Assessment of Regional and Total Skeletal Metabolism Using F-NaF PET/CT in Patients with Chronic Kidney Disease

Overview

Journal Ann Nucl Med

Date 2024 Apr 27

PMID 38676905

Authors

Sharjeel Usmani

Najeeb Ahmed

Gopinath Gnanasegaran

Fahad Marafi

Ahmed Bani-Mustafa

Tim Van den Wyngaert

Affiliations

Soon will be listed here.

Abstract

Objective: The study aims to assess regional and total bone metabolic activity in patients with chronic kidney disease using Na[F]F PET and correlation between semi-quantitative indices and blood parameters.

Methods: Seventy-two subjects (mean age 61.8 ± 13.8 years) were included. Of these 24/72 patients had end-stage renal disease (ESRD) (GFR < 15 mL/min/1.73 m), 38/72 had chronic kidney disease (CKD) (GFR between 60 and 15 mL/min/1.73 m), and 10/72 were controls with normal renal function. All subjects underwent Na[F]F PET-CT with a dose activity of 0.06 mCi/Kg. Regional and total skeletal metabolism were assessed with mean SUVs in a skeletal volume of interest (VOI), bone to soft tissue index (B/S), global SUV mean (GSUV mean) of the whole bone, and uptake in the femoral neck.

Results: Statistically significant differences were observed in a number of F-NaF metrics like femoral neck metabolism in CKD and ERSD groups in comparison to control in right (P = 0.003) and left femur (P = 0.006), bone to soft tissue index in the femur (P = 0.016) and GSUV (P = 0.006). There is also a significant difference in SUV mean in lumbar vertebrae (L1-L4) among CKD, ESRD, and controls. There was a moderate correlation between F-NaF PET scan uptake and blood parameters such as ALP and PTH. Na[F]F uptake parameters were significantly different in low versus high bone turnover state.

Conclusions: The assessment of total skeleton and regional metabolism and bone turnover in CKD patients is feasible with Na[F]F PET. Na[F]F can help to detect early changes in bone metabolism and assess the progression of bone disease in this complex condition. Quantification with Na[F]F PET might provide better assessment of the bone turnover. The difference in Na[F]F uptake in CKD compared to controls is likely related to a change in bone turnover which, however, requires further validation.

Citing Articles

Validation of quantitative [F]NaF PET uptake parameters in bone diseases: a systematic review.

de Ruiter R, Zwama J, Raijmakers P, Yaqub M, Burchell G, Boellaard R Ann Nucl Med. 2024; 39(2):98-149.

PMID: 39729191 PMC: 11799077. DOI: 10.1007/s12149-024-01991-9.

References

Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B . Chronic kidney disease: global dimension and perspectives. Lancet. 2013; 382(9888):260-72. DOI: 10.1016/S0140-6736(13)60687-X. View

Coen G, Ballanti P, Bonucci E, Calabria S, Costantini S, Ferrannini M . Renal osteodystrophy in predialysis and hemodialysis patients: comparison of histologic patterns and diagnostic predictivity of intact PTH. Nephron. 2002; 91(1):103-11. DOI: 10.1159/000057611. View

Fukagawa M, Hamada Y, Nakanishi S, Tanaka M . The kidney and bone metabolism: Nephrologists' point of view. J Bone Miner Metab. 2006; 24(6):434-8. DOI: 10.1007/s00774-006-0719-7. View

Green A, Colon-Emeric C, Bastian L, Drake M, Lyles K . Does this woman have osteoporosis?. JAMA. 2004; 292(23):2890-900. DOI: 10.1001/jama.292.23.2890. View

Hygum K, Starup-Linde J, Harslof T, Jorgensen N, Hartmann B, Holst J . The diurnal variation of bone formation is attenuated in adult patients with type 2 diabetes. Eur J Endocrinol. 2019; 181(3):221-231. DOI: 10.1530/EJE-19-0309. View

Lehmann G, Stein G, Huller M, Schemer R, Ramakrishnan K, Goodman W . Specific measurement of PTH (1-84) in various forms of renal osteodystrophy (ROD) as assessed by bone histomorphometry. Kidney Int. 2005; 68(3):1206-14. DOI: 10.1111/j.1523-1755.2005.00513.x. View

Sprague S, Bellorin-Font E, Jorgetti V, Carvalho A, Malluche H, Ferreira A . Diagnostic Accuracy of Bone Turnover Markers and Bone Histology in Patients With CKD Treated by Dialysis. Am J Kidney Dis. 2015; 67(4):559-66. DOI: 10.1053/j.ajkd.2015.06.023. View

