Pilot Prospective Evaluation of (18)F-Alfatide II for Detection of Skeletal Metastases

Baoming Mi, Chunjing Yu, Donghui Pan, Min Yang, Weixing Wan, Gang Niu, Xiaoyuan Chen, Baoming Mi, Chunjing Yu, Donghui Pan, Min Yang, Weixing Wan, Gang Niu, Xiaoyuan Chen

Abstract

This pilot prospective evaluation study is to verify the efficiency of (18)F-Alfatide II, a specific PET imaging agent for integrin αvβ3, in detecting bone metastasis in human, with comparison to (18)F-FDG PET. Thirty recruited patients underwent (18)F-FDG and (18)F-alfatide II PET/CT successively within days. The final diagnosis of bone lesions was established based on the comprehensive assessment of all available data and clinical follow-up, which fall into four groups: osteolytic, osteoblastic, mixed and bone marrow. Visual analysis and quantification of SUVmax were performed to compare the detection sensitivity of (18)F-Alfatide II and (18)F-FDG PET. Eleven patients were found to have a total of 126 bone metastasis lesions. (18)F-Alfatide II PET can detect the bone metastatic lesions with good contrast and higher sensitivity (positive rate of 92%) than (18)F-FDG PET (77%). Especially, (18)F-Alfatide II PET showed superiority to (18)F-FDG PET in detecting osteoblastic (70% vs. 53%) and bone marrow metastatic lesions (98% vs. 77%). In conclusion, (18)F-Alfatide II PET/CT can be used to detect skeletal and bone marrow metastases, with nearly 100% sensitivity in osteolytic, mixed and bone marrow lesions. The sensitivity of (18)F-Alfatide II PET/CT in osteoblastic metastases is relatively low but still significantly higher than that of (18)F-FDG PET/CT. This pilot clinical study warrants the further application of (18)F-Alfatide II PET/CT in metastatic lesion detection, patient management and drug therapy response monitoring.

Keywords: Alfatide II; FDG; PET/CT; RGD peptide; bone metastasis.

Conflict of interest statement

COMPETING INTERESTS: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
2D projection images of 18F-Alfatide II PET (A) and 18F-FDG PET (B) of a patient (no. 2) with metastatic adenocarcinoma of unknown primary site. 18F-Alfatide II PET demonstrated intense local accumulation of radioactivity in bone metastatic lesions located in thoracic vertebras, sacrum and right scapula, and right clavicle with good background contrast, whereas 18F-FDG PET only showed moderate uptake in some thoracic vertebras and sacral lesions. The transaxial CT (C), 18F-Alfatide II PET (D), and 18F-FDG PET (E) were presented to focus on the lesions at sacrum. There is also bone metastasis with abnormal 18F-Alfatide II uptake (G) but not visible by transaxial CT (F) or 18F-FDG PET (H).
Figure 2
Figure 2
CT (left), 18F-Alfatide II PET (middle), and 18F-FDG PET (right) of a patient (no. 5) with bladder cancer for 9 years and newly diagnosed with gastric cancer. A lesion in sinuses ventriculi with high FDG uptake was confirmed as adenocarcinoma by biopsy. Multiple metastatic bone lesions were confirmed either as osteolytic (A), osteoblastic (B) or mixed (C) by CT. These lesions showed low or no uptake on 18F-FDG PET and accumulation of 18F-Alfatide II with various intensities.
Figure 3
Figure 3
18F-Alfatide II PET (A, D, E) and 18F-FDG PET (B, G, H) of a 68-y-old female patient (no. 1) with lung cancer. Besides the primary tumor in the left lung and multiple vertebral osteolytic bone metastases (C, F), bilateral humerus and femur bone marrow cavities showed strip-shaped radiotracer uptake on 18F-Alfatide II PET. 18F-FDG PET only discerned the primary site and bone metastases, but not the abnormality in the bone marrow cavities.
Figure 4
Figure 4
SUVmax of 18F-FDG and 18F-Alfatide II PET in different categories of bone metastases.

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