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Kidney Week

Abstract: TH-PO576

Can a New 18F-NaF PET/CT Scan Replace Bone Biopsy to Determine Bone Turnover in Patients with CKD-MBD?

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical


  • Vrist, Marie Houmaa, University Clinic of Nephrology and Hypertension, Holstebro, Denmark
  • Mose, Frank H., University Clinic of Nephrology and Hypertension, Holstebro, Denmark
  • Fynbo, Claire A., Herning Hospital, Herning, Denmark
  • Theil, Jorn, Herning Hospital, Herning, Denmark
  • Langdahl, Bente, Aarhus University Hospital, Aarhus N, Denmark
  • Lauridsen, Thomas Guldager, University Clinic of Nephrology and Hypertension, Holstebro, Denmark
  • Bech, Jesper N., University Clinic of Nephrology and Hypertension, Holstebro, Denmark

CKD-MBD is an enormous problem in dialysis patients. Before optimal treatment can be accomplished, bone turnover has to be established. The golden standard, double tetracycline-labeled transiliac bone biopsy, has many disadvantages and is seldom performed. Bone biopsy is cumbersome, expensive, painful, and invasive. It would therefore be of outmost interest to develop an alternative method to establish bone turnover.
The purpose of this 18F-NaF PET/CT trail is to implement a new method for several region determination of bone turnover in patients with CKD-MBD.


A pilot study was conducted in which 17 dialysis patients underwent the new dynamic/static 18F-NaF PET/CT scan. This scan method is initiated with a 60 min. thoracic dynamic scan followed by a 30 min. whole-body static scan. Venous blood samples are drawn at -5, 40, 50, 60 and 90 minutes after a 150 MBq 18F-NaF intravenous injection. A 3-tissue compartment model is used to estimate regional bone 18F-NaF clearance (Ki). Ki is an expression for bone turnover. One cardiac (left ventricle) volume-of-interest (VOI) and four thoracic vertebrae VOIs are placed. Time activity curves are generated. The software PMOD is used for this analysis. Moreover multi-point Patlak analysis is conducted. The PMOD analysis and the Patlak analysis are compared.
Finally, the patients underwent double tetracycline-labeled transialic bone biopsy. As a control of the new method, the scan-bone turnover was then compared with the biopsy-bone turnover.


To date, data have been obtained from 9 of 17 included patients. Preliminary results of PMOD analysis demonstrated a vertebral mean Ki-value of 0.041 ±0.01 ml/min/cm3. The corresponding value by multi-point Patlak analysis was 0.035 ±0.01 ml/min/cm3. Ki-values present the same range as previously published data for diverse patient groups.
We are looking forward to compare results from this new method with results from the bone biopsies and hopefully we get the pleasure of presenting the full dataset at Kidney Week 2019.


The 18F-NaF PET/CT seems feasible for measurement of bone turnover in CKD-MBD. The next step will be to appraise the clinical value to determinate changes in Ki (bone turnover) after medical intervention.


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