Combined ¹⁸F-Fluoride and ¹⁸F-FDG PET/CT Scanning for Evaluation of Malignancy: Results of an International Multicenter Trial

Approaches to Multireceptor Targeting: Hybrid Radioligands, Radioligand Cocktails, and Sequential Radioligand Applications

“…There are only a few examples of the use of the cocktail approach in the clinic, such as using SPECT agents for the localization of parathyroid adenomas and medullary thyroid cancer as well as some cardiac nuclear imaging studies (52). In addition the Stanford group advocated for the combined administration of 18 F-NaF and 18 F-FDG in a single PET scan and initiated a prospective international multicenter trial (53). The authors concluded that the cocktail shows high sensitivity, lower cost, increased patient comfort, and reduced radiation exposure when compared with separate scans.…”

PET/CT Imaging for Monitoring Recurrence and Evaluating Response to Treatment in Breast Cancer

“…Combined NaF/FDGPET/CT has shown promising early results using the same amount of radiation as BS and FDGPET/CT [38]. According to Gradishar et al, if a FDG PET/CT scan clearly indicates bone metastasis on both the PET and CT components, a bone scan or sodium fluoide PET/CT may not be needed [9].…”

“…According to Gradishar et al, if a FDG PET/CT scan clearly indicates bone metastasis on both the PET and CT components, a bone scan or sodium fluoide PET/CT may not be needed [9]. In some conditions, considering the coexistence of both lytic and sclerotic lesions and the different mecha nisms of radiotracer uptake, PET and BS are mu tually complementary methods for the diagnosis of bone metastasis [38].…”

Critical considerations on the combined use of 18F-FDG and 18F-fluoride for PET assessment of metastatic bone disease

“…In 2009, a pilot study was published [4,5] by another research group, with data obtained for 18 F-FDG PET/CT alone, 18 F-fluoride PET/CT alone, and combined 18 F-FDG and 18 F-fluoride PET/CT in the same group of patients. This had attracted immediate attention and discussion [6,7].…”

“…In their protocol, 555 MBq (15 mCi) of 18 F-FDG+185 MBq (5 mCi) of 18 F-fluoride were combined to make a cocktail tracer, while a single PET/CT image was obtained starting at 60 min after intravenous administration of the combined radiotracers [4,5]. The authors of that study concluded that combined use of 18 F-fluoride and 18 F-FDG in a single PET/CT scan improved the diagnostic accuracy as compared with 18 F-FDG PET/CT imaging alone [4,5]. While very appealing at first sight, there are several critical issues associated with combined 18 F-FDG and 18 F-fluoride imaging, and these will be highlighted in the following sections.…”