Evaluation of 18F-Fluoride PET/MR and PET/CT in patients with unclear foot pain

NewsBot · Feb 14, 2015

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Evaluation of 18F-Fluoride PET/MR and PET/CT in patients with unclear foot pain.
Rauscher I et al
J Nucl Med. 2015 Feb 12. pii: jnumed.114.150532

Aim: To evaluate the quality and diganostic performance of 18F-Fluoride positron-emission tomography/magnetic resonance imaging (18F-Fluoride PET/MR) compared to 18F-Fluoride positron-emission tomography/computed tomography (18F-Fluoride PET/CT) imaging in patients with unclear foot pain.
MATERIALS AND METHODS:
Twenty-two patients (9 men, 13 women; mean age 48±18 years, range: 20-78 years) were prospectively included in this study and underwent a single injection dual imaging protocol with 18F-Fluoride PET/CT (Siemens Biograph mCT) and PET/MR (Siemens Biograph mMR). PET/MR protocol included at least T1w SE and PD fs sequences in two planes each with simultaneous acquisition of PET over 20 min. PET/CT included a native isotropic (0.6 mm) diagnostic CT (120 kV, 90 mAs) and a subsequent PET (2 min per bed position (BP)). Two blinded readers assessed in consensus randomly both PET datasets for image quality (three-point scale) and for the presence of focal lesions with increased 18F-Fluoride uptake (maximum of 4 lesions). For each dataset (PET/CT vs. PET/MR) the diagnoses were defined by using both PET and morphological dataset. SUV values from the two devices were compared using linear correlation and Bland-Altman plots. Moreover we estimated the potential for dose reduction for PET/MR compared to PET/CT considering the longer acquisition time of PET/MR analyzing count rate statistics.
RESULTS:
Image quality was rated diagnostic for both PET datasets. However, with a mean rating of 3.0/3 for PET/MR and 2.3/3 for PET/CT, image quality was significantly superior for PET/MR (p<0.0001). Sensitivity of the PET datasets in PET/MR and PET/CT were equivalent with the same 42 lesions with focal 18F-Fluoride uptake. In PET/MR mean SUVmean was 10.4 [range 2.0-67.7] and mean SUVmax 15.6 [range 2.9-94.1], corresponding mean SUVmean of PET/CT was 10.2 [range 1.8-55.6] and mean SUVmax 16.3 [range 2.5-117.5], resulting in a high linear correlation coefficient (correlation coefficient r = 0.96, p<0.0001 for SUVmean and for SUVmax, respectively). A final consensus reading revealed as most frequent main diagnoses, osteoarthritis, stress fracture and bone marrow edema (BME). Hereby, PET/CT was more precise in visualizing osteoarthritis, while PET/MR was more specific in non-degenerative pathologies due to the higher soft-tissue and bone marrow contrast. The longer acquisition time of MR compared to CT would potentially allow 18F-Fluoride dose reduction using hybrid 18F-Fluoride PET/MR imaging of at least 50 % according to the count rate analysis.
CONCLUSION:
In patients with unclear foot pain 18F-Fluoride PET/MR is technical feasible and robust in terms of image quality and SUV quantification compared to 18F-Fluoride PET/CT. In a majority of patients 18F-Fluoride PET/MR provided more diagnostic information at a higher diagnostic certainty as compared to PET/CT. Thus PET/MR combines the high sensitivity of 18F-Fluoride PET to pinpoint areas with the dominant disease activity and the specificity of MRI for the final diagnosis with the potential for a substantial dose reduction compared to PET/CT.
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