18F-NaF PET/CT: EANM procedure guidelines for bone imaging

Abstract

The aim of this guideline is to provide minimum standards for the performance and interpretation of (18)F-NaF PET/CT scans. Standard acquisition and interpretation of nuclear imaging modalities will help to provide consistent data acquisition and numeric values between different platforms and institutes and to promote the use of PET/CT modality as an established diagnostic modality in routine clinical practice. This will also improve the value of scientific work and its contribution to evidence-based medicine.

Positron Emission Tomography (PET) Radiopharmaceuticals in Multiple Myeloma

“…3.6. 18 F-Sodium Fluoride ( 18 F-NaF) 18 F-NaF is a highly sensitive biomarker of bone reconstruction, with potential indications in a wide range of bone disease [71][72][73][74]. The uptake of the tracer in bone occurs by chemisorption onto hydroxyapatite, followed by exchange with hydroxyl groups in the hydroxyapatite, resulting in formation of fluoroapatite.…”

Evaluation of Prostate Cancer Bone Metastases with 18F-NaF and 18F-Fluorocholine PET/CT

“…With a suggested adult dose of 1.5-3.7 MBq/kg (maximum, 370 MBq) and a first-pass clearance of nearly 100% (38,39), about 50% of the administered dose is taken up in the osseous structures, 30% diffuses in red blood cells, and the remainder is eliminated in urine within 6 h of injection (40). Therefore, when preparing a patient for a conventional whole-body bone scan with the urinary bladder as the target organ, hydration with at least a half-liter of water before and after imaging and frequent voiding are strongly recommended to reduce radiation exposure as much as possible (39,40).…”

The Role of 18F-Sodium Fluoride PET/CT Bone Scans in the Diagnosis of Metastatic Bone Disease from Breast and Prostate Cancer

“…As described by Segall et al (9) and the 2015 Guidelines of the European Association of Nuclear Medicine (8), patients are first to be provided with an information leaflet before the test, and then a member of the PET/CT team is to explain the procedure to them on their arrival in the department. 18 F-NaF radiotracer (370 MBq) is injected into the patient intravenously, and there is usually a 1-h wait before the scan, although this can be shortened to 30-45 min if necessary.…”

“…The usual CT settings sufficient for attenuation correction and localization are a tube current of 30 mA, voltage of 120 kVp, rotation of 0.5 s, and pitch of 1 (8).…”

“…The European Association of Nuclear Medicine also produced procedure guidelines specifically for the use of 18 F-NaF PET/CT, outlining minimum standards for the performance and interpretation of 18 F-NaF PET/CT scans (8). Both the U.K. and the European publications refer to guidance from the Society of Nuclear Medicine and Molecular Imaging published back in 2009 (9).…”