Diagnostic accuracy and clinical value of quantitative Na[¹⁸F]F PET/CT parameters to monitor therapeutic response in patients with benign metabolic bone diseases: A systematic review.

Authors

L van Schaik, S A Huisman, N M Appelman-Dijkstra, L F de Geus-Oei, F H P van Velden, D Vriens, W van der Bruggen

Published in

Seminars in nuclear medicine. Oct 28, 2026. Epub Oct 28, 2026.

Abstract

Na[¹⁸F]F PET/CT is increasingly used to evaluate treatment responses in metabolic bone diseases (MBDs), where conventional serum biomarkers and structural imaging fail to show local dynamic changes. The performance and utility of Na[¹⁸F]F PET/CT in these diseases, however, has not been fully explored. We systematically evaluated the contemporary use of quantitative Na[¹⁸F]F PET/CT for measuring MBD treatment responses.
Current review was prospectively registered on PROSPERO (CRD420261413536) and follows PRISMA 2020 guidelines. Electronic databases were searched for clinical studies using quantitative Na[¹⁸F]F PET/CT in MBDs. Risk of bias was assessed via QUADAS-2, ROBINS-I and QUIPS. Results were synthesized narratively.
Thirteen studies (n=14-72 patients; 358 total cases) met inclusion criteria, focusing on chronic kidney disease-mineral and bone disorder (CKD-MBD, n=9 studies) and fibrous dysplasia/McCune-Albright syndrome (FD/MAS, n=4 studies). Two longitudinal studies evaluated therapeutic response: denosumab in FD/MAS yielded comparable reductions in total lesion metabolic activity across moderate (-64.9%) and high doses (-67.0%), while turnover-guided therapy in CKD-MBD significantly reduced bone kinetic flux (K_i). Remaining literature comprised cross-sectional and observational cohorts. Here, PET kinetic (K_i, FUR) and volumetric metrics (TV, TA, TLF) correlated strongly with bone formation rates and circulating biomarkers. K_i and background-adjusted uptake ratios (SUVR) discriminated bone turnover states with high accuracy (ROC AUC up to 0.98), outperforming serum parathyroid hormone in CKD-MBD. Reporting of reconstruction settings was highly variable; only one study explicitly noted EARL scanner accreditation and none documented compliance with EARL Standard 1 or 2. Risk of bias was primarily driven by small cohort sizes, attrition and unadjusted confounding.
Quantitative Na[¹⁸F]F PET/CT provides high diagnostic accuracy for tracking regional turnover and treatment response in benign MBDs. However, clinical adoption is hindered by a lack of harmonized EARL-compliant protocols, unstandardized outcome metrics and a reliance on small, unadjusted cohorts.

PMID:
42951720
Bibliographic data and abstract were imported from PubMed on 29 Oct 2026.

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