The role of positron emission tomography in the management of bone metastases.

BACKGROUND: Positron emission tomography (PET) is a nuclear medicine technique that only recently has been widely used in clinical oncology. PET, as a metabolic imaging technique, demonstrates advantages over and complements structural imaging methods and also demonstrates differences from conventional nuclear medicine, all of which has led to its enormous growth in clinical applications in recent years.

METHODS: There is now a large body of literature on the use of PET with various tracers, especially (18)F-fluorodeoxyglucose ((18)FDG), in large numbers of patients with carcinoma. In the assessment of the skeleton in patients with carcinoma, early reports of PET imaging are now available with the use of (18)F-fluoride as a bone agent and the use of (18)FDG as a tumor agent, and the current knowledge is summarized in this report.

RESULTS: High-quality tomographic PET bone scans are possible with (18)F-fluoride with possible advantages in sensitivity and specificity over conventional bone scintigraphy. With (18)FDG, it is possible to image tumor metabolism directly, and early studies have demonstrated a high sensitivity for the detection of skeletal metastases, although the demonstration of osteoblastic metastases may be less satisfactory.

CONCLUSIONS: The clinical role of PET in the evaluation of patients with bone metastases is not yet defined; however, as described in this report, there is emerging evidence that this imaging method also may aid patient management in this area with the use of either (18)FDG or (18)F-fluoride ion.