[18F]NaF PET/CT to assess bone healing capacity in orthopaedic trauma surgery: a feasibility study

N D van Rijsewijk; M Wouthuyzen-Bakker; J H van Snick; J van Sluis; K Ten Duis; A W J M Glaudemans; F F A IJpma

doi:10.1007/s00259-025-07209-y

[18F]NaF PET/CT to assess bone healing capacity in orthopaedic trauma surgery: a feasibility study

N D van Rijsewijk^*, M Wouthuyzen-Bakker, J H van Snick, J van Sluis, K Ten Duis, A W J M Glaudemans, F F A IJpma

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

OBJECTIVE: Evaluation of bone healing potential in cases of delayed union or non-union remains a challenge. This study evaluated the use of [ 18F]NaF PET/CT to assess bone healing and its role in guiding clinical decision-making in orthopaedic trauma surgery.

METHODS: From June 2019 to December 2024, a prospective study was conducted in a level 1 trauma center. The study included 18 patients (20 fractures: 15 non-unions, 5 bone defects) all showing impaired bone healing after initial surgical fracture treatment, who were eligible for revision surgery. Dynamic (first 10 min post-tracer injection) and static (1-hour post-injection) [ 18F]NaF PET/CT scans were performed to assess bone healing capacity through qualitative and quantitative analysis. The relationship between scan results and treatment outcome was evaluated.

RESULTS: Increased [ 18F]NaF uptake, suggestive for bone healing capacity, was observed in all fractures (20/20). Based on the positive [ 18F]NaF PET/CT results, watchful waiting was recommended for all fractures, with two patients preferring surgery. After prolonged watchful waiting, 72% (13/18) showed bone healing progression. Notably, atrophic fractures displayed biological activity, and non-unions demonstrated sustained metabolic activity even beyond 12 months. Most fractures requiring revision surgery (80%, 4/5) needed additional stabilization. Ultimately, [ 18F]NaF PET/CT imaging helped to avoid revision surgery in 65% of all fractures (13/20). Uptake pattern analysis suggest that whole-bone uptake could potentially indicate surgical need (χ² = 5.62, p = 0.018). Quantitative assessment provided no additional information.

CONCLUSION: [ 18F]NaF PET/CT imaging provides valuable insights into bone healing potential, especially in non-unions, helping guide clinical decisions and reducing unnecessary surgeries. This study challenges traditional non-union definitions by highlighting the biological activity of both atrophic and hypertrophic fractures.

Original language	English
Journal	European Journal of Nuclear Medicine and Molecular Imaging
DOIs	https://doi.org/10.1007/s00259-025-07209-y
Publication status	E-pub ahead of print - 27-Mar-2025

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van Rijsewijk, N. D., Wouthuyzen-Bakker, M., van Snick, J. H., van Sluis, J., Ten Duis, K., Glaudemans, A. W. J. M., & IJpma, F. F. A. (2025). [18F]NaF PET/CT to assess bone healing capacity in orthopaedic trauma surgery: a feasibility study. European Journal of Nuclear Medicine and Molecular Imaging. Advance online publication. https://doi.org/10.1007/s00259-025-07209-y

@article{3cf328e44f1c4b45aab458c7ca95f0d5,

title = "[18F]NaF PET/CT to assess bone healing capacity in orthopaedic trauma surgery: a feasibility study",

abstract = "OBJECTIVE: Evaluation of bone healing potential in cases of delayed union or non-union remains a challenge. This study evaluated the use of [ 18F]NaF PET/CT to assess bone healing and its role in guiding clinical decision-making in orthopaedic trauma surgery. METHODS: From June 2019 to December 2024, a prospective study was conducted in a level 1 trauma center. The study included 18 patients (20 fractures: 15 non-unions, 5 bone defects) all showing impaired bone healing after initial surgical fracture treatment, who were eligible for revision surgery. Dynamic (first 10 min post-tracer injection) and static (1-hour post-injection) [ 18F]NaF PET/CT scans were performed to assess bone healing capacity through qualitative and quantitative analysis. The relationship between scan results and treatment outcome was evaluated. RESULTS: Increased [ 18F]NaF uptake, suggestive for bone healing capacity, was observed in all fractures (20/20). Based on the positive [ 18F]NaF PET/CT results, watchful waiting was recommended for all fractures, with two patients preferring surgery. After prolonged watchful waiting, 72% (13/18) showed bone healing progression. Notably, atrophic fractures displayed biological activity, and non-unions demonstrated sustained metabolic activity even beyond 12 months. Most fractures requiring revision surgery (80%, 4/5) needed additional stabilization. Ultimately, [ 18F]NaF PET/CT imaging helped to avoid revision surgery in 65% of all fractures (13/20). Uptake pattern analysis suggest that whole-bone uptake could potentially indicate surgical need (χ² = 5.62, p = 0.018). Quantitative assessment provided no additional information. CONCLUSION: [ 18F]NaF PET/CT imaging provides valuable insights into bone healing potential, especially in non-unions, helping guide clinical decisions and reducing unnecessary surgeries. This study challenges traditional non-union definitions by highlighting the biological activity of both atrophic and hypertrophic fractures. ",

author = "{van Rijsewijk}, {N D} and M Wouthuyzen-Bakker and {van Snick}, {J H} and {van Sluis}, J and {Ten Duis}, K and Glaudemans, {A W J M} and IJpma, {F F A}",

note = "{\textcopyright} 2025. The Author(s).",

year = "2025",

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day = "27",

doi = "10.1007/s00259-025-07209-y",

language = "English",

journal = "European Journal of Nuclear Medicine and Molecular Imaging",

issn = "1619-7070",

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TY - JOUR

T1 - [18F]NaF PET/CT to assess bone healing capacity in orthopaedic trauma surgery