Salam S, Gallagher O, Gossiel F, Paggiosi M, Khwaja A, Eastell R . Diagnostic Accuracy of Biomarkers and Imaging for Bone Turnover in Renal Osteodystrophy. J Am Soc Nephrol. 2018; 29(5):1557-1565. PMC: 5967779. DOI: 10.1681/ASN.2017050584. View

Evenepoel P, Behets G, Laurent M, DHaese P . Update on the role of bone biopsy in the management of patients with CKD-MBD. J Nephrol. 2017; 30(5):645-652. DOI: 10.1007/s40620-017-0424-8. View

10.

Czernin J, Satyamurthy N, Schiepers C . Molecular mechanisms of bone 18F-NaF deposition. J Nucl Med. 2010; 51(12):1826-9. PMC: 3169430. DOI: 10.2967/jnumed.110.077933. View

11.

Grant F, Fahey F, Packard A, Davis R, Alavi A, Treves S . Skeletal PET with 18F-fluoride: applying new technology to an old tracer. J Nucl Med. 2007; 49(1):68-78. DOI: 10.2967/jnumed.106.037200. View

12.

Raynor W, Houshmand S, Gholami S, Emamzadehfard S, Rajapakse C, Blomberg B . Evolving Role of Molecular Imaging with (18)F-Sodium Fluoride PET as a Biomarker for Calcium Metabolism. Curr Osteoporos Rep. 2016; 14(4):115-25. DOI: 10.1007/s11914-016-0312-5. View

13.

Lasnon C, Salomon T, Desmonts C, Do P, Oulkhouir Y, Madelaine J . Generating harmonized SUV within the EANM EARL accreditation program: software approach versus EARL-compliant reconstruction. Ann Nucl Med. 2016; 31(2):125-134. DOI: 10.1007/s12149-016-1135-2. View

14.

Zirakchian Zadeh M, Ostergaard B, Raynor W, Revheim M, Seraj S, Acosta-Montenegro O . Comparison of F-sodium fluoride uptake in the whole bone, pelvis, and femoral neck of multiple myeloma patients before and after high-dose therapy and conventional-dose chemotherapy. Eur J Nucl Med Mol Imaging. 2020; 47(12):2846-2855. DOI: 10.1007/s00259-020-04768-0. View

15.

Kurata S, Ishibashi M, Nishida H, Hiromatsu Y, Hayabuchi N . A clinical assessment of the relationship between bone scintigraphy and serum biochemical markers in hemodialysis patients. Ann Nucl Med. 2004; 18(6):513-8. DOI: 10.1007/BF02984569. View

16.

Nishida H, Kaida H, Ishibashi M, Hiromatsu Y, Baba K, Iida S . Usefulness of bone uptake ratio of bone scintigraphy in hemodialysis patients. Ann Nucl Med. 2005; 19(2):91-4. DOI: 10.1007/BF03027386. View

17.

Frost M, Blake G, Park-Holohan S, Cook G, Curran K, Marsden P . Long-term precision of 18F-fluoride PET skeletal kinetic studies in the assessment of bone metabolism. J Nucl Med. 2008; 49(5):700-7. DOI: 10.2967/jnumed.107.046987. View

18.

Jadvar H, Desai B, Conti P . Sodium 18F-fluoride PET/CT of bone, joint, and other disorders. Semin Nucl Med. 2014; 45(1):58-65. PMC: 4258001. DOI: 10.1053/j.semnuclmed.2014.07.008. View

19.

Frost M, Cook G, Blake G, Marsden P, Benatar N, Fogelman I . A prospective study of risedronate on regional bone metabolism and blood flow at the lumbar spine measured by 18F-fluoride positron emission tomography. J Bone Miner Res. 2003; 18(12):2215-22. DOI: 10.1359/jbmr.2003.18.12.2215. View

20.

Aaltonen L, Koivuviita N, Seppanen M, Burton I, Kroger H, Loyttyniemi E . Bone Histomorphometry and F-Sodium Fluoride Positron Emission Tomography Imaging: Comparison Between only Bone Turnover-based and Unified TMV-based Classification of Renal Osteodystrophy. Calcif Tissue Int. 2021; 109(6):605-614. PMC: 8531121. DOI: 10.1007/s00223-021-00874-9. View