Novel strategy for a cocktail 18F-fluoride and 18F-FDG PET/CT scan for evaluation of malignancy: results of the pilot-phase study

18F-FDG PET/CT is used for detecting cancer and monitoring cancer response to therapy. However, because of the variable rates of glucose metabolism, not all cancers are identified reli-ably. Sodium 18F was previously used for bone imaging and can be used as a PET/CT skeletal tracer. The combined admin-istration of 18F and 18F-FDG in a single PET/CT study for cancer detection has not been reported to date.Methods: This is a pro-spective pilot study (November 2007–November 2008) of 14 patients with proven malignancy (6 sarcoma, 3 prostate cancer, 2 breast cancer, 1 colon cancer, 1 lung cancer, and 1 malignant paraganglioma) who underwent separate 18F PET/CT and 18F-FDG PET/CT and combined 18F/18F-FDG PET/CT scans for the evaluation of malignancy (a total of 3 scans each). There were 11 men and 3 women (age range, 19–75 y; average, 50.4 y). Re-sults: Interpretation of the combined 18F/18F-FDGPET/CT scans compared favorably with that of the 18F-FDG PET/CT (no lesions missed) and the 18F PET/CT scans (only 1 skull lesion seen on an 18F PET/CT scan was missed on the corresponding combined scan). Through image processing, the combined 18F/18F-FDG scan yielded results for bone radiotracer uptake comparable to those of the 18F PET/CT scan performed separately. Conclu-sion: Our pilot-phase prospective trial demonstrates that the combined 18F/18F-FDG administration followed by a single PET/CT scan is feasible for cancer detection. This combined method opens the possibility for improved patient care and re-duction in health care costs