Frontiers in endocrinology · 2026
Feasibility of opportunistic bone health assessment using low-dose CT trabecular attenuation and 18F-NaF uptake from PET/CT in prostate cancer.
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Liu Cailing, Liang Fenghua, Li Zuguo, Wang Zhenzhen, Fu Wei, Mu Xingyu
Аннотация
BACKGROUND: 18F-NaF PET/CT is widely used in prostate cancer for detecting skeletal metastases, but the examination also contains structural and metabolic information potentially relevant to bone health assessment.
OBJECTIVE: This study evaluated feasibility of this dual-parameter approach for opportunistic bone health assessment in prostate cancer.
DESIGN: This was a retrospective cross-sectional.
METHODS: A total of 105 men with prostate cancer without bone metastasis underwent 18F-NaF PET/CT. Stand-alone diagnostic CT-L1 was available in 76 patients and was used as an external structural reference for feasibility analysis and gray-zone stratification. Patient-level analyses used mean lumbar SUVavg and mean PET/CT-derived trabecular attenuation across L1-L4. Vertebra-level analyses used all available same-level SUVavg and same-level PET/CT-derived trabecular attenuation measurements. Patient-level metabolic-structural discordance on 18F-NaF PET/CT was assessed.
RESULTS: PET/CT-derived L1 trabecular attenuation agreed strongly with stand-alone diagnostic CT-L1, with a correlation coefficient of 0.929 and an intraclass correlation coefficient of 0.916. In the paired diagnostic CT, cross-validated discrimination for low diagnostic CT-L1 thresholds was already high with low-dose CT alone, and adding SUV did not improve performance. However, among 41 patients in the stand-alone diagnostic CT gray zone of 110-160 HU, 19 (46.3%) were classified as low 18F-NaF uptake. At the patient level, mean SUVavg across L1-L4 correlated positively with mean PET/CT-derived trabecular attenuation across L1-L4 (r = 0.521, p<0.001). In the vertebra-level mixed-effects model, each 10-HU increase in trabecular attenuation was associated with a 0.084-unit increase in SUVavg (95% CI: 0.058 to 0.110; p<0.001). Nine patients showed a higher-TA but low-uptake phenotype, whereas 30 showed low TA with higher uptake.
CONCLUSIONS: In prostate cancer, 18F-NaF PET/CT may feasibly support opportunistic bone health assessment by integrating low-dose CT-derived trabecular attenuation and 18F-NaF uptake within the same examination. The clinical contribution of 18F-NaF uptake appears to lie more in refining gray-zone stratification and identifying metabolically discordant patients. These feasibility findings are hypothesis-generating and require prospective validation against DXA and fracture endpoints before clinical use.
OBJECTIVE: This study evaluated feasibility of this dual-parameter approach for opportunistic bone health assessment in prostate cancer.
DESIGN: This was a retrospective cross-sectional.
METHODS: A total of 105 men with prostate cancer without bone metastasis underwent 18F-NaF PET/CT. Stand-alone diagnostic CT-L1 was available in 76 patients and was used as an external structural reference for feasibility analysis and gray-zone stratification. Patient-level analyses used mean lumbar SUVavg and mean PET/CT-derived trabecular attenuation across L1-L4. Vertebra-level analyses used all available same-level SUVavg and same-level PET/CT-derived trabecular attenuation measurements. Patient-level metabolic-structural discordance on 18F-NaF PET/CT was assessed.
RESULTS: PET/CT-derived L1 trabecular attenuation agreed strongly with stand-alone diagnostic CT-L1, with a correlation coefficient of 0.929 and an intraclass correlation coefficient of 0.916. In the paired diagnostic CT, cross-validated discrimination for low diagnostic CT-L1 thresholds was already high with low-dose CT alone, and adding SUV did not improve performance. However, among 41 patients in the stand-alone diagnostic CT gray zone of 110-160 HU, 19 (46.3%) were classified as low 18F-NaF uptake. At the patient level, mean SUVavg across L1-L4 correlated positively with mean PET/CT-derived trabecular attenuation across L1-L4 (r = 0.521, p<0.001). In the vertebra-level mixed-effects model, each 10-HU increase in trabecular attenuation was associated with a 0.084-unit increase in SUVavg (95% CI: 0.058 to 0.110; p<0.001). Nine patients showed a higher-TA but low-uptake phenotype, whereas 30 showed low TA with higher uptake.
CONCLUSIONS: In prostate cancer, 18F-NaF PET/CT may feasibly support opportunistic bone health assessment by integrating low-dose CT-derived trabecular attenuation and 18F-NaF uptake within the same examination. The clinical contribution of 18F-NaF uptake appears to lie more in refining gray-zone stratification and identifying metabolically discordant patients. These feasibility findings are hypothesis-generating and require prospective validation against DXA and fracture endpoints before clinical use.