Molecular Imaging in Oncology: 18F-Sodium Fluoride PET Imaging of Osseous Metastatic Disease

OBJECTIVE. This literature review details the history, pharmacokinetics, and utility of F-18-sodium fluoride ((NaF)-F-18) PET/CT in detecting osseous metastases compared with the current standard of care, technetium-99m methylene diphosphonate (Tc-99m-MDP) bone scintigraphy. Additional discussion highlights solutions to impediments for broader implementation of this modality and insight into the complementary roles of F-18-FDG PET/CT and (NaF)-F-18 PET/CT in oncology imaging, including preliminary data for combined (NaF)-F-18 and FDG PET/CT. CONCLUSION. (NaF)-F-18 PET/CT is the most comprehensive imaging modality for the evaluation of osseous metastatic disease. Although further data acquisition is necessary to expand cost-benefit analyses of this imaging agent, emerging data reinforce its diagnostic advantage, suggest methods to mitigate impediments to broader utilization of (NaF)-F-18 PET/CT, and introduce a potentially viable technique for single-session combined (NaF)-F-18 and FDG PET/CT staging of soft-tissue and osseous disease.