Prospective Comparison of 99mTc MDP Scintigraphy, Combined 18F-NaF and 18F-FDG PET/CT and Whole-Body MRI in Patients with Breast and Prostate Cancers - Abstract

We prospectively evaluated the combined 18F-NaF/18F-FDG PET/CT in patients with breast and prostate cancers, and compared the results to 99mTc MDP bone scintigraphy (BS) and whole-body MRI (WBMRI).

30 patients (15 women with breast cancer and 15 men with prostate cancer) referred for standard of care BS were prospectively enrolled in this study. 18F-NaF/18F-FDG PET/CT and WBMRI were performed following BS. WBMRI protocol consisted of both non-contrast enhanced and contrast enhanced sequences. Lesions detected with each test were tabulated and the results were compared.

For extra skeletal lesions, 18F-/18F-FDG PET/CT and WBMRI had no statistically significant differences in sensitivity (92.9% vs 92.9%, P=1.00), PPV (81.3% vs 86.7%,P=0.68) and accuracy (76.5% vs 82.4%, P=0.56). However, 18F-/18F-FDG PET/CT showed significantly higher sensitivity and accuracy than WBMRI (96.2% vs 81.4%, P<0.001, 89.8% vs 74.7%, P=0.01) and BS (96.2% vs 64.6%, P<0.001, 89.8% vs 65.9%, P<0.001) for the detection of skeletal lesions. Overall, 18F-/18F-FDG PET/CT showed higher sensitivity and accuracy than WBMRI (95.7% vs 83.3%, P<0.002, 87.6% vs 76.0%, P<0.02), but not statistically significant when compared to a combination of WBMRI and BS (95.7% vs 91.6%, P=0.17, 87.6% vs 83.0%, P=0.53). 18F-/18F-FDG PET/CT showed nosignificant difference with a combination of 18F /18F-FDG PET/CT and WBMRI. No statistically significant differences in PPV were noted among the 3 examinations.

The 18F NaF/18F FDG PET/CT is superior to WBMRI and 99mTc-MDP scintigraphy for evaluation of skeletal disease extent. Further, 18F NaF/18F FDG PET/CT and WBMRI detected extra-skeletal disease that may change the management of these patients. The 18F NaF/18F FDG PET/CT provide similar diagnostic ability with combination of WBMRI and BS in patients with breast and prostate cancers. Larger cohorts are needed in order to confirm these preliminary findings, ideally using the newly introduced simultaneous PET/MRI scanners.

Ryogo Minamimoto 1, 2, Andreas Loening 3, Mehran Jamali 1, 2, Amir Barkhodari 1, Camila Mosci 1, Tatianie Jackson 1, Piotr Obara 3, Valentina Taviani 3, Sanjiv Sam Gambhir 1, 2, Shreyas Vasanawala 3, and Andrei Iagaru 1 1 Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA 2 Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 3 Department of Radiology, Radiological Sciences Laboratory, Stanford University, Stanford, CA

First Author: R. Minamimoto Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, Stanford, CA 300 Pasteur Drive, H2200 Stanford, CA 94305-5281

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