PET/CT & SPECT/CT in benign bone disease

This thesis described the additional value of bone scintigraphy with [99mTc]Tc-oxidronate including Single Photon Emission Computed Tomography / Computed Tomography (bone-SPECT/CT) and of positron emission tomography with integrated computed tomography using sodium fluoride-18 (Na[18F]F-PET/CT) in patients with selected benign bone and joint disease.

Part I: The co-authored practice guideline for bone scintigraphy explained bone scintigraphy indications, standardized acquisition and reconstruction protocols, recommendations on interpretation and reporting, quality control and radiation protection.
Consecutively, three chapters investigated and reviewed the performance of bone-SPECT/CT in designated benign bone and joint disease of the extremities, including patients with a post-operative painful knee, post-operative hand and wrist pain and peri-operative findings in patients with a painful tarsal coalition. Bone-SPECT/CT proved useful as second- or third-line imaging in these patients to pinpoint osseous abnormalities, revealing relevant pathology such as nonviable nonunion, loosening of hardware, osteoarthritis or fracture. In post-operative patients, where MRI might be either contra-indicated or considerably hampered by metal artefacts, bone-SPECT/CT might help in precise localization of the site of pain generation and may aid surgery planning by adequately pinpointing the culprit lesion.

Part II: Na[18F]F-PET/CT was used in fibrous dysplasia / McCune Albright (FD/MAS) patients to measure individualized Na[18F]F-PET/CT Standardized Uptake Value (SUV) cutoffs to highly reproducibly discriminate normal bone from FD/MAS. Physiological bone SUV was well-normalized, but displayed large interpatient variation. The strong relations of serum biomarkers of bone formation with Na[18F]F-PET/CT FD-burden measurements suggest clinical relevance over Skeletal Burden Score as an adjunct instrument in FD/MAS-patients. During follow-up, Na[18F]F-PET/CT potentially provides new clinical insight in changing FD skeletal burden, also correlating with serum biomarkers of bone formation, especially procollagen type 1 N-terminal propeptide. The correlation of Na[18F]F-PET/CT with increased work-related pain scores also indicates clinical applicability. Therefore, Na[18F]F-PET/CT could be a meaningful tool to evaluate treatment efficacy during long-term follow-up in FD/MAS patients. It might be of further clinical value in patients with normal(ized) serum biomarkers of bone formation and clinical complaints, as an alternative to objectify response to therapy.