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Added value of using a cocktail of F-18 sodium fluoride and F-18 fluorodeoxyglucose in positron emission tomography/computed tomography for detecting bony metastasis: a case report.

Chan HP, Hu C, Yu CC, Huang TC, Peng NJ - Medicine (Baltimore) (2015)

Bottom Line: The former showed more foci and precisely showed bony lesions compared to those obtained using Tc-99m MDP WBBS.Surgical biopsy was performed in left axillary nodes, and the metastatic carcinoma was found to be of breast origin.This case demonstrated that a cocktail of F-18 NaF and F-18 FDG could be useful in PET/CT for not only detecting more skeletal lesions but also guiding biopsies accurately to the affected tissue.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Nuclear Medicine (H-PC, CH, C-CY, T-CH, N-JP), Kaohsiung Veterans General Hospital; Department of Information Engineering (C-CY), I-Shou University, Kaohsiung; and National Yang-Ming University (N-JP), School of Medicine, Taipei, Taiwan.

ABSTRACT
Current nuclear imaging of the skeletal system is achieved using technetium-99m (Tc-99m) methylene diphosphonate (MDP), F-18 sodium fluoride (NaF), or F-18 fluorodeoxyglucose (FDG). However, comparisons of these are rare in the literature. We present a case of a 51-year-old female with suspicious lung cancer due to main symptoms of dyspnea, nonproductive cough, and pleural pain. Tc-99m MDP whole-body bone scan (WBBS) showed multiple bony metastases. Five days later, positron emission tomography/computed tomography (PET/CT) images using both F-18 NaF and a cocktail of F-18 NaF and F-18 FDG were obtained on the same day 2 hours apart. The former showed more foci and precisely showed bony lesions compared to those obtained using Tc-99m MDP WBBS. However, the latter demonstrated more extensive radiotracer uptake, especially in osteolytic lesions, and additional soft tissue lesions in the left axillary and surpraclavicular nodes as well as the left pleura. Surgical biopsy was performed in left axillary nodes, and the metastatic carcinoma was found to be of breast origin. This case demonstrated that a cocktail of F-18 NaF and F-18 FDG could be useful in PET/CT for not only detecting more skeletal lesions but also guiding biopsies accurately to the affected tissue.

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(A) Technetium-99m (Tc-99m) methylene diphosphonate (MDP) whole-body bone scan (WBBS) showed hot MDP uptake in the sternum, left side of the rib cage, thoracic and lumbar regions of the spine, right sacroiliac joint, and left ischium, suggesting multiple bony metastases. (B) Maximum intensity projection of F-18 NaF PET/CT at anterior, posterior, and left anterior oblique views showed new foci at 1st right and 2nd left posterior ribs (arrows) and lateral 7th to 9th ribs (arrow head) and more precisely showed bony lesions than seen using Tc-99m MDP WBBS. NaF = sodium fluoride, PET/CT = positron emission tomography/computed tomography.
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Figure 1: (A) Technetium-99m (Tc-99m) methylene diphosphonate (MDP) whole-body bone scan (WBBS) showed hot MDP uptake in the sternum, left side of the rib cage, thoracic and lumbar regions of the spine, right sacroiliac joint, and left ischium, suggesting multiple bony metastases. (B) Maximum intensity projection of F-18 NaF PET/CT at anterior, posterior, and left anterior oblique views showed new foci at 1st right and 2nd left posterior ribs (arrows) and lateral 7th to 9th ribs (arrow head) and more precisely showed bony lesions than seen using Tc-99m MDP WBBS. NaF = sodium fluoride, PET/CT = positron emission tomography/computed tomography.

Mentions: A 51-year-old woman had a nodule of unknown pathology excised from her left breast 9 years before presenting to our clinic. She was admitted under the impression of suspected lung cancer due to dyspnea, nonproductive cough, pleural pain, poor appetite, swelling in all limbs, and recent weight loss. Tc-99m MDP WBBS showed hot MDP uptake in the sternum, left side of the rib cage, thoracic and lumbar regions of the spine, right sacroiliac joint, and left ischium, suggesting multiple bony metastases (Figure 1A). Five days later, PET/CT was performed after administering an F-18 NaF/FDG cocktail. F-18 NaF PET/CT showed new foci at the 1st right and 2nd left posterior ribs and lateral 7th to 9th ribs. It more precisely revealed obvious bony lesions than did the Tc-99m MDP WBBS (Figure 1B). It also revealed new foci in right scapula and sacrum and showed more extensive radiotracer uptake in lesions than did PET/CT using NaF only (Figure 2). In addition, it revealed soft tissue uptake in left axillary nodes, left pleura, and surpraclavicular nodes. Surgical biopsy was performed in the left axillary nodes 2 days later according to these findings (Figure 3). Pathology revealed poorly differentiated adenocarcinoma of breast origin. Therefore, the tentative diagnosis was cancer in the left breast with regional lymph node invasion, bony metastases, and pleural seeding on the left side (cT4N3M1, stage IV). Chemotherapy with Taxol (Corden Pharma Latina S.p.A.) was initiated, and she was discharged in stable condition.


