Application of 18F-NaF PET/CT bone scintigraphy to hyperparathyroid bone disease

Abstract

Objective To explore the features and value of18F-NaF PET/CT bone scintigraphy in patients with hyperparathyroid bone disease. Methods Thirty cases [11 men and 19 women, aged 18–71 (52.3±13.5) years] were confirmed through clinical and postoperative pathology as hyperparathyroidism. All patients underwent 18F-NaF PET/CT and 99Tcm-methylenediphosphonate(99Tcm-MDP) whole-body bone scintigraphy, and the characteristics of the obtained 18F-NaF PET/CT bone images were retrospectively analyzed. Results of the detection rate of local bone disease were compared between the two types of bone scintigraphy, and brown tumors were evaluated according to Mirels' criteria. Results The qualitative results of the two bone scintigraphy methods were identical. A total of 15 cases with negative bone scintigraphy and 15 cases with positive bone scintigraphy were analyzed. The osteopathy of hyperparathyroid bone disease on the 18F-NaF PET images was characterized by a variety of bone diseases that were mainly composed of diffuse bone metabolism in multiple bones throughout the body. When brown tumors, bone sclerosis, pathological fractures, and pseudofractures were concurrently present, they manifested as an abnormal distribution area of single or multiple focal imaging agents. Among the lesions found, brown tumors showed focal imaging agent concentration, imaging agent sparseness, or focal center imaging agent distribution defects with uneven imaging of the edge imaging agent. Fifteen cases of multiple forms of bone resorption, 13 cases of extensive osteoporosis, 7 cases of brown tumors, 6 cases of bone sclerosis, 3 cases of osteomalacia, and 3 cases of pathological fractures were observed. A total of 53 local bone lesions (i.e., brown tumors, bone sclerosis, pathological fractures, false fractures) were detected in 15 positive patients. All lesions were detected by 18F-NaF PET/CT bone scintigraphy, and only 32 lesions were detected by 99Tcm-MDP whole-body bone scintigraphy. Seven positive patients had long bone brown tumors with a total of 24 lesions, of which nine had a Mirels score greater than 9 points. Conclusions Hyperparathyroid bone disease shows characteristic features related to bone metabolism and anatomy on 18F-NaF PET/CT bone scintigraphy, a technique that shows more lesions, as well as details of these lesions, than 99Tcm-MDP whole-body bone scintigraphy. Taken together, the results reveal that 18F-NaF PET/CT bone scintigraphy has important value in the diagnosis, differential diagnosis, and severity assessment of hyperparathyroid bone disease. Key words: Technetium Tc 99 m medronate; Sodium fluoride; Positron emission tomography computed tomography; Hyperparathyroid bone disease; Bone scintigraphy