Clinical note
Clinical usefulness of two-phase 18F-sodium-fluoride (18F-NaF) bone PET/CT for evaluating treatment response of bone metastases from breast cancer: Case report
Utilidad clínica de la PET/TC ósea doble fase con 18F-fluoruro de sodio (18F-NaF) para valorar la respuesta terapéutica de las metástasis óseas del cáncer de mama: informe de un caso
a Department of Radiology, Soonchunhyang University Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
b Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do, 31151, Republic of Korea
c Department of Internal Medicine, Soonchunhyang Univeristy Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
d Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Simgok-ro 100 Gil 25, Seo-gu, Incheon 22711, Republic of Korea
e Department of Surgery, Soonchunhyang Univeristy Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
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En la proyección posterior, se observa una captación focal del radiotrazador en sacro. B y C) Imágenes de PET ósea con <span class="elsevierStyleSup">18</span>F-NaF. En las imágenes de intensidad máxima de la fase de perfusión (B) y ósea (C) de la PET con <span class="elsevierStyleSup">18</span>F-NaF, se detectó una captación focal adicional en L5 junto con la lesión sacra. Hubo hallazgos inespecíficos en el esternón que ya se habían detectado en gammagrafías óseas previas, sin cambios (punta de flecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.H. Seo, S.M. Lee, S.N. Yu, J.W. Lee, J.E. Lee" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.H." "apellidos" => "Seo" ] 1 => array:2 [ "nombre" => "S.M." "apellidos" => "Lee" ] 2 => array:2 [ "nombre" => "S.N." "apellidos" => "Yu" ] 3 => array:2 [ "nombre" => "J.W." "apellidos" => "Lee" ] 4 => array:2 [ "nombre" => "J.E." "apellidos" => "Lee" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2253808918300715" "doi" => "10.1016/j.remnie.2018.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918300715?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18301276?idApp=UINPBA00004N" "url" => "/2253654X/0000003800000004/v1_201906280916/S2253654X18301276/v1_201906280916/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2253808919300436" "issn" => "22538089" "doi" => "10.1016/j.remnie.2019.04.001" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1062" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:243-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Melorheostosis: a rare sclerosing bone dysplasia. Usefulness of bone scintigraphy" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "244" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Melorreostosis: displasia ósea esclerosante infrecuente. Utilidad de la gammagrafía ósea" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2167 "Ancho" => 1433 "Tamanyo" => 142269 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy with <span class="elsevierStyleSup">99m</span>Tc-methylene diphosphonate: intense diffuse uptake in right femur, extending outside the borders of the bone and deforming the bone. The anterior border of the iliac crest is also affected as well as the acetabular region and homolateral patella. Additional osteoblastic focus in the upper third of the tibia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E.R. Marqués Aparicio, J. Dolado Ardit, A. Crespo-Jara, A. Martínez Caballero, M.A. Antón Leal, J.M. Clavel Claver, M.M. Riera Ayora, J. Verdú Rico" "autores" => array:8 [ 0 => array:2 [ "nombre" => "E.R." "apellidos" => "Marqués Aparicio" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Dolado Ardit" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Crespo-Jara" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Martínez Caballero" ] 4 => array:2 [ "nombre" => "M.A." "apellidos" => "Antón Leal" ] 5 => array:2 [ "nombre" => "J.M." "apellidos" => "Clavel Claver" ] 6 => array:2 [ "nombre" => "M.M." "apellidos" => "Riera Ayora" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Verdú Rico" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X1830221X" "doi" => "10.1016/j.remn.2019.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X1830221X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919300436?idApp=UINPBA00004N" "url" => "/22538089/0000003800000004/v1_201907020628/S2253808919300436/v1_201907020628/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808919300114" "issn" => "22538089" "doi" => "10.1016/j.remnie.2019.01.003" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1047" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:234-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical note</span>" "titulo" => "Complications of shoulder arthroplasty: added value of SPECT/CT imaging" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "234" "paginaFinal" => "237" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complicaciones de las prótesis de hombro: valor añadido de la imagen SPECT/TC" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 953 "Ancho" => 1200 "Tamanyo" => 119490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy of left RSA. (A) Delayed planar images in anterior (left) and posterior (right) projections showing an increased uptake in the left glenoid region (arrow), compatible with prosthetic loosening. A mild focal uptake is barely seen in the middle third of the left humerus (head arrow). (B) SPECT/CT images (from up to down: CT, SPECT and fusion images; from left to right: coronal, sagittal and axial views) are consistent with mechanical loosening of the glenoid component (arrows). (C) Details of coronal (left) and axial (right) views of the fusion SPECT/CT images, localizing the mild humeral uptake previously described on the medial side of the cortical bone of the left humeral diaphysis (arrows), far from the stem tip (head arrow), suggesting a stress lesion, and therefore discarding a loosening of the humeral prosthetic component.