Abstract: Ｏｂｊｅｃｔｉｖｅ：To evaluate the bone imaging characteristics of maintenance hemodialysis (MHD) patients with renal osteodystrophy (ROD) using 1¹⁸F-NaF PET／CT imaging, and to analyze the correlation between ¹⁸F-NaF uptake and bone turnover markers, in order to explore the diagnostic value of ¹⁸F-NaF PET／CT imaging in ROD.
Ｍｅｔｈｏｄｏｌｏｇｙ：A retrospective study was conducted on 20 MHD patients with ROD who underwent ¹⁸F-NaF PET／CT imaging at the Department of Nephrology of the Affiliated Hospital of Southwest Medical University from May 2020 to November 2022. Clinical data and biochemical markers including calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), total type I collagen amino-terminal propeptide (t-P1NP), N-terminal mid-region osteocalcin (N-MID OS), and β-carboxy-terminal telopeptide of type I collagen (β-CTX) were collected. Regions of interest (ROIs) were placed in the iliac crest, lumbar vertebrae, femoral neck, and standardized uptake value (SUV) of ¹⁸F-NaF was calculated. To describe the imaging features of ROD bone imaging and analyze the relationship between SUV and biochemical indicators, so as to understand the correlation between ¹⁸F-NaF uptake and ROD.
Ｒｅｓｕｌｔｓ：The images of 70％ of MHD patients with ROD showed abnormal accumulation of imaging agents in multiple bones, consistent with the super bone scan. Skull and jaw bone imaging showed obvious “black skull” or “lion face” signs. The rib and costochondral junctions showed symmetric imaging with bead-like changes. The proximal ends of long bones showed diffuse and uniform increases in imaging agent uptake or cortical thickening with increased uptake, presenting a “double track sign.” The correlation analysis showed that the SUV values of the lumbar vertebrae were positively correlated with ALP (r=0.493, P<0.05), and the SUV values of the femoral neck were positively correlated with iPTH (r=0.641, P<0.01), t-P1NP (r=0.630, P<0.01), and β-CTX (r=0.513, P<0.05).
Ｃｏｎｃｌｕｓｉｏｎ：¹⁸F-NaF PET／CT imaging can diagnose and comprehensively evaluate the location and extent of ROD in MHD patients. The good correlation between ¹⁸F-NaF uptake and bone turnover markers in the lumbar vertebrae and femoral neck suggests that ¹⁸F-NaF PET／CT bone imaging may become a promising non-invasive imaging method for the diagnosis and assessment of renal bone disease.

Key words: chronic kidney disease, maintenance hemodialysis, renal osteodystrophy, bone turnover markers, positron-emission tomography, ¹⁸F-NaF