The Role of ¹⁸F-NaF Skeletal PET/CT in Oncology

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.50
Procedures: 0.50
Head, Spine, and Musculoskeletal: 0.50

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Endocrine and Oncology Procedures: 0.50
Other Imaging Procedures: 2.00

Outline

1. Introduction
2. Sodium Fluoride ¹⁸F
3. Pharmacokinetics and Biologic Properties
4. Comparison of ¹⁸F-NaF and ^99mTc-MDP as Bone Agents
5. Clinical Indications
6. ¹⁸F-NaF PET/CT Protocol
7. Radiation Dosimetry
8. Image Interpretation
9. Extraosseous Uptake of ¹⁸F-NaF
10. Limitations
11. Comparison of ¹⁸F-NaF PET/CT and FDG PET/CT: Which Examination Should Be Performed
12. Conclusions

Objectives

Upon completion of this course, students will:

1. know the primary tumor types which are most likely to metastasize to bone
2. identify the device which produces nearly all of the clinically used ¹⁸F-NaF
3. know how ¹⁸F-NaF uptake indicates osteoblastic activity
4. understand why¹⁸F-NaF patients can be imaged 1 hour or less post injection
5. know the advantages of bone imaging with ^99mTc-MDP over ¹⁸F-NaF
6. identify imaging modalities that improve ^99mTc-MDP bone imaging specificity
7. identify the area of the body where the superior spatial resolution of ¹⁸F-NaF is particularly important
8. identify the initial imaging modality of choice for the evaluation of suspected child abuse
9. understand how ¹⁸F-NaF imaging can benefit in the characterization of the biology of atherosclerotic plaques
10. know the factors that affect the time of imaging per bed position for ¹⁸F-NaF
11. be familiar with the reasons for encouraging hydration for ¹⁸F-NaF imaging
12. understand the factors which effect radiation dosimetry in ¹⁸F-NaF PET/CT
13. identify the organ/structure which receives the highest radiation dose in ¹⁸F-NaF PET imaging
14. know the normal uptake pattern of ¹⁸F-NaF within the body
15. understand the mechanism by which metastatic lesions are visualized in ¹⁸F-NaF bone imaging
16. be familiar with what the discovery of bone metastases from breast cancer may indicate for a patient
17. be familiar with benign processes demonstrating increased ¹⁸F-NaF uptake
18. understand possible implications of ¹⁸F-NaF uptake in atherosclerotic plaque
19. know the possible interpretation of spinal lesions not associated with the endplate or joint surface that do not show a typical ¹⁸F-NaF uptake pattern
20. be familiar with the differences in ¹⁸F-NaF and FDG prospective evaluations