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.P. Suárez, M.L. Domínguez, N. Zeidán, M.E. García, D. Lisei, N. Martín, F.M. González" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.P." "apellidos" => "Suárez" ] 1 => array:2 [ "nombre" => "M.L." "apellidos" => "Domínguez" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Zeidán" ] 3 => array:2 [ "nombre" => "M.E." "apellidos" => "García" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Lisei" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Martín" ] 6 => array:2 [ "nombre" => "F.M." "apellidos" => "González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X18302725" "doi" => "10.1016/j.remn.2018.12.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18302725?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808919300114?idApp=UINPBA00004N" "url" => "/22538089/0000003800000004/v1_201907020628/S2253808919300114/v1_201907020628/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical note</span>" "titulo" => "Clinical usefulness of two-phase <span class="elsevierStyleSup">18</span>F-sodium-fluoride (<span class="elsevierStyleSup">18</span>F-NaF) bone PET/CT for evaluating treatment response of bone metastases from breast cancer: Case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "238" "paginaFinal" => "242" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jin Ho Seo, Sang Mi Lee, Shi Nae Yu, Jeong Won Lee, Jong Eun Lee" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Jin Ho" "apellidos" => "Seo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Sang Mi" "apellidos" => "Lee" "email" => array:1 [ 0 => "gareen@naver.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Shi Nae" "apellidos" => "Yu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Jeong Won" "apellidos" => "Lee" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Jong Eun" "apellidos" => "Lee" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Department of Radiology, Soonchunhyang University Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do, 31151, Republic of Korea" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Internal Medicine, Soonchunhyang Univeristy Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Simgok-ro 100 Gil 25, Seo-gu, Incheon 22711, Republic of Korea" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Surgery, Soonchunhyang Univeristy Cheonan Hospital, 23-20 Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad clínica de la PET/TC ósea doble fase con <span class="elsevierStyleSup">18</span>F-fluoruro de sodio (<span class="elsevierStyleSup">18</span>F-NaF) para valorar la respuesta terapéutica de las metástasis óseas del cáncer de mama: informe de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3500 "Ancho" => 2289 "Tamanyo" => 394823 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Follow up images in bone phase of <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT. (a) MIP images of bone phase three months (left) and six months (right) later. (b) Trans-axial images of bone phase (L5) three months (upper) and six months (lower) later. (c) Trans-axial images of bone phase (sacrum) three months (upper) and six months (lower) later.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Metastases to bone, which occur much more frequently than primary bone tumors, are a common source of malignancy in the skeleton, and breast cancer is one of the most common malignancies that metastasizes to bone.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Breast cancer is prone to relapse and metastases and approximately 40% of patients who receive radical mastectomy suffer a relapse, with a high probability of developing metastases in the bone, lung, liver, lymph nodes, chest wall, and brain.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The presence of bone metastases in breast cancer affects prognosis and treatment planning. Furthermore, the treatment response of bone metastases in breast cancer patients has a major impact on the overall treatment strategy and is an important determinant of the course of illness and the quality of life.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Many imaging modalities such as planar <span class="elsevierStyleSup">99m</span>Tc-diphosphonate bone scanning, single-photon emission computed tomography (SPECT), positron emission tomography/computed tomography (PET/CT), and whole-body magnetic resonance imaging (MRI) techniques can be used for the detection of bone metastasis and the evaluation of response to treatment in breast cancer patients.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Recently, <span class="elsevierStyleSup">18</span>F-sodium-fluoride (<span class="elsevierStyleSup">18</span>F-NaF) bone PET/CT has been used to detect bone metastases and has shown higher sensitivity than planar bone scintigraphy, bone SPECT, CT, MRI, and <span class="elsevierStyleSup">18</span>F-fluorodeoxyglucose (<span class="elsevierStyleSup">18</span>F-FDG) PET/CT.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> Moreover, a recent case report has demonstrated that two-phase <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT, which is comprised of an early perfusion phase and routine bone phase images, can provide additional information for the accurate diagnosis of inflammatory disease.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Here, we report a case of a breast cancer patient in whom the two-phase <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT showed its clinical value in detecting an additional metastatic bone lesion and assessing the treatment response of bone metastasis.