Quantitative [18F]NaF PET in Metastatic and Metabolic Bone Diseases

About this Research Topic

Background

The functional imaging technique of [18F]NaF PET offers a non-invasive method of quantifying bone metabolism, i.e., a combination of bone resorption and formation, at clinically important sites with high fracture risk in the skeleton, which is not possible with other techniques. Invasive bone biopsy is painful for the patient, and biochemical markers in serum or urine measure whole-skeletal bone metabolism and mask the regional information. Dual-energy x-ray absorptiometry (DXA) is a clinically used tool to assess fracture risk by measuring the bone mineral density that reflects structural changes in the bone, which can take between 6-12 months to occur post-treatment. However, [18F]NaF PET can measure changes in bone metabolism that occur much earlier (i.e., within 9-12 weeks post-treatment) than the bone structural changes that can be assessed with DXA.

There are two ways of measuring bone metabolism, namely the plasma clearance method (Ki) and standardised uptake value (SUV). If bone disease or its treatment is potent enough to alter the area under the [18F] NaF plasma clearance curve (AUC), then there is a decoupling of the usual correlation between SUV and Ki, and the latter is the more reliable measurement. Otherwise, the two measurements remain well correlated and SUV is preferred due to its practical applicability in clinical settings. Examples of circumstances where AUC might be changed are in patients undergoing treatment with a potent anabolic effect on bone, in patients with extensive or very active Paget’s disease, or those with extensive or very active metastatic bone disease, for example, in breast cancer. In the past, the measurement of Ki required a conventional 60-min dynamic PET scan. Recently, methods to measure Ki from a static 4-min or dynamic 12-min scan have been developed, which shortens scan times, cost, and the number of blood samples required to measure Ki values.

This Research Topic aims to extend the use of [18F]NaF PET studies in humans including, but not limited to,

• studies comparing quantitative outcomes from healthy individuals and patients with metastatic or metabolic bone diseases; or

• studies comparing changes in bone metabolism before and after hormone therapy, surgery, chemotherapy, or radiotherapy (or combination treatment) in metastatic bone diseases as well as anabolic or anti-resorptive drugs (or combination treatment) in metabolic bone diseases; or

• studies exploring reference ranges of bone metabolism to differentiate between low, normal, and high bone metabolism values in metabolic or metastatic bone diseases; or

• studies comparing imaging-based quantitative outcomes against the gold standard of bone biopsy; or

• studies exploring novel applications of [18F]NaF PET in bone diseases where it has not been used before to assess bone metabolism; or

• studies with technological advancements, either a single-center or multi-center study performing analysis in previously published or unpublished datasets by performing retrospective analysis that may help standardize the use of quantitative [18F]NaF PET technique with aspects, including but not limited to, partial volume correction, segmentation, input function, kinetic modelling, quantitative analysis, and the use of artificial intelligence (AI) - traditional (e.g., computational methods that are sometimes referred to as symbolic AI) or modern (e.g., neural networks that are sometimes referred to as connectionist AI).

We welcome submissions of several article types including but not limited to: Original Research, Reviews, Hypothesis and Theory, and Data Reports. For information on accepted article types and manuscript length, please follow (https://www.frontiersin.org/journals/nuclear-medicine/for-authors/article-types).

Keywords: [18F]NaF PET, bone metabolism, metastatic bone diseases, metabolic bone diseases, image analysis, artificial intelligence

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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