Assessment of regional and total skeletal metabolism using 18F-NaF PET/CT in patients with chronic kidney disease

Sharjeel Usmani; Najeeb Ahmed; Gopinath Gnanasegaran; Fahad Marafi; Ahmed Bani-Mustafa; Tim Van den Wyngaert

doi:10.1007/s12149-024-01929-1

Assessment of regional and total skeletal metabolism using ¹⁸F-NaF PET/CT in patients with chronic kidney disease

Ann Nucl Med. 2024 Apr 27. doi: 10.1007/s12149-024-01929-1. Online ahead of print.

Authors

Sharjeel Usmani^{1

2

3}, Najeeb Ahmed^{4

5}, Gopinath Gnanasegaran⁶, Fahad Marafi⁷, Ahmed Bani-Mustafa⁸, Tim Van den Wyngaert^{9

10}

Affiliations

¹ Department of Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman. dr_shajji@yahoo.com.
² Hull York Medical School, Hull, UK. dr_shajji@yahoo.com.
³ Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. dr_shajji@yahoo.com.
⁴ Department of Nuclear Medicine, Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, UK.
⁵ Hull York Medical School, Hull, UK.
⁶ Department of Nuclear Medicine, Royal Free Hospital NHS Trust, London, UK.
⁷ Department of Nuclear Medicine, Jaber Al-Ahmad Molecular Imaging Center, Kuwait, Kuwait.
⁸ Australian College of Kuwait, Kuwait, Kuwait.
⁹ Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.
¹⁰ Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.

PMID: 38676905
DOI: 10.1007/s12149-024-01929-1

Abstract

Objective: The study aims to assess regional and total bone metabolic activity in patients with chronic kidney disease using Na[¹⁸F]F PET and correlation between semi-quantitative indices and blood parameters.

Methods: Seventy-two subjects (mean age 61.8 ± 13.8 years) were included. Of these 24/72 patients had end-stage renal disease (ESRD) (GFR < 15 mL/min/1.73 m²), 38/72 had chronic kidney disease (CKD) (GFR between 60 and 15 mL/min/1.73 m²), and 10/72 were controls with normal renal function. All subjects underwent Na[¹⁸F]F PET-CT with a dose activity of 0.06 mCi/Kg. Regional and total skeletal metabolism were assessed with mean SUVs in a skeletal volume of interest (VOI), bone to soft tissue index (B/S), global SUV mean (GSUV mean) of the whole bone, and uptake in the femoral neck.

Results: Statistically significant differences were observed in a number of ¹⁸F-NaF metrics like femoral neck metabolism in CKD and ERSD groups in comparison to control in right (P = 0.003) and left femur (P = 0.006), bone to soft tissue index in the femur (P = 0.016) and GSUV₅ (P = 0.006). There is also a significant difference in SUV mean in lumbar vertebrae (L1-L4) among CKD, ESRD, and controls. There was a moderate correlation between ¹⁸F-NaF PET scan uptake and blood parameters such as ALP and PTH. Na[¹⁸F]F uptake parameters were significantly different in low versus high bone turnover state.

Conclusions: The assessment of total skeleton and regional metabolism and bone turnover in CKD patients is feasible with Na[¹⁸F]F PET. Na[¹⁸F]F can help to detect early changes in bone metabolism and assess the progression of bone disease in this complex condition. Quantification with Na[¹⁸F]F PET might provide better assessment of the bone turnover. The difference in Na[¹⁸F]F uptake in CKD compared to controls is likely related to a change in bone turnover which, however, requires further validation.

Keywords: 18F-NaF PET-CT; Chronic kidney disease; End-stage renal disease; Metabolic bone disease; Skeletal metabolism.