Skeletal tracer kinetics: Science and practice

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Quantitative bone scan imaging has a useful role in studies of the pathophysiology of metabolic bone disease and the response of patients to treatment. The advantage of nuclear medicine imaging as a way of studying bone remodelling is that it offers a unique way of measuring bone turnover both for the whole skeleton and in selected localised regions of interest (ROI). This chapter reviews methods of quantifying <sup>99m</sup>Tc-MDP and <sup>18</sup>F-fluoride skeletal tracer kinetics by combining imaging data with blood sampling to measure bone plasma clearance. For studies using <sup>99m</sup>Tc-MDP, we describe three methods of measuring whole-skeleton plasma clearance (K <inf>bone</inf>): (1) The area-under-the-curve (AUC) method based on taking six blood samples between 5 min and 4 h and measuring the plasma concentration of free <sup>99m</sup>Tc-MDP by ultrafiltration. The AUC method requires a simultaneous measurement of glomerular filtration rate (GFR) using <sup>51</sup>Cr-EDTA as a co-tracer. (2) The modified Brenner method, which measures K <inf>bone</inf> by drawing a soft tissue ROI over the adductor muscles and plotting the soft tissue counts at 1, 2, 3 and 4 h against the AUC values at the corresponding time points. (3) The Patlak method based on combining gamma camera measurements of whole-body retention with plasma data and finding K <inf>bone</inf> from the slope of the Patlak plot fitted to the 2, 3 and 4 h data points. Unlike the first two methods, the Patlak plot can also be used to measure regional values of K <inf>bone</inf> for any chosen ROI. Studies of <sup>18</sup>F-fluoride skeletal tracer kinetics are performed using a 60-min dynamic positron emission tomography (PET) scan with measurement of the input function by either direct arterial sampling or using an image-derived input function from the heart, aorta or femoral artery and can be used to measure the net plasma clearance to the bone mineral compartment (K <inf>i</inf> ) at either the spine, hip or humerus. Further studies are required comparing radionuclide measurements with the gold standard of bone biopsy. Nuclear medicine measurements of bone turnover have an established role as a research technique, and there is a need for further studies to examine their role in assessing the pathophysiology of metabolic bone diseases, such as osteoporosis, Paget's disease and renal osteodystrophy, and better understanding the effects of new pharmaceutical treatments at various sites throughout the skeleton.

Original languageEnglish
Title of host publicationRadionuclide and Hybrid Bone Imaging
EditorsIgnac Fogelman, Gopinath Gnanasegaran, Hans van der Wall
PublisherSpringer-Verlag Berlin Heidelberg
Number of pages23
ISBN (Electronic)978-3-642-02400-9
ISBN (Print)978-3-642-02399-6
Publication statusPublished - 1 Oct 2013


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