Correlation between 18F-Sodium Fluoride positron emission tomography and bone histomorphometry in dialysis patients

Louise Aaltonen; Niina Koivuviita; Marko Seppänen; Xiaoyu Tong; Heikki Kröger; Eliisa Löyttyniemi; Kaj Metsärinne

doi:10.1016/j.bone.2020.115267

Correlation between ¹⁸F-Sodium Fluoride positron emission tomography and bone histomorphometry in dialysis patients

Bone. 2020 May:134:115267. doi: 10.1016/j.bone.2020.115267. Epub 2020 Feb 11.

Authors

Louise Aaltonen¹, Niina Koivuviita², Marko Seppänen³, Xiaoyu Tong⁴, Heikki Kröger⁵, Eliisa Löyttyniemi⁶, Kaj Metsärinne²

Affiliations

¹ Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland. Electronic address: louise.aaltonen@tyks.fi.
² Kidney Center, Department of Medicine, Turku University Hospital, PL 52, Kiinamyllynkatu 4-8, Turku 20521, Finland.
³ Department of Clinical Physiology, Nuclear Medicine and Turku PET Centre, University of Turku, Kiinamyllynkatu 4-8, Turku 20521, Finland.
⁴ Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland.
⁵ Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, University of Eastern Finland, POB 1627, Kuopio, Finland; Kuopio University Hospital, Kuopio, Finland.
⁶ Department of Biostatistics, University of Turku, Kiinamyllynkatu 10, 20014 Turku, Finland.

PMID: 32058018
DOI: 10.1016/j.bone.2020.115267

Abstract

Background: The diagnosis of renal osteodystrophy is challenging. Bone biopsy is the gold standard, but it is invasive and limited to one site of the skeleton. The ability of biomarkers to estimate the underlying bone pathology is limited. ¹⁸F-Sodium Fluoride positron emission tomography (¹⁸F-NaF PET) is a noninvasive quantitative imaging technique that allows assessment of regional bone turnover at clinically relevant sites. The hypothesis of this study was, that ¹⁸F-NaF PET correlates with bone histomorphometry in dialysis patients and could act as a noninvasive diagnostic tool in this patient group.

Methods: This was a cross-sectional diagnostic test study. 26 dialysis patients with biochemical abnormalities indicating mineral and bone disorder were included. All the participants underwent a ¹⁸F-NaF PET scan and a bone biopsy. Fluoride activity in the PET scan was measured in the lumbar spine and at the anterior iliac crest. Dynamic and static histomorphometric parameters of the bone biopsy were assessed. As histomorphometric markers for bone turnover we used bone formation rate per bone surface (BFR/BS) and activation frequency per year (Ac.f).

Results: There was a statistically significant correlation between fluoride activity in the ¹⁸F-NaF PET scan and histomorphometric parameters such as bone formation rate, activation frequency and osteoclast and osteoblast surfaces and mineralized surfaces. ¹⁸F-NaF PET's sensitivity to recognize low turnover in respect to non-low turnover was 76% and specificity 78%. Because of the small number of patients with high turnover, we were unable to demonstrate significant predictive value in this group.

Conclusions: A clear correlation between histomorphometric parameters and fluoride activity in the ¹⁸F-NaF PET scan was established. ¹⁸F-NaF PET may possibly be a noninvasive diagnostic tool in dialysis patients with low turnover bone disease, but further research is needed.

Keywords: (18)F-NaF PET; Bone biopsy; Bone histomorphometry; Renal osteodystrophy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Chronic Kidney Disease-Mineral and Bone Disorder* / diagnostic imaging
Cross-Sectional Studies
Fluorides*
Fluorine Radioisotopes
Humans
Positron-Emission Tomography*
Renal Dialysis*
Sodium Fluoride*

Substances

Fluorine Radioisotopes
Sodium Fluoride
Fluorides