Musculoskeletal imaging using fluoride PET.

The convenience of (18)F-fluoride imaging is undeniable both because of its favorable tracer and because of its technical characteristics, including high image quality and short examination times leading to increased patient comfort. Depending on the activity administered, the radiation dose to patients is about comparable to higher using (18)F-fluoride for bone imaging compared with conventional scintigraphy using 99mTc-methylene diphosphonate. In times of molybdenum shortage, (18)F-fluoride represents a good alternative to 99mTc-based bone tracers. Besides malignant skeletal disease(18)F-fluoride PET/CT has in the last decade been investigated in a variety of non-oncologic musculoskeletal disorders of all parts of the skeleton. Studies included imaging of the skull with a special focus on bisphosphonate-induced osteonecrosis of the jaw in patients treated with bisphosphonates due to benign or malignant bone changes. Further studies evaluated the appendicular skeleton with emphasis on postsurgical changes including patients after knee and hip surgery and patients having received bone grafts of their limbs. Also, therapeutic effect of (18)F-fluoride PET/CT on patients with unclear foot pain was investigated. Finally imaging of the axial skeleton was analyzed including patients with ankylosing spondylitis and with Paget disease as well as patients after spine surgery including assessment of cage incorporation after cervical and lumbar spine fusion surgery. Furthermore, children suspected of child abuse as well as young patients with back pain were investigated by either (18)F-fluoride PET or PET/CT. Regarding its favorable technical aspects as well as study results presented, it is imaginable that (18)F-fluoride PET/(CT) will be increasingly used for non-oncologic musculoskeletal imaging in the future either as an adjunct or alternative to so far established imaging modalities and seems to be promising regarding decision making in the therapeutic management of patients with non-oncologic musculoskeletal disorders.

Therapeutic impact of [(18)F]fluoride positron-emission tomography/computed tomography on patients with unclear foot pain.

PURPOSE: To evaluate the therapeutic impact of [(18)F]fluoride positron-emission tomography/computed tomography ([(18)F]fluoride PET/CT) imaging on patients with unclear foot pain. METHODS: Twenty-eight patients were prospectively included in this study. Therapeutic management was defined by two experienced dedicated foot surgeons before and after [(18)F]fluoride PET/CT imaging. Twenty-six patients underwent cross-sectional imaging [CT, magnetic resonance (MR)] prior to PET/CT. A retrospective analysis of the magnetic resonance imaging (MRI) diagnoses was performed when a therapy change occurred after PET/CT imaging. RESULTS: In 13/28 (46%) patients therapeutic management was changed due to PET/CT results. Management changes occurred in patients with the following diagnoses: os trigonum syndrome; sinus tarsi syndrome; os tibiale externum syndrome; osteoarthritis of several joints; non-consolidated fragments; calcaneo-navicular coalition; plantar fasciitis; insertional tendinopathy; suggestion of periostitis; neoarticulations between metatarsal bones. Os trigonum, os tibiale externum, subtalar osteoarthritis and plantar fasciitis were only seen to be active on PET/CT images but not on MR images. CONCLUSION: [(18)F]fluoride PET/CT has a substantial therapeutic impact on management in patients with unclear foot pain.