18F-NaF uptake in skull-base bone as a predictor of treatment response in advanced nasopharyngeal carcinoma

Abstract

Abstract This study investigates the utility of 18F-sodium fluoride (18F-NaF) positron emission tomography/computed tomography (PET/CT) in assessing skull-base bone invasion (SBBI) and predicting treatment response in advanced nasopharyngeal carcinoma (NPC). A retrospective analysis was conducted on 142 patients with newly diagnosed advanced NPC who underwent 18F-NaF PET/CT for initial staging from December 2020 to December 2023. 18F-NaF PET/CT scans were analyzed for uptake values at the skull-base bone, and these were correlated with treatment outcomes of primary tumor using the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Statistical analyses involved Mann–Whitney U tests for group comparisons and logistic regression for evaluating risk factors. Higher 18F-NaF uptake at the skull-base bone was significantly associated with advanced T stages (p 10.0 and SUVmean > 5.2 as predictive of non-CR, with AUC values of 0.77 and 0.76, respectively. Univariate and multivariable analysis confirmed SUVmax as a significant predictor of treatment response (OR = 7.03, 95% CI: 1.97–25.13, p < 0.05). Elevated 18F-NaF uptake at the skull-base bone is predictive of poorer treatment outcomes, highlighting its potential as a prognostic biomarker in advanced NPC. This study demonstrates that 18F-NaF PET/CT is a valuable imaging modality for evaluating SBBI in NPC, offering metabolic information that complements the anatomical findings from MRI.

Keywords

• 18F-NaF
• PET/CT
• Skull-base bone invasion
• Nasopharyngeal carcinoma
• Treatment response