Musculoskeletal imaging using fluoride PET.

The convenience of (18)F-fluoride imaging is undeniable both because of its favorable tracer and because of its technical characteristics, including high image quality and short examination times leading to increased patient comfort. Depending on the activity administered, the radiation dose to patients is about comparable to higher using (18)F-fluoride for bone imaging compared with conventional scintigraphy using 99mTc-methylene diphosphonate. In times of molybdenum shortage, (18)F-fluoride represents a good alternative to 99mTc-based bone tracers. Besides malignant skeletal disease(18)F-fluoride PET/CT has in the last decade been investigated in a variety of non-oncologic musculoskeletal disorders of all parts of the skeleton. Studies included imaging of the skull with a special focus on bisphosphonate-induced osteonecrosis of the jaw in patients treated with bisphosphonates due to benign or malignant bone changes. Further studies evaluated the appendicular skeleton with emphasis on postsurgical changes including patients after knee and hip surgery and patients having received bone grafts of their limbs. Also, therapeutic effect of (18)F-fluoride PET/CT on patients with unclear foot pain was investigated. Finally imaging of the axial skeleton was analyzed including patients with ankylosing spondylitis and with Paget disease as well as patients after spine surgery including assessment of cage incorporation after cervical and lumbar spine fusion surgery. Furthermore, children suspected of child abuse as well as young patients with back pain were investigated by either (18)F-fluoride PET or PET/CT. Regarding its favorable technical aspects as well as study results presented, it is imaginable that (18)F-fluoride PET/(CT) will be increasingly used for non-oncologic musculoskeletal imaging in the future either as an adjunct or alternative to so far established imaging modalities and seems to be promising regarding decision making in the therapeutic management of patients with non-oncologic musculoskeletal disorders.