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 48-year-old woman was diagnosed with invasive ductal carcinoma in the left breast at our medical center. <span class="elsevierStyleSup">18</span>F-FDG PET/CT for staging before surgery showed no distant lymph nodes or organ metastases. She had undergone left lumpectomy with sentinel lymph node biopsy. The histopathological stage was T2N0 and afterwards she underwent adjuvant radiotherapy and chemotherapy and subsequent maintenance hormone therapy. However, after two years of hormone therapy, she stopped treatment arbitrarily.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In a routine surveillance performed six years after surgery, a blood test showed an elevated tendency of both carbohydrate antigen 15-3 (CA15-3; from 7.20<span class="elsevierStyleHsp" style=""></span>U/mL to 7.93<span class="elsevierStyleHsp" style=""></span>U/mL; normal range <25<span class="elsevierStyleHsp" style=""></span>U/mL) and carcinoembryonic antigen (CEA; from 1.08<span class="elsevierStyleHsp" style=""></span>ng/mL to 1.12<span class="elsevierStyleHsp" style=""></span>ng/mL; normal range <5<span class="elsevierStyleHsp" style=""></span>ng/mL) levels. Furthermore, a planar bone scintigraphy showed a new lesion in the sacrum that had not been evident previously (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). With the suspicion of a new bone metastasis, two-phase <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT was performed for further diagnostic work-up. Immediately following intravenous injection of 185 MBq of <span class="elsevierStyleSup">18</span>F-NaF, using a Biograph mCT 128 scanner (Siemens Healthcare, Knoxville, TN, USA), the early perfusion phase images were acquired with static acquisition (2<span class="elsevierStyleHsp" style=""></span>min per bed position) from L1 spine to sacrum, and 45<span class="elsevierStyleHsp" style=""></span>min following injection of <span class="elsevierStyleSup">18</span>F-NaF, standard bone phase PET/CT images were acquired.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> In both perfusion and bone phase images of <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT, we found focally increased perfusion and uptake in the left ala of the sacrum and in the vertebral body of L5 near the upper end plate, suggesting metastatic bone lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b, c).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Upon the diagnosis of newly developed bone metastases, the patient received palliative chemotherapy and radiotherapy. Three months after treatment, blood tests showed a decrease in CA15-3 (from 7.93<span class="elsevierStyleHsp" style=""></span>U/mL to 6.73<span class="elsevierStyleHsp" style=""></span>U/mL) and CEA (from 1.12<span class="elsevierStyleHsp" style=""></span>ng/mL to 0.89<span class="elsevierStyleHsp" style=""></span>ng/mL) levels.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Follow-up two-phase <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT was also performed 3 months and 6 months following treatment for the evaluation of treatment response. In the visual analysis, perfusion phase images showed decreased uptake in the metastatic bone lesions (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In contrast, no significant changes of uptake in the lesions were observed in the bone phase images (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). There were no newly developed metastatic bone lesion on follow-up PET/CT. For semi-quantitative analysis, a circular-shaped region of interest (ROI) was drawn over the metastatic lesions in the L5 vertebra and sacrum and the mean and maximum uptake of radiotracer were measured using standardized uptake value (SUV). Furthermore, to measure the reference organ uptake, 1.5<span class="elsevierStyleHsp" style=""></span>cm-sized ROIs were also drawn in the aortic arch on three consecutive slices, and the mean SUVs of the ROIs were calculated.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> The mean and maximum SUVs of metastatic bone lesions were divided by the reference organ uptake for normalization of the uptake. The results of semi-quantitative analysis showed that perfusion phase images showed greater decrease of uptake in both lesions than bone phase images did in both three-month and six-month images (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Based on the findings of <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT and serum tumor marker levels, it was determined that the palliative chemotherapy and radiotherapy achieved a favorable treatment response.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Uptake of <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT reflects bone remodeling, and the uptake indicates osteoblastic activity by identifying reactive changes in the underlying affected bone.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Abnormal areas of increased <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT uptake depicted on the PET images are due to processes that increase exposure of the surface of bone and provide a higher availability of binding sites, such as osteolytic and osteoblastic processes.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> Many studies have demonstrated that <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT presents a higher detection rate of bone metastases than other imaging modalities.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> In this case, <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT was found to have additional metastatic lesions that were underestimated in bone scintigraphy.