Abstract
BackgroundSodium fluoride (NaF) positron emission tomography combined with computer tomography (PET/CT) has shown to be more sensitive than the whole-body bone scan in the detection of skeletal uptake due to metastases in prostate cancer. We aimed to calculate a 3D index for NaF PET/CT and investigate its correlation to the bone scan index (BSI) and overall survival (OS) in a group of patients with prostate cancer.MethodsNaF PET/CT and bone scans were studied in 48 patients with prostate cancer. Automated segmentation of the thoracic and lumbar spines, sacrum, pelvis, ribs, scapulae, clavicles, and sternum were made in the CT images. Hotspots in the PET images were selected using both a manual and an automated method. The volume of each hotspot localized in the skeleton in the corresponding CT image was calculated. Two PET/CT indices, based on manual (manual PET index) and automatic segmenting using a threshold of SUV 15 (automated PET15 index), were calculated by dividing the sum of all hotspot volumes with the volume of all segmented bones. BSI values were obtained using a software for automated calculations.ResultsBSI, manual PET index, and automated PET15 index were all significantly associated with OS and concordance indices were 0.68, 0.69, and 0.70, respectively. The median BSI was 0.39 and patients with a BSI >0.39 had a significantly shorter median survival time than patients with a BSI <0.39 (2.3 years vs not reached after 5 years of follow-up [p = 0.01]). The median manual PET index was 0.53 and patients with a manual PET index >0.53 had a significantly shorter median survival time than patients with a manual PET index <0.53 (2.5 years vs not reached after 5 years of follow-up [p < 0.001]). The median automated PET15 index was 0.11 and patients with an automated PET15 index >0.11 had a significantly shorter median survival time than patients with an automated PET15 index <0.11 (2.3 years vs not reached after 5 years of follow-up [p < 0.001]).ConclusionsPET/CT indices based on NaF PET/CT are correlated to BSI and significantly associated with overall survival in patients with prostate cancer.
Highlights
Sodium fluoride (NaF) positron emission tomography combined with computer tomography (PET/computed tomography (CT)) has shown to be more sensitive than the whole-body bone scan in the detection of skeletal uptake due to metastases in prostate cancer
Several studies have indicated that NaF Positron emission tomography (PET)/CT has superior sensitivity compared to bone scan in detecting skeletal changes due to bone metastasis in prostate cancer [8,9,10]
Study group We retrospectively studied positron emission tomography combined with computer tomography (PET/CT) scans and bone scans in prostate cancer patients who previously had been selected for a study at Odense University Hospital, Denmark, with the aim to compare whole-body bone scans, choline-PET/CT, and NaF PET/CT with MRI [12]
Summary
Sodium fluoride (NaF) positron emission tomography combined with computer tomography (PET/CT) has shown to be more sensitive than the whole-body bone scan in the detection of skeletal uptake due to metastases in prostate cancer. Similar to bone scan interpretation prior to the development of BSI, there is no objective method to evaluate skeletal uptake in PET/CT scans. The prostate cancer working group 3 consensus criteria state that there is a lack of standards in NaF PET interpretation for reporting disease presence or changes posttreatment and that NaF should be approached as a new biomarker subjected to independent validation [11]. Quantification from NaF PET/CT images could make it possible to stratify prognosis and track disease progress It would yield an objective way of evaluating treatment outcome which would enable the development of new therapies
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