Sodium Fluoride PET/CT in Clinical Use

This pocket book is the first of its kind on sodium fluoride (18F-NaF)-PET and addresses skeletal as well as cardiovascular applications. In malignant metastatic diseases 18F-NaF-PET has already demonstrated its benefits in cancer staging, re-staging, follow-up and response evaluation. It also has an emerging diagnostic role in the calcified soft-tissue metastases of primary bone tumours, and can be applied to evaluate cardiovascular diseases, such as calcifications in heart valves and peripheral vascular disease.

The book is divided into 11 chapters: five on oncology, four addressing the general aspects of skeletal conditions, and two on cardiovascular diseases. It offers a valuable guide for referring colleagues, nuclear medicine physicians/radiologists and aid clinicians, and highlights the main applications and limitations of 18F-NaF-PET hybrid imaging (PET/CT).

• Language: English
• Publisher: Springer
• Release date: Nov 4, 2019
• ISBN: 9783030235772

Book preview

© Springer Nature Switzerland AG 2020

K. Kairemo, H. A. Macapinlac (eds.)Sodium Fluoride PET/CT in Clinical UseClinicians’ Guides to Radionuclide Hybrid Imaginghttps://doi.org/10.1007/978-3-030-23577-2_1

1.  ¹⁸F Sodium Fluoride: Tracer and Technique

Lesley Flynt¹  

(1)

Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA

Lesley Flynt

Email: [e-mail]

1.1 Historical Perspective

1.2 Radiotracer Properties and Technique

1.3 Patient Preparation

1.4 Technique

References

1.1 Historical Perspective

The first images of the bones of the skeleton date back to the late 1890s when German physicist Wilhelm Röntgen produced the first plain film by projecting X-rays through his wife’s hand to produce a picture of the hand bones on a photographic plate [1, 2]. We have come a long way since the 1890s.

Standard radiology procedures continue to use this method of imaging by producing pictures of the human body by sending radiation from outside of the body, to the inside.

Nuclear medicine imaging , on the other hand, produces pictures of the human body by gathering radiation coming from inside of the body, to the outside. Further, nuclear techniques look at activity within the body by using targeted radiotracers. That is, nuclear medicine images are for viewing active physiologic processes, rather than anatomy.

One of the first targeted radiotracers to be developed was Sodium 18-Fluoride (NaF). It was first discovered in the 1960s as a dedicated imaging agent of activity in the bony skeleton from the inside, out, and for the first time, allowed scientists and physicians the ability to visualize radiotracer distribution, or osteoblastic activity, in the bones of the human body [3].

It was during that time that nuclear imaging was performed using the Rectilinear Scanner which was invented by Benedict Cassen in 1949 [4, 5], specifically for the detection of radioactivity from the body, for medical use. This scanner had the capability to image a wide range of photon energies; however, it was quickly replaced by the gamma camera, or Anger camera, invented by Hal O. Anger in 1957 [5, 6]. The gamma camera produced images which were far superior to those of the Rectilinear Scanner; however, a limitation of the conventional gamma camera was the inability to image moderately high energy radionuclides. NaF has a moderately high energy [3, 5, 7–9].

To add to the decline of the use of NaF was the development of the table-top Molybdenum-99/Technetium-99 (⁹⁹Mo/⁹⁹mTc) generator out of Brookhaven Labs in 1958 [10–12]. This led to even more excitement around the increasingly popular gamma camera, as there was now easy access to a radioisotope which was perfect for use with the gamma camera, as ⁹⁹mTc is a relatively low energy radionuclide with ideal nuclear properties for gamma imaging [12]. This ease of access led to the development of many new radiotracers for other medical applications using ⁹⁹mTc as the radioactive source, and a swift decline in the price tag of the table top generator.

NaF, on the other hand, is produced by a particle accelerator or cyclotron [13], and in the 1960s, cyclotrons were not as abundant as they are today. Also, with the less optimal nuclear properties of NaF, for example, a relatively short half-life, it is necessary to have access to a reasonably closely located cyclotron in order to obtain enough radionuclide for use [13–16].

Yet another blow to NaF was the discovery of ⁹⁹mTc-methyl diphosphonate (⁹⁹mTc-MDP) in 1971 by McAfee and Subramanian, which is a bone seeking agent using the easily accessible ⁹⁹mTc radionuclide combined with a relatively simply, and cost effectively, made compound, which is still routinely used in nuclear medicine for evaluation of many diseases of the bones [17]. The abandonment of NaF was not based on limitations of the tracer itself, but rather due to high cost and the now widely available ⁹⁹mTc-MDP. Again, we have come a long way since the 1970s. Enter: The Positron Emission Tomography (PET) scanner.

The first PET scanner was built in 1961 at Brookhaven National Laboratory and is based on the idea of detecting two gamma photons traveling in opposite directions, produced where uptake of the radiotracer occurs [18]. This scanner is called a positron scanner because it detects radiotracers which emit photons produced by the interaction of a positron with an electron, also known as an annihilation event [18].

The PET scanner gained significant popularity following experiments using [¹⁸F] fluoro-deoxy glucose (FDG) , which is the glucose analog used to detect areas of varying metabolic activity, which is of particular importance in consideration of the Warburg Effect and its relation to actively dividing cancer cells [19–21].

The first dose of FDG for human use was prepared in August 1976 at Brookhaven Laboratory, and flown from Long Island to Philadelphia where Dr. Abass Alavi at the University of Pennsylvania was the first person to inject this radiotracer into humans. Following injection, he imaged the brain of a volunteer medical student [20–22]. Then, they proceeded to image the entirety of the body, and from that point on, imaging of physiology in Nuclear Medicine would never be the same [22].

In 1998 following development of the hybrid PET/CT scanner, as well as the appearance of more medical cyclotrons for production of ¹⁸F, widespread use of PET/CT imaging transpired [23,