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In previous studies, perfusion images were used to characterize lesions, for staging, to predict patient outcome or response to therapy, and to evaluate relapse and tumor resistance to drugs, as well as pharmacodynamics in cancer drug development.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Using two-phase <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT scan, perfusion phase images can also be easily acquired.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> In this case, the clinical usefulness of perfusion phase images in evaluating the treatment response of bone metastases of breast cancer is demonstrated. In addition to visual analysis, we also performed semi-quantitative analysis using SUV, which has been previously used as a purely descriptive indicator of the uptake on <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> demonstrating that tumor-to-reference organ uptake ratios in perfusion images were more greatly reduced than those in bone phase images.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the process of treating bone metastases of breast cancer, flare phenomenon may cause continuously increased radiotracer uptake in metastatic bone lesion on bone scan.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> In our case, continuous radiotracer uptake was observed in the bone phase of follow-up <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT. This finding in our case could be explained by the flare phenomenon, but further research is warranted to elucidate the mechanism of the finding.</p><p id="par0060" class="elsevierStylePara elsevierViewall">It is known that the therapeutic response of bone metastasis is difficult to evaluate with conventional imaging modalities such as bone scintigraphy, bone single photon emission tomography (SPECT) and CT, as well as with bone PET/CT.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> However, in this case, we could easily confirm the therapeutic response with additional perfusion phase images of <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT scanning, suggesting that two-phase <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT scanning might be used as an alternative method for evaluating the treatment response of bone metastasis. Still, because only planar bone scintigraphy was performed in the present case, further studies are required to compare <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT with bone SPECT/CT in diagnosing metastatic bone lesion and evaluating treatment response.</p><p id="par0065" class="elsevierStylePara elsevierViewall">This is the first case to evaluate the therapeutic response of metastatic bone lesions of breast cancer using visual and semi-quantitative analysis of two-phase <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT. These findings indicate that two-phase <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT may be a useful imaging modality for evaluating the treatment response of bone metastases as well as for detecting bone metastases.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1214689" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1130588" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1214690" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1130587" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 8 => array:2 [ "identificador" => "xack415219" "titulo" => "Acknowledgement" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-22" "fechaAceptado" => "2018-09-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1130588" "palabras" => array:3 [ 0 => "Positron emission tomography" 1 => "<span class="elsevierStyleSup">18</span>F-sodium fluoride" 2 => "Breast cancer" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1130587" "palabras" => array:3 [ 0 => "Tomografía por emisión de positrones" 1 => "<span class="elsevierStyleSup">18</span>F-fluoruro de sodio" 2 => "cáncer de mama" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report the case of a breast cancer patient in whom a two-phase <span class="elsevierStyleSup">18</span>F-sodium-fluoride (<span class="elsevierStyleSup">18</span>F-NaF) bone PET/CT was useful for detecting hidden bone metastases and assessing treatment response. The patient underwent a two-phase bone PET/CT to evaluate a newly developed lesion found on bone scintigraphy following surgery. In the perfusion and bone phase PET/CT images, focally increased perfusion and bony uptake were found in the sacrum and L5 vertebra, suggesting bone metastases of breast cancer. Therefore, the patient subsequently underwent palliative treatment. In another two PET/CT studies (each including two-phase bone images) performed after three and six months of follow-up, the perfusion phase images showed an improvement of the lesion uptake more clearly than in the bone phase images in the visual and semi-quantitative analyses, and thus the perfusion phase images were more useful for clarifying the treatment response earlier than the bone phase images. This is the first case showing the clinical usefulness of <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT with the perfusion imaging technique for evaluating bone metastases and the therapeutic response of metastatic bone lesions.