T2 - a feasibility study

AU - van Rijsewijk, N D

AU - Wouthuyzen-Bakker, M

AU - van Snick, J H

AU - van Sluis, J

AU - Ten Duis, K

AU - Glaudemans, A W J M

AU - IJpma, F F A

PY - 2025/3/27

Y1 - 2025/3/27

N2 - OBJECTIVE: Evaluation of bone healing potential in cases of delayed union or non-union remains a challenge. This study evaluated the use of [ 18F]NaF PET/CT to assess bone healing and its role in guiding clinical decision-making in orthopaedic trauma surgery. METHODS: From June 2019 to December 2024, a prospective study was conducted in a level 1 trauma center. The study included 18 patients (20 fractures: 15 non-unions, 5 bone defects) all showing impaired bone healing after initial surgical fracture treatment, who were eligible for revision surgery. Dynamic (first 10 min post-tracer injection) and static (1-hour post-injection) [ 18F]NaF PET/CT scans were performed to assess bone healing capacity through qualitative and quantitative analysis. The relationship between scan results and treatment outcome was evaluated. RESULTS: Increased [ 18F]NaF uptake, suggestive for bone healing capacity, was observed in all fractures (20/20). Based on the positive [ 18F]NaF PET/CT results, watchful waiting was recommended for all fractures, with two patients preferring surgery. After prolonged watchful waiting, 72% (13/18) showed bone healing progression. Notably, atrophic fractures displayed biological activity, and non-unions demonstrated sustained metabolic activity even beyond 12 months. Most fractures requiring revision surgery (80%, 4/5) needed additional stabilization. Ultimately, [ 18F]NaF PET/CT imaging helped to avoid revision surgery in 65% of all fractures (13/20). Uptake pattern analysis suggest that whole-bone uptake could potentially indicate surgical need (χ² = 5.62, p = 0.018). Quantitative assessment provided no additional information. CONCLUSION: [ 18F]NaF PET/CT imaging provides valuable insights into bone healing potential, especially in non-unions, helping guide clinical decisions and reducing unnecessary surgeries. This study challenges traditional non-union definitions by highlighting the biological activity of both atrophic and hypertrophic fractures.

AB - OBJECTIVE: Evaluation of bone healing potential in cases of delayed union or non-union remains a challenge. This study evaluated the use of [ 18F]NaF PET/CT to assess bone healing and its role in guiding clinical decision-making in orthopaedic trauma surgery. METHODS: From June 2019 to December 2024, a prospective study was conducted in a level 1 trauma center. The study included 18 patients (20 fractures: 15 non-unions, 5 bone defects) all showing impaired bone healing after initial surgical fracture treatment, who were eligible for revision surgery. Dynamic (first 10 min post-tracer injection) and static (1-hour post-injection) [ 18F]NaF PET/CT scans were performed to assess bone healing capacity through qualitative and quantitative analysis. The relationship between scan results and treatment outcome was evaluated. RESULTS: Increased [ 18F]NaF uptake, suggestive for bone healing capacity, was observed in all fractures (20/20). Based on the positive [ 18F]NaF PET/CT results, watchful waiting was recommended for all fractures, with two patients preferring surgery. After prolonged watchful waiting, 72% (13/18) showed bone healing progression. Notably, atrophic fractures displayed biological activity, and non-unions demonstrated sustained metabolic activity even beyond 12 months. Most fractures requiring revision surgery (80%, 4/5) needed additional stabilization. Ultimately, [ 18F]NaF PET/CT imaging helped to avoid revision surgery in 65% of all fractures (13/20). Uptake pattern analysis suggest that whole-bone uptake could potentially indicate surgical need (χ² = 5.62, p = 0.018). Quantitative assessment provided no additional information. CONCLUSION: [ 18F]NaF PET/CT imaging provides valuable insights into bone healing potential, especially in non-unions, helping guide clinical decisions and reducing unnecessary surgeries. This study challenges traditional non-union definitions by highlighting the biological activity of both atrophic and hypertrophic fractures.

U2 - 10.1007/s00259-025-07209-y

DO - 10.1007/s00259-025-07209-y

M3 - Article

C2 - 40214741

SN - 1619-7070

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

ER -

[18F]NaF PET/CT to assess bone healing capacity in orthopaedic trauma surgery: a feasibility study

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