J Korean Soc Radiol.  2018 Jun;78(6):408-411. 10.3348/jksr.2018.78.6.408.

Early Evaluation of Inflammatory Focus and Treatment Response Using ¹⁸F-Sodium Fluoride Bone Positron Emission Tomography/Computed Tomography in Patients with Metallic Implants: A Case Report

• Moon JH
• Lee SM
• Hong CH
• Lee JW

• KMID: 2412359
• DOI: http://doi.org/10.3348/jksr.2018.78.6.408

Abstract

We report a case of a 76-year-old woman with elevated serum C-reactive protein levels for two weeks after spinal surgery. ⁹⁹mTc-labeled white blood cell scan and dual ¹â¸F-sodium-fluoride (¹â¸F-NaF) bone positron emission tomography/computed tomography (PET/CT) were used to detect the site of inflammation. Using non-attenuation corrected images, soft tissue inflammation was detected without metal artifact. Antibiotic treatment attenuated inflammation as seen in an early-phase scan using follow-up ¹â¸F-NaF bone PET/CT. This case demonstrates the role of ¹â¸F-NaF bone PET/CT in the detection of inflammation sites, and can be used to evaluate treatment response in patients with metallic implants.

MeSH Terms

Aged
Artifacts
C-Reactive Protein
Electrons*
Female
Fluorides*
Follow-Up Studies
Humans
Inflammation
Leukocytes
Positron-Emission Tomography and Computed Tomography
Sodium Fluoride
Treatment Outcome
C-Reactive Protein
Fluorides
Sodium Fluoride

Figure

• 

  Fig. 1 A 76-year-old woman with perioperative inflammation detected on 18F-NaF bone PET/CT. A. MIP images of WBC SPECT. Upper row shows anterior view and lower row displays oblique view. Uptake of the soft tissue area in the early phase of 18F-NaF bone PET/CT is also observed in the WBC scan (arrow). B. MIP of early-phase 18F-NaF bone PET/CT scan shows increased radiotracer uptake around the hematoma removal site (arrows) and the spinal operation site, both on attenuation corrected (left) and non-attenuation corrected (right) images. C. MIP of standard 18F-NaF bone PET/CT scan shows an increase in radiotracer uptake at the operation site of spine. D. T2-weighted sagittal image of L-spine magnetic resonance imaging, using the Dixon technique. Image shows post-operative hematoma (arrow) and low signal intensity around the operation site due to metal artifact. E. The follow-up images of MIP of early-phase 18F-NaF bone PET/CT scan show decreased radiotracer uptake around the hematoma removal site (arrows), both on attenuation-corrected (left) and non-attenuation corrected (right) images. F. The follow-up image of MIP in standard 18F-NaF bone PET/CT scan shows diffuse radiotracer uptake due to post-operative changes without any significant difference compared with previous images. 18F-NaF = 18F-sodium-fluoride, MIP = maximum intensity projection, PET/CT = positron emission tomography/computed tomography, SPECT = single-photon emission computed tomography, WBC = white blood cell

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