Volume 45, Number 1
January 2015
Guest Editorial: Skeletal Nuclear Medicine
T
his issue of the Seminars of Nuclear Medicine is devoted to the role of nuclear medicine in the diagnosis, management, and therapy of a variety of skeletal diseases. The scope of the articles represents a microcosm of the evolution of nuclear medicine. Until the early 1970s, most nuclear medicine imaging was performed with strontium-85 (85Sr), a long-lived radionuclide that decayed by beta decay and emitted a high-energy 512-keV γ photon. Moreover, as a bivalent cation, it was secreted into the bowel, further confounding image interpretation. Owing to the unfavorable physical characteristics, administered doses were limited to 100 μCi to patients with confirmed malignant diseases and 50 μCi to those only suspected of having a tumor. It is difficult for physicians and others involved in nuclear medicine after the introduction of the technetium-99m (99mTc)–labeled compounds to even imagine what the 85Sr scans looked like. For the past 40 years, nuclear medicine has had access to a succession of 99mTc-labeled molecules; initially 99m Tc-polyphosphate, then 99mTc-pyrophosphate, and finally the 99mTc-phosphonates, which were less vulnerable to enzymatic degradation and thus provide better images. In the past few years, 18F-fluoride has re-entered the clinical arena. Although recognized as a potential bone imaging agent in the 1960s and 1970s, imaging the energetic 511-keV photon on traditional rectilinear scanners and gamma cameras was far from satisfactory. With the current availability of PET/CT scanners, 18F-fluoride-PET imaging has become practical and has already been demonstrated to be worthwhile. As bone scintigraphy was initially used to identify bone tumors, Dr Chaudhry and his colleagues have provided a
2
http://dx.doi.org/10.1053/j.semnuclmed.2014.08.004 0001-2998/& 2015 Elsevier Inc. All rights reserved.
review of the state of the art for this application. This is followed by a review by the guest editors of this issue on the role of diagnostic imaging in multiple myeloma, with an emphasis on the utilization of 18F-FDG-PET/CT, a disease that almost always involves the bone marrow and produces osseous lesions. Dr Palestro has provided a current assessment of radionuclide imaging for the diagnosis of osteomyelitis, a clinical entity that continues to be a challenge to clinicians and diagnostic imaging physicians. Skeletal imaging has also benefited from improvements in single-photon imaging. Dr Scharf has accumulated a remarkable experience with a highresolution SPECT/CT device to evaluate patients with sportsrelated injuries. Drs Jadvar, Desai, and Conti have provided a summary of the present status of 18F-fluoride-PET/CT imaging. Treating bone metastases with bone-seeking radionuclide has progressed over the last 25 years from the earliest efforts involving 32P to 89Sr, 153Sm, 186Re, and most recently, the alpha emitter 223Ra. This subject is thoroughly reviewed by Dr Abi Ghanem and his associates. Finally, Dr Zuckier has provided a compendium of images illustrating altered biodistribution observed while performing bone scintigraphy. We, the guest editors, have appreciated the opportunity to assemble this body of knowledge in a single compendium for this issue of the Seminars of Nuclear Medicine. The guest editors also would like to thank all of the contributors to this Seminar for sharing their expertise with us. Stanley J. Goldsmith, MD Jasna Mihailovic, MD, PhD
January 2015
Guest Editorial: Skeletal Nuclear Medicine
T
his issue of the Seminars of Nuclear Medicine is devoted to the role of nuclear medicine in the diagnosis, management, and therapy of a variety of skeletal diseases. The scope of the articles represents a microcosm of the evolution of nuclear medicine. Until the early 1970s, most nuclear medicine imaging was performed with strontium-85 (85Sr), a long-lived radionuclide that decayed by beta decay and emitted a high-energy 512-keV γ photon. Moreover, as a bivalent cation, it was secreted into the bowel, further confounding image interpretation. Owing to the unfavorable physical characteristics, administered doses were limited to 100 μCi to patients with confirmed malignant diseases and 50 μCi to those only suspected of having a tumor. It is difficult for physicians and others involved in nuclear medicine after the introduction of the technetium-99m (99mTc)–labeled compounds to even imagine what the 85Sr scans looked like. For the past 40 years, nuclear medicine has had access to a succession of 99mTc-labeled molecules; initially 99m Tc-polyphosphate, then 99mTc-pyrophosphate, and finally the 99mTc-phosphonates, which were less vulnerable to enzymatic degradation and thus provide better images. In the past few years, 18F-fluoride has re-entered the clinical arena. Although recognized as a potential bone imaging agent in the 1960s and 1970s, imaging the energetic 511-keV photon on traditional rectilinear scanners and gamma cameras was far from satisfactory. With the current availability of PET/CT scanners, 18F-fluoride-PET imaging has become practical and has already been demonstrated to be worthwhile. As bone scintigraphy was initially used to identify bone tumors, Dr Chaudhry and his colleagues have provided a
2
http://dx.doi.org/10.1053/j.semnuclmed.2014.08.004 0001-2998/& 2015 Elsevier Inc. All rights reserved.
review of the state of the art for this application. This is followed by a review by the guest editors of this issue on the role of diagnostic imaging in multiple myeloma, with an emphasis on the utilization of 18F-FDG-PET/CT, a disease that almost always involves the bone marrow and produces osseous lesions. Dr Palestro has provided a current assessment of radionuclide imaging for the diagnosis of osteomyelitis, a clinical entity that continues to be a challenge to clinicians and diagnostic imaging physicians. Skeletal imaging has also benefited from improvements in single-photon imaging. Dr Scharf has accumulated a remarkable experience with a highresolution SPECT/CT device to evaluate patients with sportsrelated injuries. Drs Jadvar, Desai, and Conti have provided a summary of the present status of 18F-fluoride-PET/CT imaging. Treating bone metastases with bone-seeking radionuclide has progressed over the last 25 years from the earliest efforts involving 32P to 89Sr, 153Sm, 186Re, and most recently, the alpha emitter 223Ra. This subject is thoroughly reviewed by Dr Abi Ghanem and his associates. Finally, Dr Zuckier has provided a compendium of images illustrating altered biodistribution observed while performing bone scintigraphy. We, the guest editors, have appreciated the opportunity to assemble this body of knowledge in a single compendium for this issue of the Seminars of Nuclear Medicine. The guest editors also would like to thank all of the contributors to this Seminar for sharing their expertise with us. Stanley J. Goldsmith, MD Jasna Mihailovic, MD, PhD