Added value of using a cocktail of F-18 sodium fluoride and F-18 fluorodeoxyglucose in positron emission tomography/computed tomography for detecting bony metastasis: a case report.

Chan HP, Hu C, Yu CC, Huang TC, Peng NJ - Medicine (Baltimore) (2015)

(A) Technetium-99m (Tc-99m) methylene diphosphonate (MDP) whole-body bone scan (WBBS) showed hot MDP uptake in the sternum, left side of the rib cage, thoracic and lumbar regions of the spine, right sacroiliac joint, and left ischium, suggesting multiple bony metastases. (B) Maximum intensity projection of F-18 NaF PET/CT at anterior, posterior, and left anterior oblique views showed new foci at 1st right and 2nd left posterior ribs (arrows) and lateral 7th to 9th ribs (arrow head) and more precisely showed bony lesions than seen using Tc-99m MDP WBBS. NaF = sodium fluoride, PET/CT = positron emission tomography/computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554036&req=5

Figure 1: (A) Technetium-99m (Tc-99m) methylene diphosphonate (MDP) whole-body bone scan (WBBS) showed hot MDP uptake in the sternum, left side of the rib cage, thoracic and lumbar regions of the spine, right sacroiliac joint, and left ischium, suggesting multiple bony metastases. (B) Maximum intensity projection of F-18 NaF PET/CT at anterior, posterior, and left anterior oblique views showed new foci at 1st right and 2nd left posterior ribs (arrows) and lateral 7th to 9th ribs (arrow head) and more precisely showed bony lesions than seen using Tc-99m MDP WBBS. NaF = sodium fluoride, PET/CT = positron emission tomography/computed tomography.
Mentions: A 51-year-old woman had a nodule of unknown pathology excised from her left breast 9 years before presenting to our clinic. She was admitted under the impression of suspected lung cancer due to dyspnea, nonproductive cough, pleural pain, poor appetite, swelling in all limbs, and recent weight loss. Tc-99m MDP WBBS showed hot MDP uptake in the sternum, left side of the rib cage, thoracic and lumbar regions of the spine, right sacroiliac joint, and left ischium, suggesting multiple bony metastases (Figure 1A). Five days later, PET/CT was performed after administering an F-18 NaF/FDG cocktail. F-18 NaF PET/CT showed new foci at the 1st right and 2nd left posterior ribs and lateral 7th to 9th ribs. It more precisely revealed obvious bony lesions than did the Tc-99m MDP WBBS (Figure 1B). It also revealed new foci in right scapula and sacrum and showed more extensive radiotracer uptake in lesions than did PET/CT using NaF only (Figure 2). In addition, it revealed soft tissue uptake in left axillary nodes, left pleura, and surpraclavicular nodes. Surgical biopsy was performed in the left axillary nodes 2 days later according to these findings (Figure 3). Pathology revealed poorly differentiated adenocarcinoma of breast origin. Therefore, the tentative diagnosis was cancer in the left breast with regional lymph node invasion, bony metastases, and pleural seeding on the left side (cT4N3M1, stage IV). Chemotherapy with Taxol (Corden Pharma Latina S.p.A.) was initiated, and she was discharged in stable condition.

Bottom Line: The former showed more foci and precisely showed bony lesions compared to those obtained using Tc-99m MDP WBBS.Surgical biopsy was performed in left axillary nodes, and the metastatic carcinoma was found to be of breast origin.This case demonstrated that a cocktail of F-18 NaF and F-18 FDG could be useful in PET/CT for not only detecting more skeletal lesions but also guiding biopsies accurately to the affected tissue.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Nuclear Medicine (H-PC, CH, C-CY, T-CH, N-JP), Kaohsiung Veterans General Hospital; Department of Information Engineering (C-CY), I-Shou University, Kaohsiung; and National Yang-Ming University (N-JP), School of Medicine, Taipei, Taiwan.

ABSTRACT
Current nuclear imaging of the skeletal system is achieved using technetium-99m (Tc-99m) methylene diphosphonate (MDP), F-18 sodium fluoride (NaF), or F-18 fluorodeoxyglucose (FDG). However, comparisons of these are rare in the literature. We present a case of a 51-year-old female with suspicious lung cancer due to main symptoms of dyspnea, nonproductive cough, and pleural pain. Tc-99m MDP whole-body bone scan (WBBS) showed multiple bony metastases. Five days later, positron emission tomography/computed tomography (PET/CT) images using both F-18 NaF and a cocktail of F-18 NaF and F-18 FDG were obtained on the same day 2 hours apart. The former showed more foci and precisely showed bony lesions compared to those obtained using Tc-99m MDP WBBS. However, the latter demonstrated more extensive radiotracer uptake, especially in osteolytic lesions, and additional soft tissue lesions in the left axillary and surpraclavicular nodes as well as the left pleura. Surgical biopsy was performed in left axillary nodes, and the metastatic carcinoma was found to be of breast origin. This case demonstrated that a cocktail of F-18 NaF and F-18 FDG could be useful in PET/CT for not only detecting more skeletal lesions but also guiding biopsies accurately to the affected tissue.

Show MeSH
Related in: MedlinePlus