Korean J Radiol.  2016 Apr;17(2):281-288. 10.3348/kjr.2016.17.2.281.

F-18 Sodium Fluoride Positron Emission Tomography/Computed Tomography for Detection of Thyroid Cancer Bone Metastasis Compared with Bone Scintigraphy

• Lee H
• Lee WW
• Park SY
• Kim SE

• KMID: 2360215
• DOI: http://doi.org/10.3348/kjr.2016.17.2.281

Abstract

OBJECTIVE
The aim of the study was to compare the diagnostic performances of F-18 sodium fluoride positron emission tomography/computed tomography (bone PET/CT) and bone scintigraphy (BS) for the detection of thyroid cancer bone metastasis.
MATERIALS AND METHODS
We retrospectively enrolled 6 thyroid cancer patients (age = 44.7 ± 9.8 years, M:F = 1:5, papillary:follicular = 2:4) with suspected bone metastatic lesions in the whole body iodine scintigraphy or BS, who subsequently underwent bone PET/CT. Pathologic diagnosis was conducted for 4 lesions of 4 patients.
RESULTS
Of the 17 suspected bone lesions, 10 were metastatic and 7 benign. Compared to BS, bone PET/CT exhibited superior sensitivity (10/10 = 100% vs. 2/10 = 20%, p = 0.008), and accuracy (14/17 = 82.4% vs. 7/17 = 41.2%, p < 0.025). The specificity (4/7 = 57.1%) of bone PET/CT was not significantly different from that of BS (5/7 = 71.4%, p > 0.05).
CONCLUSION
Bone PET/CT may be more sensitive and accurate than BS for the detection of thyroid cancer bone metastasis.

Keyword

Thyroid cancer; Bone metastasis; Bone scintigraphy; F-18 sodium fluoride; Positron emission tomography

MeSH Terms

Adult
Bone Neoplasms/*radiography/secondary
Bone and Bones/*radiography
Contrast Media/*chemistry
Female
Fluorine Radioisotopes/chemistry
Humans
Male
Middle Aged
Positron-Emission Tomography
Retrospective Studies
Sodium Fluoride/*chemistry
Thyroid Neoplasms/*pathology
Tomography, X-Ray Computed
Whole Body Imaging
Contrast Media
Fluorine Radioisotopes
Sodium Fluoride

Figure

• 

  Fig. 1 True positive finding of bone PET/CT. A. WBIS showed abnormal uptake in lower T spine area (red arrow), suggesting metastasis. B. There was no increased uptake in lower T spine area on BS. C. Bone PET/CT revealed increased F-18 uptake in T10 vertebral body (yellow arrows) (upper, coronal fusion PET/CT; lower, transaxial fusion PET/CT). Lesion was pathologically confirmed as thyroid cancer bone metastasis. bone PET/CT = F-18 sodium fluoride positron emission tomography/computed tomography, BS = bone scintigraphy, WBIS = whole body iodine scintigraphy

• 

  Fig. 2 True positive findings of bone PET/CT. A. WBIS showed abnormal uptake in right pelvic bone area, suggesting metastasis (red arrow). Faint uptake of I-131 was observed in sternal area (dotted red arrow). Hot uptake visible in anterior neck is remnant thyroid activity. B. There was no increased uptake in right pelvic bone on subsequent BS. Sternal defect with surrounding increased uptake and posterior skull lesion represent possible bone metastases (short arrows). C. Bone PET/CT showed multiple lesions spreading from skull to pelvic bones (yellow arrows). Right iliac bone lesion (red arrow) was pathologically proven as metastatic bone lesion. bone PET/CT = F-18 sodium fluoride positron emission tomography/computed tomography, BS = bone scintigraphy, MIP = maximal intensity projection, WBIS = whole body iodine scintigraphy

• 

  Fig. 3 False positive finding of bone PET/CT. A. WBIS showed abnormal intense uptake in skull area (red arrow), suggesting metastasis. Lesion was observed in both whole body images (upper row) and additional regional images after take-off of clothes (lower row). B. There was no increased uptake in skull area on BS. Notably, photon defect visible in left proximal femur was due to wide excision of previous metastasis and left hip replacement surgery. C. Bone PET/CT showed increased F-18 uptake in skull (yellow arrows). D. This lesion was confirmed as benign inclusion cyst lined with respiratory epithelium. bone PET/CT = F-18 sodium fluoride positron emission tomography/computed tomography, BS = bone scintigraphy, WBIS = whole body iodine scintigraphy

• 

  Fig. 4 False positive findings of bone PET/CT. A. WBIS showed multiple suspected bone lesions in skull, T-L spines, and left femur (red arrows). There was no evidence of bone metastasis on BS at day 9 post-radioactive iodine administration (B), and bone PET/CT at day 37 post-radioactive iodine administration (C). D. Gd-DTPA enhanced T1-weighted sagittal MRI also showed no abnormal lesions. bone PET/CT = F-18 sodium fluoride positron emission tomography/computed tomography, BS = bone scintigraphy, Gd-DTPA = gadolinium-diethylenetriamine penta-acetic acid, MIP = maximal intensity projection, WBIS = whole body iodine scintigraphy

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