Arizona Oncology - The US Oncology Network

Arizona Oncology offers cutting edge bone imaging with Sodium Fluoride PET scans.

6/11/2011

Arizona Oncology is pleased to announce the newest bone imaging service, Positron Emission Tomography combined with Computed Tomography (PET/CT) with 18F NaF to the greater Phoenix region.  These state-of-the-art diagnostic PET/CT bone imaging services are critical to help effectively diagnose and treat patients with metastatic cancer. 

One in three people will experience cancer in their lifetime.  According to the American Cancer Society, approximately 1.5 million new cases of cancer will be diagnosed this year alone in the United States1.  But having unchecked or under-diagnosed cancer can spread to other organs and increase the risk of bone metastases, making early detection even more important.  Bone metastasis is the most common malignant bone tumor.  In fact 30% - 70% of all cancer patients will have skeletal involvement2.  Bone metastasis is most frequently found in patients with lung, breast, prostate, thyroid, and kidney cancers3.

Diagnosis of metastatic bone disease is critical and bone imaging has several available diagnostic offerings.   They consist of traditional bone scintigraphy with 99mTc MDP or 99mTc HDP,  X-ray, MRI, and PET with18F FDG.  Now, with the new National Oncologic PET Registry (NOPR) for 18F NaF, referring physicians have one more choice. 

Frequently Asked Questions:

  • How does 18F NaF compare to other bone imagine alternatives?
  • What are the benefits of using PET/CT with 18F NaF for bone imaging?

What you need to know:

SPECT/CT bone imaging using 99mTc MDP or 99mTc HDP can be an effective approach to help identify bone metastasis4.  These scans show more sensitivity than planar bone scans but patients will have to endure much longer imaging times4,5. 18F FDG PET imaging is useful in finding osteolytic lesions due to the aggressive nature of these lesions, but can be less sensitive in identifying sclerotic (or osteoblastic) lesions6.  When compared with other imaging modalities18F NaF can be a viable option to consider for bone imaging.  18F NaF with PET/CT has been shown to provide higher sensitivity and more accurate differentiation7,8,9.

In addition, 18F NaF has been shown to have faster bone uptakethan for 99mTc medronate; rapid clearance and low protein binding, higher bone to background ratios, minimal patient preparation, and shorter study times10, 11,12.   When coupling PET with CT, 18F NaF PET scans provide higher specificity and allows for morphological characterization of the function of the lesion13. Patients who typically benefit from an 18F NaF PET scan are those who have primary cancers that often metastasize to the bone6.  This hybrid modality can help provide a compounded advantage in patient care and assists in early cancer detection, staging the progression of cancer and monitoring the success of therapy6.  With this approach, early detection of bone metastasis can result in a better chance of successful treatment and lower risk of future metastases14.

In February of 2011, the Centers for Medicare and Medicaid Services announced it will provide coverage for 18F NaF PET studies under the Coverage with Evidence Development (CED) program, i.e. through the National Oncologic PET Registry (NOPR) which is now open to accept provider and patient registrations. Coverage is available for 18F NaF PET claims for initial treatment strategy (PI) or subsequent treatment strategy (PS) for suspected or biopsy proven bone metastasis, BUT ONLY IN THE CONTEXT OF A CLINICAL STUDY approved by CMS and in which both the patient and imaging services provider are enrolled. All other uses of 18F NaF PET are non-covered15.

18F NaF with PET/CT can offer important information for patients and physicians and is now available in our community.  To learn more or schedule a patient for 18F NaF PET/CT imaging procedure, call 602-283-2345.  For more information about NOPR,visit http://www.cancerpetregistry.org

 

 

References:

  1. http://www.cancer.org/Cancer/news/News/annual-report-us-cancer-death-rates-still-declining- www.cancer.org/ American Cancer Society. 
  2. Even-Sapir, Einat. Imaging of Malignant Bone Involvement by Morphologic, Scintigraphic, and Hybrid Modalities. J Nucl Med 2005; 46:1356-1367.  
  3. http://www.cancer.org/Cancer/BoneMetastasis/DetailedGuide/bone-metastasis-risk-factors - www.cancer.org/ American Cancer Society
  4. Even-Sapir, Einat. Imaging of Malignant Bone Involvement by Morphologic, Scintigraphic, and Hybrid Modalities. J Nucl Med 2005; 46:1356-1367.
  5. Grant, Frederick, et al. Skeletal PET with 18F-fluoride: Applying New Technology to an Old Tracer. J Nucl Med 2008; 49:68-78.
  6. Even-Sapir, Einat. Imaging of Malignant Bone Involvement by Morphologic, Scintigraphic, and Hybrid Modalities. J Nucl Med 2005; 46:1356-1367.
  7. Schirrmeister, Holger, et al. Sensitivity in Detecting Osseous Lesions Depends on anatomic Localization: Planar Bone Scintigraphy Versus 18F PET.  J Nucl Med 1999; 40: 1623-1629.
  8. Schirrmeister, et al.  Prospective Evaluation of the Clinical Value of Planar bone Scans, SPECT< and 18F – Labeled NaF PET in Newly diagnosed Lung Cancer. JNM 2001;42:1800-1804.
  9. Frederick, DG et al.  Skeletal PET with 18F-Fluoride: Applying New Technology to an Old Tracer. J Nucl Med 2008; 49:68–78.
  10. Schirrmeister, H et al. Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography. J Clin Oncol. 1999; 17(8): 2381-2389.
  11. Frederick, DG et al.  Skeletal PET with 18F-Fluoride: Applying New Technology to an Old Tracer. J Nucl Med 2008; 49:68–78.
  12. Even-Sapir, E et al.  The Detection of Bone Metastases in Patients with High-Risk Prostate Cancer: 99mTc-MDP Planar Bone Scintigraphy, Single- and Multi-Field-of-View SPECT, 18F-Fluoride PET, and 18F-Fluoride PET/CT. J Nucl Med 2006; 47:287–297.
  13. Grant, Frederick, et al. Skeletal PET with 18F-fluoride: Applying New Technology to an Old Tracer. J Nucl Med 2008; 49:68-78.
  14. http://www.cancer.org/Cancer/BoneMetastasis/DetailedGuide/bone-metastasis-risk-factors- www.cancer.org
  15. http://www.cancerpetregistry.org