Feasibility of opportunistic bone health assessment using low-dose CT trabecular attenuation and 18F-NaF uptake from PET/CT in prostate cancer - Report - MDSpire

Evaluation of the Viability of Opportunistic Bone Health Evaluation Utilizing Low-Dose CT Trabecular Attenuation and 18F-NaF PET/CT Uptake in Prostate Cancer Patients

  • By

  • Cailing Liu

  • Fenghua Liang

  • Zuguo Li

  • Zhenzhen Wang

  • Wei Fu

  • Xingyu Mu

  • July 20, 2026

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Clinical Report: Evaluation of Opportunistic Bone Health in Prostate Cancer

Overview

This study assesses the feasibility of using 18F-NaF PET/CT for opportunistic bone health evaluation in prostate cancer patients.

Background

Prostate cancer significantly affects older men, who are already at risk for age-related bone loss. Treatments like androgen deprivation therapy can exacerbate this risk, leading to increased fragility fractures. Current guidelines recommend baseline bone health assessments, but implementation remains inconsistent, highlighting the need for opportunistic screening strategies.

Data Highlights

MeasurementCorrelation CoefficientIntraclass Correlation Coefficient
Trabecular Attenuation (TA) with CT-L10.9290.916
Mean SUVavg across L1-L4r = 0.521p<0.001
10-HU increase in TA0.084-unit increase in SUVavg95% CI: 0.058 to 0.110; p<0.001

Key Findings

  • Strong correlation between PET/CT-derived L1 trabecular attenuation and stand-alone diagnostic CT-L1.
  • Adding SUV to low-dose CT did not improve performance for low diagnostic CT-L1 thresholds.
  • Among patients in the gray zone of 110–160 HU, 46.3% were classified as low 18F-NaF uptake.
  • Metabolic-structural discordance was observed in 39% of patients.
  • Feasibility findings require prospective validation against DXA and fracture endpoints.

Clinical Implications

The integration of 18F-NaF PET/CT for bone health assessment may provide a practical approach to monitor bone health in prostate cancer patients.

Conclusion

The study indicates that 18F-NaF PET/CT may serve as a tool for opportunistic bone health assessment in prostate cancer.

Related Resources & Content

  1. Comparison of 99mTc-HDP Bone Scintigraphy and 18F-Sodium Fluoride PET/CT for Initial Staging in Prostate Cancer Patients
  2. Diagnostic performance of 18F-FDG PET-CT and SPECT for bone metastases from colorectal cancer: a retrospective study
  3. Impact of Radiomic Assessment of [18F]Fluoromethylcholine PET/CT on Predicting Biochemical Recurrence in Intermediate and High-Risk Prostate Cancer Patients During Initial Staging
  4. Assessing the Role of Baseline 18F-sodium Fluoride and 18F-choline PET Imaging in Predicting Response to Radium-223 Therapy in Bone Metastases of Castration-Resistant Prostate Cancer
  5. EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer 2024
  6. Osteoporosis Screening Recommendations - U.S. Preventive Services Taskforce
  7. Opportunistic screening of osteoporosis by CT scan compared to DXA: A systematic review and meta-analysis
  8. CT image-based biomarkers for opportunistic screening of osteoporotic fractures: a systematic review and meta-analysis
  9. Opportunistic screening for osteoporosis and vertebral fracture using CT attenuation from 18F-fluorocholine PET/CT in patients with prostate cancer - PMC
  10. Measurement of lumbar vertebral body attenuation at PET-CT is a reliable method of diagnosing osteoporosis - ScienceDirect
  11. https://snmmi.org/common/Uploaded%20files/Web/Clinical%20Practice/Procedure%20Standards/2023/Bone%20Scintigraphy_UPDATED2024.pdf
  12. Validation of quantitative [18F]NaF PET uptake parameters in bone diseases: a systematic review - PubMed
  13. Predicting Fractures Using Vertebral 18F-NaF Uptake in Prostate Cancer Patients - PMC

Original Source(s)

Feasibility of opportunistic bone health assessment using low-dose CT trabecular attenuation and 18F-NaF uptake from PET/CT in prostate cancer

  • by Cailing Liu, Fenghua Liang, Zuguo Li, Zhenzhen Wang, Wei Fu, Xingyu Mu

  • July 20, 2026

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