Energy = 511 keV • Highly sensitive bone seeking tracer • Uptake mechanism resembles 99mTc MDP • Excellent pharmacokinetic characteristics
History • Recognised in the late 60’s Early 70’s 18Fas an excellent tracer for skeletal imaging • Limitations = short half life, high energy level, poor scanner design and availability
PET/CT • 18F NaF
99mTc BS 18F NaF
GE Discovery VCT 64 slice GE Infinia Hawkeye SPECT/CT 64 SLICE
Case Study 2 • 99mTc BS
Advantages of NaF PET/CT • Superior pharmacokinetics • Sensitive for lytic lesions • Better resolution and sensitivity • Routine tomographic data • Routine use of CT improves specificity • Shorter total examination time • One stop shop
References • The SNM Practice Guideline For Sodium 18F-Fluoride PET/CT Bone Scans 1.1 • Grant FD, Fahey FH, Packard AB, Davis RT, Alvai A, and Treves ST. Skeletal PET with 18-Fluoride: Applying New Technology to an Old Tracer. JNM 2008;49:68-78. • Apostolova I, Brenner W. Measuring Bone Metabolism with Fluoride PET: Methodological Considerations. PET Clin 2010;5:247-257. • Abikhzer G, Kennedy J. 18F NaF PET/CT and conventional Bone Scanning in Routine Clinical Practice; Compartive Analysis of Tracers, Clinical Acquisition Protocols, and Performance Indices. PET Clin 2012;:315-328. • Czernin J, Satyamurthy N, Schiepers C. Molecular Mechanisms of Bone 18F-NaF Deposition. JNM 2010;51:1826-1829 • Klaus Strodel, Reza Vali. 18F NaF PET/CT Versus Conventional Bone Scanning in the Assessment of Benign Bone Disease. PET Clin 2012 • Mosci C, Lagaru A. 18F NaF PET/CT in the Assessment of Malignant Bone Disease. PET Clin 2012 • Southern Cross Health Insurance Eligibility criteria PET/CT
Breast Cancer • Initial Staging in high risk Breast Cancer(Clinical Stage lllA or higher) or • Initial Staging in Clinical l-llB Breast Cancer with symptoms of bone pain or elevated alkaline phosphatase levels suggesting the presence of bone metastases • Restaging of all stage disease with symptoms of bone pain or elevated alkaline phosphatase levels strongly suggestive of the presence of bone metastases Southern Cross Health Insurance
Limitations of 99mTc Bone Scan • Inferior spatial resolution and sensitivity of gamma cameras • Longer uptake time • Longer scan times • SPECT/CT isn’t routinely used
Advantages of 99mTc Bone Scan • Wide availability • Generator produced/daily elution • Longer physical half-life • Flow, blood pool and delayed • Lower radiation dose(0.0057mSv/MBq)
Limitations of NaF PET/CT • Cyclotron produced • Availability • Higher radiation exposure • Lack of flow and blood pool capabilities