Vol.:(0123456789) 1 3 Annals of Nuclear Medicine https://doi.org/10.1007/s12149-018-1279-3 ORIGINAL ARTICLE Technical feasibility, radiation dosimetry and clinical use of  18 F-sodium fuoride (NaF) in evaluation of metastatic bone disease in pediatric population Sharjeel Usmani 1  · Tim Van den Wyngaert 2,3  · Najeeb Ahmed 4  · Fahad Maraf 5  · Abdulredha Esmail 5  · Fareeda al kandari 1  · Mishari al Nuaimi 1  · Gopinath Gnanasegaran 6 Received: 11 June 2018 / Accepted: 12 July 2018 © The Japanese Society of Nuclear Medicine 2018 Abstract Purpose The role of 18 F-fuoride ( 18 F-NaF) PET-CT for the detection of bone metastases in adults is well established and is considered superior to conventional bone scintigraphy. However, data pertaining use of 18 F-NaF PET-CT in pediatric oncology is relatively sparse. The aim of the present study is to retrospectively analyze and share a single-center experience of 18 F-NaF PET-CT in pediatric population and to provide preliminary information regarding imaging technique, feasibility of this modality in young patients and radiation dosimetry measurements in pediatric oncology cases. Materials and methods Twenty-four pediatric patients (mean age 8.0 ± 3.9) were included in the study for retrospective analysis. All patients were referred for primary staging or restaging for potential osseous metastatic disease and PET-CT scan was performed by injecting 2.2 MBq/kg (0.06 mCi/kg) of 18 F-NaF. Results Nine patients were imaged for primary staging and in all cases increase osteoblastic activity was seen in the primary tumor and of these, metastatic bone disease was identifed in 2/9 patients. In the restaging group comprising 15/24 patients, metastatic deposits were identifed in 3/15 whilst no disease was seen in the remaining 12 patients. Patients were injected a mean dose of 90.35 ± 22.9 MBq with an estimated mean efective absorbed doses of 2.98 ± 0.75 mSv for 18 F-NaF and 3.37 ± 2.4 mSv for CT alone. Mean cumulative efective dose of 18 F-NaF PET-CT scan was 5.11 ± 2.7 mSv. Conclusions 18 F-NaF PET-CT may be a feasible alternative to 99m Tc MDP for radionuclide bone scintigraphy in the evalua- tion of pediatric bone pathology. Due to its better pharmacokinetics, there is potential that osseous staging can be achieved with relatively low doses and with a similar radiation burden as with 99m Tc-MDP imaging. Keywords 18 F-NaF PET-CT · Pediatric oncology · Bone metastasis Introduction Skeletal scintigraphy is useful in the staging and follow-up of pediatric malignancies. Whole body skeletal scintigraphy in pediatric oncology is most frequently used in the setting of sarcoma and neuroblastoma, in-particular to detect skip metastasis. The technique may also provide useful informa- tion in selected patients with leukemia, lymphoma, primitive neuroectodermal tumors, Wilm’s tumor, or medulloblastoma [1]. Sodium fuoride ( 18 F-NaF) has proven to be an excellent bone-seeking agent [2]. It has high image quality, spatial resolution and greater sensitivity than conventional 99m Tc- methylene diphosphate (MDP) bone scintigraphy, due to its rapid bone uptake, minimal serum protein binding, rapid frst-pass extraction and faster blood clearance [3, 4]. These * Sharjeel Usmani dr_shajji@yahoo.com 1 Department of Nuclear Medicine, Kuwait Cancer Control Center (KCCC), Kuwait City, Kuwait 2 Antwerp University Hospital Belgium, Antwerp, Belgium 3 Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium 4 Jack Brignall PET/CT Centre, Castle Hill Hospital, Cottingham, UK 5 Jaber Al-Ahmad Molecular Imaging Center, Kuwait City, Kuwait 6 Royal Free London NHS Foundation Trust, London, UK