The precision and sensitivity of 18F-fluoride PET for measuring regional bone metabolism: A comparison of quantification methods

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The planning of research studies requires an understanding of the minimum number of subjects required. The aim of this study was to evaluate different methods of analyzing F-18-fluoride PET (F-18(-) PET) dynamic spine scans to find the approach that requires the smallest sample size to detect a statistically significant response to treatment. Methods: Eight different approaches to F-18(-) PET analysis (3 variants of the Hawkins 3-tissue compartmental model, 3 variants of spectral analysis, deconvolution, and Patlak analysis) were used to evaluate the fluoride plasma clearance to bone mineral (K-i). Standardized uptake values (SUVs) were also studied. Data for 20 women who had F-18(-) PET spine scans at 0, 6, and 12 mo after stopping long-term bisphosphonate treatment were used to compare precision errors. Data for 18 women who had scans at baseline and 6 mo after starting teriparatide treatment were used to compare response to treatment. Results: The 4 approaches that fitted the rate constant k(4) describing the reverse flow of F-18 from bone as a free variable showed close agreement in K-i values, with correlation coefficients greater than 0.97. Their % CVs were 14.4%-14.8%, and treatment response to teriparatide was 23.2%-23.8%. The 3 methods that assumed k(4) = 0 gave K-i values 20%-25% lower than the other methods, with correlation coefficients of 0.83-0.94, percentage coefficients of variation (% CVs) of 12.9%-13.3%, and treatment response of 25.2%-28.3%. A Hawkins model with k(4) = 0.01 min(-1) did not perform any better (% CV, 14.2%; treatment response, 26.1%). Correlation coefficients between SUV and the different K-i methods varied between 0.60 and 0.65. Although SUV gave the best precision (% CV, 10.1%), the treatment response (3.1%) was not statistically significant. Conclusion: Methods that calculated K-i assuming k(4) = 0 required fewer subjects to demonstrate a statistically sigificant response to treatment than methods that fitted k4 as a free variable. Although SUV gave the smallest precision error, the absence of any significant changes make it unsuitable for examining response to treatment in this study.

Original languageEnglish
Pages (from-to)1748-1755
Number of pages8
JournalJournal of Nuclear Medicine
Issue number11
Publication statusPublished - 1 Nov 2011


  • precision errors
  • sensitivity
  • positron emission tomography
  • F-18-fluoride
  • bone metabolism


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