Abstract
18F-sodium fluoride uptake mechanism is based on the fluoride ion exchange, with a hydroxyl group of the hydroxyapatite being at the surface of the bone crystals and thus forming fluorapatite, especially at sites with a high rate of bone remodeling. 18F-fluoride shows a lower protein binding and faster plasma clearance with respect to 99mTc-diphosphonates (twice increased bone uptake). The adult dose range is 185–370MBq, whereas in children it is advisable to adjust dose (0.057mCi/kg). The acquisition time of the 18F-fluoride PET study is similar to that of 18F-FDG one (60±30minutes). The CT is required for attenuation correction (low amperage 30mAs) but also allows artifact reduction and quantification. 18F-fluoride PET shows high sensitivity for detection of bone metastases, affecting its specificity. However, CT addition may increase specificity, resulting in a high accuracy of 18F-fluoride PET/CT. Given its uptake mechanism, its sensitivity is higher for mixed and blastic metastases rather than for lytic ones. Multiple studies have shown that the sensitivity of the 18F-fluoride is higher than bone scan, including whole-body bone SPECT. However, 18F-fluoride PET/CT should find their real indications in the current algorithms of clinical practice.
Published Version
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