Can Spatiotemporal Fluoride (¹⁸F^-) Uptake be Used to Assess Bone Formation in the Tibia? A Longitudinal Study Using...

Area of Science:

• Orthopaedic Surgery
• Nuclear Medicine
• Radiology

Background:

• Bone healing assessment is crucial for orthopedic surgeons.
• Fluoride (¹⁸F^-) ion imaging with PET/CT is gaining traction for evaluating bone conditions.
• ¹⁸F^- uptake reflects local bone physiological activity, indicating healing or lack thereof.

Purpose of the Study:

• To determine if videos of spatiotemporal ¹⁸F^- uptake via PET bone scans can identify problematic bone healing in complex tibia cases.
• To assess if semiquantification of radionuclide uptake correlates with bone healing progress.

Main Methods:

• Investigated tibia bone formation in patients with complex fractures, osteomyelitis, and osteotomies using ¹⁸F^- PET/CT.
• Compared clinical healing with spatiotemporal ¹⁸F^- uptake and standardized uptake value (SUV).
• Utilized spatially registered CT/PET data for qualitative video reconstruction and quantitative SUVmean/SUVmax calculations (SUVmeanDPD, SUVmaxDPD).

Main Results:

• Visual assessment of ¹⁸F^- uptake identified three patients with poor healing due to uneven radionuclide distribution.
• An SUVmaxDPD of 0.18 or greater indicated good bone formation progress in 10 patients, verified by shorter TSF treatment duration.
• Semiquantification values (SUVmaxDPD) were ambiguous in 11 patients who achieved successful completion.

Conclusions:

• Spatiotemporal ¹⁸F^- uptake visualization is a promising method for assessing bone formation progress.
• Uneven or very low ¹⁸F^- uptake may indicate impaired bone healing, necessitating early intervention.
• Current semiquantification methods (SUVmaxDPD, SUVmeanDPD) showed ambiguity in correlating with bone healing progress.