Abstract
In a healthy body, homeostatic actions of osteoclasts and osteoblasts maintain the integrity of the skeletal system. When cellular activities of osteoclasts and osteoblasts become abnormal, pathological bone conditions, such as osteoporosis, can occur. Traditional imaging modalities, such as radiographs, are insensitive to the early cellular changes that precede gross pathological findings, often leading to delayed disease diagnoses and suboptimal therapeutic strategies. 18F-sodium fluoride (18F-NaF)-positron emission tomography (PET) is an emerging imaging modality with the potential for early diagnosis and monitoring of bone diseases through the detection of subtle metabolic changes. Specifically, the dissociated 18F- is incorporated into hydroxyapatite, and its uptake reflects osteoblastic activity and bone perfusion, allowing for the quantification of bone turnover. While 18F-NaF-PET has traditionally been used to detect metastatic bone disease, recent literature corroborates the use of 18F-NaF-PET in benign osseous conditions as well. In this review, we discuss the cellular mechanisms of 18F-NaF-PET and examine recent findings on its clinical application in diverse metabolic, autoimmune, and osteogenic bone disorders.
Highlights
Bone is a dynamic tissue that is constantly remodeled by the actions of bone-resorbing osteoclasts and bone-forming osteoblasts
18 F-NaF-positron emission tomography (PET) is specific to osteoblast activity, it can be sensitive for lytic bone lesions that are accompanied by a component of abnormal osteoblast activity [11]
Variations in regional bone perfusion to the different bones of the body have been previously demonstrated with 18 F-NaF-PET, and abnormal 18 F-NaF uptake in pathological conditions may reflect altered vascularity and angiogenesis, which are known to be associated with bone turnover [30]
Summary
Fluoride PET as a Diagnostic Modality for Metabolic, Autoimmune, and Osteogenic Bone Disorders: Cellular Mechanisms and Clinical Applications.
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