References: 

Hoh XK, Hawkins, RA, Dahlbom M, et al (UCLA):  Whole body skeletal imaging with [18F]fluoride ion and PET.  J Comput Assist Tomogr. 1993 Jan-Feb;17(1):34-41. Using our recently reported whole body PET imaging technique, we performed whole body PET studies of the skeletal system with [18F]fluoride ion in 19 patients with a range of malignant and benign skeletal conditions and in 19 normal male volunteers. The technique produces two-dimensional projection images of the entire skeletal system ("a PET bone scan"), in addition to coronal, sagittal, and axial tomographic images of the skeletal system. The tomographic images had a 13% higher lesion detection sensitivity than the projection images. Whole body PET skeletal imaging with [18F]fluoride ion is technically feasible, provides images of excellent quality, and may be coupled with more quantitatively precise kinetic PET [18F]fluoride ion studies (over limited regions of the body) when numerical estimates of skeletal [18F]fluoride ion uptake are desired. The method is potentially useful in clinical applications where the high resolution and numerical precision of PET are of particular value (e.g., in accurately defining the anatomic location and extent of lesions and in assessing changes in bone metabolism on serial studies).

Ronald G. Tompkins, M.D., Sc.D.; Alan J. Fischman, M.D., Ph.D.: Non-Invasive Monitoring of Bone Growth After Thermal Injury 

Messa C, Goodman WG, Hoh CK, Choi Y, Nissenson AR, Salusky IB, Phelps ME, Hawkins RA (UCLA):  Bone metabolic activity measured with positron emission tomography and [18F] fluoride ion in renal osteodystrophy:  correlation with bone histomorphometry.  J Clin Endocrinology & Metabolism 1993, 77:949-55.  The authors evaluated the bone metabolic activity in patients with renal osteodystrophy using positron emission tomography and [[sup 18]F] fluoride ion.^Eight patients had secondary hyperparathyroidism (HPT), and three had low-turnover bone disease.^Eleven normal subjects were also studied, and three of the eight HPT patients were reevaluated after therapy.^A rate constant (K) describing the net transport of [[sup 18]F] fluoride ion into a bound compartment in bone was calculated using both a three-compartment model and Patlak graphical analysis.^Values of K were compared with biochemical data and with histomorphometric indices.^The results indicate that K is significantly higher (P < 0.01) in HPT patients than in normal subjects and patients with low-turnover bone disease.^Values of K correlated with serum alkaline phosphatase (r = 0.81) and PTH (r = 0.93) levels and with histomorphometric indices of bone formation rate (r = 0.84, P < 0.01) and eroded perimeter (r = 0.77, P < 0.05).^Values of K decreased by 40 and 30%, respectively, in two patients who underwent parathyroidectomy and medical therapy.^Positron emission tomography studies of bone using [[sup 18]F] fluoride ion can differentiate low turnover from high turnover lesions of renal osteodystropy and provide quantitative estimates of bone cell activity that correlate with histomorphometric data.

Schirrmeister H, Guhlmann A, Kotzerke J, et al (Depts Nuclear Med, Gynecology, Radiation Oncology, and Diagnostic Radiology, University Hosptial Ulm, Germany):  Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography.  J Clin Oncology 1999, 17:2381-?.   PURPOSE: Previous studies have shown that bone metastases are revealed by magnetic resonance imaging (MRI) or bone marrow scintigraphy several months before they are visible by conventional bone scintigraphy (BS). We present a new approach for detecting bone metastases in patients with breast cancer. We compared findings obtained with fluoride ion (F-18) and positron emission tomography (PET) with those obtained with conventional BS. PATIENTS AND METHODS: Thirty-four breast cancer patients were prospectively examined using F-18–PET and conventional BS. F-18–PET and BS were performed within 3 weeks of each other. Metastatic bone disease was previously known to be present in six patients and was suspected (bone pain or increasing levels of tumor markers, Ca²⁺, alkaline phosphatase) in 28 patients. Both imaging modalities were compared by patient-by-patient analysis and lesion-by-lesion analysis, using a five-point scale for receiver operating characteristic (ROC) curve analysis. A panel of reference methodswas used, including MRI (28 patients), planar x-ray (17 patients), and spiral computed tomography (four patients). RESULTS: With F-18–PET, 64 bone metastases were detected in 17 patients. Only 29 metastases were detected in 11 patients with BS. As a result of F-18–PET imaging, clinical management was changed in four patients (11.7%). For F-18–PET, the area under the ROC curve was 0.99 on a lesion basis (for BS, it was 0.74; P < .05) and 1.00 on a patient basis (for BS, it was 0.82; P < .05). CONCLUSION: F-18–PET demonstrates a very early bone reaction when small bone marrow metastases are present, allowing accurate detection of breast cancer bone metastases. This accurate detection has a significant effect on clinical management, compared with the effect on management brought about by detection with conventional BS.