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This prospective study aims to assess the diagnostic test characteristics of Na[ 18 F]F PET/CT for the skeletal staging of cancer in morbidly obese patients compared with  99m Tc-methylene diphosphonate (MDP), whole-body planar (WBS), SPECT, and SPECT/CT acquisitions. One hundred seventeen obese patients (BMI 46.5 ± 6.1 kg/m 2  and mean age, 59.0 years; range 32–89 years) with BMI &gt; 40 kg/m 2  were prospectively enrolled and underwent [ 99m Tc]Tc-MDP WBS, SPECT, SPECT/CT, and Na[ 18 F]F PET/CT within two weeks for the osseous staging of a malignancy. Images were assessed qualitatively using a 3-point scale. Patient and lesion-based diagnostic test characteristics were estimated using an optimistic and pessimistic dichotomization method. Bone metastases were confirmed in 44 patients. Patient-based optimistic diagnostic test characteristics were (sensitivity, specificity, overall accuracy): Na[ 18 F]F PET/CT (95.5%, 95.9%, 95.7%), [ 99m Tc]Tc-MDP WBS (52.3%, 71.2%, 64.1%), SPECT (61.4%, 80.8%, 73.5%) and SPECT/CT (65.9%, 91.8%, 82.1%). Lesion-based optimistic diagnostic test characteristics were: Na[ 18 F]F PET/CT (97.7%, 97.9%, 97.7%), [ 99m Tc]Tc-MDP WBS (39%, 67%, 48.9%), SPECT (52.9%, 93.6%, 67.3%) and SPECT/CT (65.9%, 91.8%, 82.1%). There was no significant difference in the specificity of Na[ 18 F]F and SPECT/CT. All other pairwise comparisons were significant ( p &lt;.001). ROC curve analysis showed a high overall accuracy of Na[ 18 F]F with significantly higher AUCs for Na[ 18 F]F PET/CT compared to [ 99m Tc]Tc-MDP WBS, SPECT, and SPECT/CT on both patient and lesion-based analysis ( p &lt;.001). Moreover, Na[ 18 F]F PET/CT changed patient management in 38% of patients. Na[ 18 F]F PET/CT may be the preferred imaging modality for skeletal staging in morbidly obese patients. The technique provides excellent diagnostic test characteristics superior to [ 99m Tc]Tc-MDP bone scan (including SPECT/CT), impacts patient management, has an acceptable radiation exposure profile, and is well-tolerated. Further cost-effectiveness evaluations are warranted.

acta oncologica

Prospective study of Na[ 18 F]F PET/CT for cancer staging in morbidly obese patients compared with [ 99m Tc]Tc-MDP whole-body planar, SPECT and SPECT/CT