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REVIEW  BONE METASTASES IN THE ERA OF TARGETED TREATMENTS 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2019 June;63(2):112-28

DOI: 10.23736/S1824-4785.19.03198-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Molecular imaging of bone metastases using bone targeted tracers

Sofia VAZ 1 , Sharjeel USMANI 2, Gopinath GNANASEGARAN 3, Tim Van den WYNGAERT 4, 5

1 Department of Nuclear Medicine Radiopharmacology, Champalimaud Center for the Unknown, Lisbon, Portugal; 2 Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Khaitan, Kuwait City, Kuwait; 3 Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK; 4 Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium; 5 Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium



Molecular imaging using bone targeted tracers has been used in clinical practice for almost fifty years and still plays an essential role in the diagnosis and follow-up of bone metastases. It includes both [99mTc]bisphosphonates for bone scan and [18F]NaF for positron emission tomography/computed tomography (PET/CT) which are very sensitive to detect osteoblastic activity, but it is important to consider several aspects to increase the specificity of reported findings (such as specific tracer characteristics and mechanism of action, patient’s clinical history, common metastatic patterns, changes after treatment, limitations of the technique, variations and pitfalls). This will enable useful information for clinical management being provided in the report. Furthermore, iatrogenic skeletal adverse events are common and they should also be identified, as they have impact on patient’s quality of life. This review makes a brief summary of the mechanism of action of bone targeted tracers, followed by a discussion of classic patterns of bone metastasis, treatment response assessment and iatrogenic skeletal complications. The value of hybrid imaging techniques with bone targeted tracers, including single photon emission computed tomography and PET/CT is also explored. The final part summarizes new bone targeted tracers with superior imaging characteristics that are being developed, and which may further enhance the applications of radionuclide bone imaging.


KEY WORDS: Neoplasm metastasis; Positron emission tomography computed tomography; Molecular imaging

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