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Reportamos el caso de una paciente con cáncer de mama, en la que la PET/TC ósea doble fase con <span class="elsevierStyleSup">18</span>F-fluoruro de sodio (<span class="elsevierStyleSup">18</span>F-NaF) resultó de utilidad para detectar metástasis óseas ocultas y valorar la respuesta al tratamiento. La paciente fue sometida a un estudio PET/TC óseo doble fase de una lesión de nuevo desarrollo detectada en la gammagrafía posterior a la intervención. En las imágenes PET/TC de perfusión y óseas, se encontraron captaciones en las fases de perfusión y ósea, puntualmente incrementadas en el sacro y la vértebra L5, sugerentes de metástasis óseas del cáncer de mama, por lo que se sometió a la paciente a terapia paliativa. En las imágenes de PET/TC ósea doble fase, realizadas a los tres y seis meses, las imágenes de perfusión reflejaron más claramente la mejora de la captación de la lesión que las imágenes de la fase ósea en los análisis visual y semi-cuantitativo, utilizándose por tanto las imágenes de la fase de perfusión para esclarecer la respuesta a la terapia con mayor prontitud que las imágenes de la fase ósea. Se trata del primer caso que refleja la utilidad clínica de la PET/TC ósea con <span class="elsevierStyleSup">18</span>F-NaF, con la técnica de imagen de perfusión, para evaluar las metástasis óseas y la respuesta terapéutica de las lesiones óseas metastásicas.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Seo JH, Lee SM, Yu SN, Lee JW, Lee JE. Utilidad clínica de la PET/TC ósea doble fase con <span class="elsevierStyleSup">18</span>F-fluoruro de sodio (<span class="elsevierStyleSup">18</span>F-NaF) para valorar la respuesta terapéutica de las metástasis óseas del cáncer de mama: informe de un caso. Rev Esp Med Nucl Imagen Mol. 2019;38:238–242.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1826 "Ancho" => 3167 "Tamanyo" => 240548 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Bone scintigraphy (a) and <span class="elsevierStyleSup">18</span>F-NaF bone PET images (b, c). (a) In the posterior view of bone scintigraphy, focal radiotracer uptake is shown in sacrum. In maximal intensity images of perfusion phase (b) and bone phase (c) of <span class="elsevierStyleSup">18</span>F-NaF bone PET, additional focal uptake in L5 vertebra was detected along with sacral lesion. There were nonspecific findings in the sternum that had been observed in previous bone scans without any change (arrowhead).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3417 "Ancho" => 2206 "Tamanyo" => 378991 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Follow up images in perfusion phase of <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT. (a) MIP image of perfusion phase three months (left) and six months (right) later. (b) Trans-axial images of perfusion phase (L5) three months (upper) and six months (lower) later. (c) Trans-axial images of perfusion phase (sacrum) three months (upper) and six months (lower) later.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3500 "Ancho" => 2289 "Tamanyo" => 394823 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Follow up images in bone phase of <span class="elsevierStyleSup">18</span>F-NaF bone PET/CT. (a) MIP images of bone phase three months (left) and six months (right) later. (b) Trans-axial images of bone phase (L5) three months (upper) and six months (lower) later. (c) Trans-axial images of bone phase (sacrum) three months (upper) and six months (lower) later.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Phase</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Perfusion</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bone</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">L5 (mean)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Date (month/year) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">06/17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">09/17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12/17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">06/17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">09/17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12/17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lesion to reference organ uptake ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.75 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">%change \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−47.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−6.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−25.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">L5 (max)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lesion to reference organ uptake ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.88 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">%change \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−30.61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−59.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-40.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sacrum (mean)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lesion to reference organ uptake ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">%change \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−29.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−48.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−49.43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sacrum (max)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lesion to reference organ uptake ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">%change \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−32.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−37.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">−40.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2073714.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Results of semi-quantitative analysis of 18F-NaF bone PET/CT according to aortic arch for reference organ.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bone metastases: incidence and complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.D. 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| Year/Month | Html | Total | |
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| 2023 March | 3 | 1 | 4 |
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