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Year : 2014  |  Volume : 29  |  Issue : 2  |  Page : 120-121  

18F-Fluoride bone positron emission tomography demonstrating changes related to finger clubbing and hypertrophic osteoarthropathy


1 Department of Nuclear Medicine and PET, American Oncology Institute, Nallagandla, Hyderabad, Andhra Pradesh, India
2 Department of Radiotherapy, American Oncology Institute, Nallagandla, Hyderabad, Andhra Pradesh, India

Date of Web Publication9-Apr-2014

Correspondence Address:
Raghava Kashyap
Department of Nuclear Medicine and PET, American Oncology Institute, Nallagandla, Hyderabad - 500 019, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.130319

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   Abstract 

Hypertrophic pulmonary osteoarthropathy is manifested by clubbing and periostitis of bones. We present a very rare documentation of increased F18-sodium fluoride uptake in the distal phalanges of both hands correlating to clubbing of the fingers in a 55-year-old female patient with carcinoma of lung in whom bone positron emission tomography was performed for metastatic work-up.

Keywords: Clubbing, F18-sodium fluoride, positron emission tomography


How to cite this article:
Kashyap R, Ali MA, Nagaraju M, Muntimadugu B. 18F-Fluoride bone positron emission tomography demonstrating changes related to finger clubbing and hypertrophic osteoarthropathy. Indian J Nucl Med 2014;29:120-1

How to cite this URL:
Kashyap R, Ali MA, Nagaraju M, Muntimadugu B. 18F-Fluoride bone positron emission tomography demonstrating changes related to finger clubbing and hypertrophic osteoarthropathy. Indian J Nucl Med [serial online] 2014 [cited 2019 May 19];29:120-1. Available from: http://www.ijnm.in/text.asp?2014/29/2/120/130319

A 55-year-old female patient with carcinoma of the lung was subjected to positron emission tomography (PET) bone scan for metastatic work-up. F18-sodium fluoride (NaF) bone PET carried out 60 min after intra-venous injection of 340 MBq of 18F-NaF on a PET/computed tomography (CT) scanner (GE Discovery ST600, Milwaukee, USA) showed metastatic foci in cervical and dorsal vertebrae [Figure 1]a. Tram-track appearance is seen in the femur on both sides is indicative of hypertrophic osteoarthropathy (HOA) (curved arrow). Image [Figure 1]b also demonstrates increased fluoride uptake in the distal phalanges of both hands (arrows). Clinical photograph [Figure 1]c shows finger clubbing. Fused axial PET CT images showing increased fluoride uptake in the phalanges and uptake along the femur. The additional advantage of F-18 NaF bone PET is, being a whole body imaging procedure, the modality demonstrated changes along the femur apart from the metastatic sites in the vertebral column in this particular case.
Figure 1: (a) Maximum intensity projection image of F18-fluoride bone positron emission tomography (PET) done 60 min after intra-venous injection of 340 mBq of 18F-sodium fluoride on a GE Discovery ST600 PET/computed tomography (CT) (Milwaukee, USA) demonstrate, metastatic foci in cervical and dorsal vertebrae. Tram-track appearance is seen in the femur on both sides is indicative of hypertrophic osteoarthropathy (curved arrow). Image also demonstrates increased fluoride uptake in the distal phalanges of both hands (arrows). (b) Clinical photograph showing finger clubbing. (c) Fused axial PET CT images showing increased fluoride uptake in the phalanges and uptake along the femur

