Molecular probes proliferate

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Fluoro-deoxyglucose, or FDG, has been the contrast agent of choice for PET oncologic and infection imaging. It is also the only PET contrast agent for these indications approved for reimbursement by private payors and the Centers for Medicare & Medicaid Services (CMS).

That may be changing, however. In a noteworthy event this month, a randomized, multi-center multinational trial investigating the use of 18F-sodium fluoride (18F-NaF) PET/CT to detect bony metastases began. The study compares conventional planar 99mTc-MDP bone imaging with 18F-NaF PET/CT in patients with breast, prostate and non-small cell lung cancers. The protocol was developed in conjunction with the FDA and CMS, and calls for data on more than 500 patients.

This trial seeks to provide an evidence basis for both utilization and reimbursement of the PET imaging agent, as early work indicates that 18F-NaF PET/CT bone scanning may have advantages over conventional 99mTc-MDP bone imaging because it is able to find smaller metastases and differentiate more accurately between cancerous and non-cancerous conditions.

Sodium fluoride and sugar aren’t the only condiments on the PET imaging agent table. Novel radiotracers for DNA synthesis, hypoxia, amino acid and hormone receptor imaging are also under investigation at facilities worldwide.

According to two researchers from Memorial Sloan-Kettering Cancer Center in New York City, these clinical PET tools should improve therapeutic planning and response assessment and should lead to improved patient outcomes. The duo reviewed the current state of clinical investigations of promising PET radiopharmaceuticals in one of this month’s top stories.

Getting regulatory and reimbursement approval for these new PET imaging agents appears to be a lengthy process given the lack of funding for widespread clinical trials. SNM President, Robert W. Atcher, PhD, Osman Ratib, MD, from the University Hospital Geneva, and Johannes Czernin, MD, from UCLA's David Geffen School of Medicine recently shared their thoughts on the challenges of conducting evidence-based trials for PET agents in our other top story for this edition.

In other news, if the potential and possibilities of molecular imaging make your pulse quicken, be sure to swing by our Molecular Imaging Insight Web site. You can sign up for our weekly newsletter as well as subscribe to our quarterly magazine. In addition, if you or your group is interested in finding out more about technologies and systems for molecular imaging in your practice, head over to our Healthcare TechGuide and check out the variety of offerings available there.

Lastly, if you have a comment or report to share about the utilization of molecular imaging and nuclear medicine in your practice, please contact me at the address below. I look forward to hearing from you.

Jonathan Batchelor, Web Editor