¹⁸F-sodium fluoride PET/CT as a complementary measure of osteoblastic disease burden in axial spondyloarthritis: a prospective exploratory study
9 affiliations
- 1Division of Rheumatology, Immunology, Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan
- 2Department of Internal Medicine, National Defense Medical University, Taipei, Taiwan
- 3Department of Nuclear Medicine, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan
- 4Division of Radiology, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan
- 5Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan
- 6Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- 7Division of Allergy, Immunology, Rheumatology, Department of Internal Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- 8Division of Allergy, Immunology, Rheumatology, Department of Internal Medicine, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan
- 9Division of Allergy, Immunology, Rheumatology, Department of Internal Medicine, Kaohsiung Veteran General Hospital, No.386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City, 813414 Taiwan (R.O.C.)
Abstract
Purpose: To determine whether SIJ ¹⁸F-NaF uptake is associated with MRI-defined inflammation and structural damage and whether it provides a complementary measure of osteoblastic disease burden.
Methods: In this prospective exploratory study, 43 adults with chronic low back pain underwent pelvic radiography, sacroiliac joint (SIJ)-MRI, and whole-body ¹⁸F-NaF PET/CT and were classified as having radiographic axial spondyloarthritis or ankylosing spondylitis (AS; n = 29), non-radiographic axial spondyloarthritis (nr-axSpA; n = 5), or degenerative joint disease (DJD; n = 9). MRI was evaluated using SPARCC inflammation and structural scores. SIJ uptake was assessed visually and quantified using SUVmax. The primary endpoint was the correlation between SIJ SUVmax and the SPARCC structural score.
Results: SIJ SUVmax correlated with the SPARCC inflammation (ρ = 0.629) and structural (ρ = 0.606) scores (both p < 0.001) on SIJ-MRI; both associations persisted after mutual adjustment. Median SIJ SUVmax differed across AS, nr-axSpA, and DJD (14.7 [11.2–22.4], 5.5 [4.4–9.9], and 5.7 [4.0–9.2], respectively; p = 0.001). Visually positive uptake occurred in 23/29 (79.3%) patients with AS, including 10/16 without MRI-defined bone marrow edema; no patient with AS had edema without increased uptake. Peripheral joint and entheseal uptake were frequent but non-discriminatory. Exploratory AUCs were 0.841 for AS versus DJD and 0.848 for AS versus nr-axSpA.
Conclusion: SIJ ¹⁸F-NaF uptake was associated with both MRI-defined inflammation and structural burden in patients with AS, including those without active inflammation on MRI. SIJ SUVmax warrants evaluation as a complementary quantitative imaging biomarker of osteoblastic disease burden, but all derived thresholds require external validation.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08190-w.
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BibTeX
@article{chen2026¹⁸fsodium,
title = {{¹⁸F-sodium fluoride PET/CT as a complementary measure of osteoblastic disease burden in axial spondyloarthritis: a prospective exploratory study}},
author = {Hung-Yi Chen and Yu-Li Chiu and Sin-Yi Lyu and Chun-Hao Kao and Li-Fan Lin and En Chao and Yu-Hsiang Chiu and Shi-Jye Chu and Feng-Cheng Liu and Fu-Chiang Yeh and Ya-Chi Li and Hsiang-Cheng Chen and Deh-Ming Chang and Chun-Chi Lu},
journal = {European Journal of Nuclear Medicine and Molecular Imaging},
year = {2026},
month = oct,
doi = {10.1007/s00259-026-08190-w},
url = {https://doi.org/10.1007/s00259-026-08190-w},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - ¹⁸F-sodium fluoride PET/CT as a complementary measure of osteoblastic disease burden in axial spondyloarthritis: a prospective exploratory study
AU - Hung-Yi Chen
AU - Yu-Li Chiu
AU - Sin-Yi Lyu
AU - Chun-Hao Kao
AU - Li-Fan Lin
AU - En Chao
AU - Yu-Hsiang Chiu
AU - Shi-Jye Chu
AU - Feng-Cheng Liu
AU - Fu-Chiang Yeh
AU - Ya-Chi Li
AU - Hsiang-Cheng Chen
AU - Deh-Ming Chang
AU - Chun-Chi Lu
PY - 2026
DA - 2026/10/03
JO - European Journal of Nuclear Medicine and Molecular Imaging
DO - 10.1007/s00259-026-08190-w
UR - https://doi.org/10.1007/s00259-026-08190-w
AB - Purpose: To determine whether SIJ ¹⁸F-NaF uptake is associated with MRI-defined inflammation and structural damage and whether it provides a complementary measure of osteoblastic disease burden. Methods: In this prospective exploratory study, 43 adults with chronic low back pain underwent pelvic radiography, sacroiliac joint (SIJ)-MRI, and whole-body ¹⁸F-NaF PET/CT and were classified as having radiographic axial spondyloarthritis or ankylosing spondylitis (AS; n = 29), non-radiographic axial spondyloarthritis (nr-axSpA; n = 5), or degenerative joint disease (DJD; n = 9). MRI was evaluated using SPARCC inflammation and structural scores. SIJ uptake was assessed visually and quantified using SUVmax. The primary endpoint was the correlation between SIJ SUVmax and the SPARCC structural score. Results: SIJ SUVmax correlated with the SPARCC inflammation (ρ = 0.629) and structural (ρ = 0.606) scores (both p < 0.001) on SIJ-MRI; both associations persisted after mutual adjustment. Median SIJ SUVmax differed across AS, nr-axSpA, and DJD (14.7 [11.2–22.4], 5.5 [4.4–9.9], and 5.7 [4.0–9.2], respectively; p = 0.001). Visually positive uptake occurred in 23/29 (79.3%) patients with AS, including 10/16 without MRI-defined bone marrow edema; no patient with AS had edema without increased uptake. Peripheral joint and entheseal uptake were frequent but non-discriminatory. Exploratory AUCs were 0.841 for AS versus DJD and 0.848 for AS versus nr-axSpA. Conclusion: SIJ ¹⁸F-NaF uptake was associated with both MRI-defined inflammation and structural burden in patients with AS, including those without active inflammation on MRI. SIJ SUVmax warrants evaluation as a complementary quantitative imaging biomarker of osteoblastic disease burden, but all derived thresholds require external validation. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00259-026-08190-w.
SN - 1619-7070
SN - 1619-7089
ER -