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THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING

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A Journal on Nuclear Medicine and Molecular Imaging
Affiliated to the Society of Radiopharmaceutical Sciences and to the International Research Group of Immunoscintigraphy
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ORIGINAL ARTICLES  BONE METASTASES 2011:NEW ACHIEVEMENTS OF DIAGNOSTIC AND THERAPEUTIC NUCLEAR MEDICINE


The Quarterly Journal of Nuclear Medicine and Molecular imaging 2011 August;55(4):448-57

language: English

Fluorocholine (18F) and sodium fluoride (18F) PET/CT in the detection of prostate cancer: prospective comparison of diagnostic performance determined by masked reading

Langsteger W. 1, Balogova S. 2,3, Huchet V. 3, Beheshti M. 1, Paycha F. 4, Egrot C. 5, Janetschek G. 6, Loidl W. 7, Nataf V. 8, Kerrou K. 3, Pascal O. 3, Cussenot O. 5, Talbot J.-N. 3

1 PET-CT Center Linz, St Vincent’s Hospital, Linz, Austria;
2 Comenius University, Bratislava, Slovakia;
3 Nuclear Medicine Department, Hôpital Tenon AP-HP & UPMC, Paris, France;
4 Nuclear Medicine Department, Hôpital Lariboisière AP-HP, Paris, France;
5 Urology Department, Hôpital Tenon AP-HP & UPMC, Paris, France;
6 Urology Department, Private Medical University of Salzburg, Austria;
7 Urology Department, St Vincent’s Hospital, Linz, Austria;
8 Radiopharmacy, Hôpital Tenon AP-HP & UPMC, Paris, France


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AIM.The aim of this paper was to compare the diagnostic performance of positron emission tomography/computed tomography (PET/CT) with fluorocholine (18F) (FCH) or fluoride(18F) (FNa) for the detection of bone metastasis in patients with prostate cancer complaining from osteoarticular pain, taking into account whether they were referred for initial staging or recurrence localization. The initial hypothesis was that FCH site-based specificity would be superior to that of F Na, with no loss in sensitivity.
METHODS_ Forty-two patients were enrolled in this prospective study, underwent both PET/CTs and were then followed-up for at least 6 months. The standard of truth (SOT) about the presence/absence and location of bone metastasis could be determined in 40 patients, by 2 independent medical assessors, blinded to the results of both PET/CTs. The comparison was performed according to the guideline of the European Medicines Agency, i.e. based on the results of blind reading with SOT as reference.
RESULTS:Bone extension was present in 22 patients and absent in 18. Patient-based performance for FCH vs. FNa was 91% vs. 91% for sensitivity, 89% vs. 83% for specificity and 90% vs. 88% for accuracy (no significant difference). Of 360 skeletal sites, 68 were malignant and 292 non-invaded. There was no significant difference in site-based performance in the group of patients referred at initial staging, but in the group of patients referred for suspicion of recurrence, FCH was significantly more specific than FNa (96% vs. 91%, P=0.033 with Obuchowski’s correction) while sensitivity was the same, 89%.
CONCLUSION: Both radiopharmaceuticals, based on a very different metabolic approach, showed good diagnostic performance. If FCH is available, it should be preferred in patients after initial treatment.

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jean-noel.talbot@tnn.aphp.fr