Diagnostic Accuracy of 18F-NaF PET/CT versus 99mTc Bone Scintigraphy for Detection of Skeletal Metastases
A Critical Review of Comparative Evidence
DOI:
https://doi.org/10.59667/sjoranm.v25i1.16Keywords:
sodium fluoride, 18F-NaF PET/CT, bone scintigraphy, skeletal metastases, diagnostic accuracy, critical reviewAbstract
Objective: To reassess the comparative diagnostic evidence for 18F-sodium fluoride (NaF) PET/CT and 99mTc bone scintigraphy following inconsistencies in the original quantitative synthesis.
Methods: This critical review audited primary reports and accessible supplements following PubMed and Europe PMC searches covering publications through 31 March 2025. Comparisons were separated by scintigraphic protocol. Verified patient-based counts yielded study-specific sensitivity and specificity with exact 95% binomial confidence intervals. Incomplete source verification prevented a definitive replacement meta-analysis; this is not a completed systematic review.
Results: Five selected paired comparisons with planar scintigraphy comprised 266 participants. Under the stated study-specific interpretation rules, observed NaF PET/CT sensitivity ranged from 88.9% to 100%, versus 52.3% to 78.9% for planar scintigraphy. Specificity ranged from 90.0% to 100% and from 57.1% to 100%, respectively. These descriptive ranges are not pooled estimates. Additional studies differed in comparator protocol, analysis population or data availability.
Conclusion: NaF PET/CT showed higher observed sensitivity in the verified planar comparisons, but generalization across cancers and scintigraphic protocols is not established. The original pooled claims are not retained. This review does not establish improved patient outcomes or cost-effectiveness.
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Copyright (c) 2025 Dr. Tosif Quazi MD, Dr. Haroon Rashid MD, Dr. Aamir Majeed Shah MD, Elena Khalid
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