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HOA is seen in approximately 1% of cases of lung cancer. [1] Clubbing is an intrinsic feature of HOA. The increased uptake in the long bones is secondary to periostitis induced osteoblastic activity. [2] The increased vascularity and soft-tissue proliferation with erosion of the distal phalanges [3] induced by platelet derived growth factor and vascular endothelial growth factor result in increased tracer uptake in the distal phalanges. Demonstration of changes of clubbing has been documented on 18F-fluorodeoxyglucose studies [4],[5],[6],[7] and on conventional bone scan with fusion imaging. [8],[9],[10] F18-NaF bone PET has been demonstrated through-out the literature to be more sensitive than conventional bone scan with technetium 99 m - methylene diphosphonate. This is due to the fact that uptake of NaF like other bone agents is dependent on blood flow and osteoblastic activity. Fluoride is adsorbed onto the surface of bone in exchange for hydroxyapatite. However, it is characterized by 2-fold higher uptake, faster clearance from blood and better target to non-target ratio. [11],[12] The addition of CT component to the PET increases its specificity for interpretation of findings. [13],[14] We present a very rare documentation of clubbing related changes on F18-NaF study.

 
   References Top

1.Ito T, Goto K, Yoh K, Niho S, Ohmatsu H, Kubota K, et al. Hypertrophic pulmonary osteoarthropathy as a paraneoplastic manifestation of lung cancer. J Thorac Oncol 2010;5:976-80.  Back to cited text no. 1
    
2.Uchisako H, Suga K, Tanaka N, Nishigauchi K, Matsumoto T, Matsunaga N, et al. Bone scintigraphy in growth hormone-secreting pulmonary cancer and hypertrophic osteoarthropathy. J Nucl Med 1995;36:822-5.  Back to cited text no. 2
    
3.Sarkar M, Mahesh DM, Madabhavi I. Digital clubbing. Lung India 2012;29:354-62.  Back to cited text no. 3
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4.Makis W, Abikhzer G, Rush C. Hypertrophic pulmonary osteoarthropathy diagnosed by FDG PET-CT in a patient with lung adenocarcinoma. Clin Nucl Med 2009;34:625-7.  Back to cited text no. 4
    
5.Pauls S, Krüger S, Mottaghy FM. 18F-FDG PET/CT in paraneoplastic osteoarthropathy. Rofo 2007;179:80-2.  Back to cited text no. 5
    
6.Strobel K, Schaefer NG, Husarik DB, Hany TF, Steinert H. Pulmonary hypertrophic osteoarthropathy in a patient with nonsmall cell lung cancer: Diagnosis with FDG PET/CT. Clin Nucl Med 2006;31:624-6.  Back to cited text no. 6
    
7.Smit F, Valdés Olmos RA, Sivro-Prndelj F, Hoefnagel CA. Hypertrophic osteoarthropathy on bone scintigraphy related to a mediastinal tumour of unknown origin imaged by FDG-PET. Eur J Nucl Med Mol Imaging 2003;30:332.  Back to cited text no. 7
    
8.Russo RR, Lee A, Mansberg R, Emmett L. Hypertrophic pulmonary osteoarthropathy demonstrated on SPECT/CT. Clin Nucl Med 2009;34:628-31.  Back to cited text no. 8
    
9.Hod N, Pinkas L, Ben-Ezra Z, Horne T. Scintigraphic evidence of clubbing on a bone scan. Clin Nucl Med 2001;26:860.  Back to cited text no. 9
    
10.Mohan HK, Groves AM, Clarke SE. Detection of finger clubbing and primary lung tumor on Tc-99 MDP bone scintigraphy in a patient with a scaphoid fracture. Clin Nucl Med 2004;29:450-1.  Back to cited text no. 10
    
11.Ishiguro K, Nakagaki H, Tsuboi S, Narita N, Kato K, Li J, et al. Distribution of fluoride in cortical bone of human rib. Calcif Tissue Int 1993;52:278-82.  Back to cited text no. 11
    
12.Cook GJ, Fogelman I. The role of positron emission tomography in skeletal disease. Semin Nucl Med 2001;31:50-61.  Back to cited text no. 12
    
13.Damle NA, Bal C, Bandopadhyaya GP, Kumar L, Kumar P, Malhotra A, et al. The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: A comparison with FDG PET/CT and 99mTc-MDP bone scan. Jpn J Radiol 2013;31:262-9.  Back to cited text no. 13
    
14.Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med 2006;47:287-97.  Back to cited text no. 14
    


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