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

A review of the indications, imaging appearances, and utility of 18F-NaF PET/CT in the evaluation of skeletal disease.

Course ID: Q00420 Category:
Modalities: , , ,


Satisfaction Guarantee


Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after February 24, 2023:
[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: 3.00
Procedures: 3.00
Radionuclides and Radiopharmaceuticals: 0.50
Endocrine and Oncology Procedures: 0.50
Other Imaging Procedures: 2.00


  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


Upon completion of this course, students will:

  1. know the primary tumor types which are most likely to metastasize to bone
  2. be familiar with the complications of bone metastases
  3. know the particles actually used for imaging with 18F-NaF
  4. identify the device which produces nearly all of the clinically used 18F-NaF
  5. identify the basis of the mechanism of skeletal uptake of 18F-NaF
  6. know how 18F-NaF uptake indicates osteoblastic activity
  7. understand the comparative advantages of 18F-NaF over 99mTc-MDP
  8. understand why 18F-NaF patients can be imaged 1 hour or less post injection
  9. know the advantages of bone imaging with 99mTc-MDP over 18F-NaF
  10. identify imaging modalities that improve 99mTc-MDP bone imaging specificity
  11. know a key similarity between 99mTc-MDP and 18F-NaF bone imaging
  12. understand why 18F-NaF depicts spinal lesions before 99mTc-MDP imaging
  13. identify the area of the body where the superior spatial resolution of 18F-NaF is particularly important
  14. identify the current primary usage for 18F-NaF PET/CT
  15. identify the initial imaging modality of choice for the evaluation of suspected child abuse
  16. know the imaging modality of choice for evaluating the viability of the remaining femoral head after surgery
  17. know the metabolic bone diseases that can be evaluated with 18F-NaF functional imaging
  18. understand how 18F-NaF imaging can benefit in the characterization of the biology of atherosclerotic plaques
  19. be familiar with the recommended dosages of 18F-NaF
  20. know the factors that affect the time of imaging per bed position for 18F-NaF
  21. understand the value of attenuation correction for 18F-NaF imaging
  22. be familiar with the reasons for encouraging hydration for 18F-NaF imaging
  23. understand the factors which effect radiation dosimetry in 18F-NaF PET/CT
  24. identify the organ/structure which receives the highest radiation dose in 18F-NaF PET imaging
  25. know the normal uptake pattern of 18F-NaF within the body
  26. understand the mechanism by which metastatic lesions are visualized in 18F-NaF bone imaging
  27. be familiar with what the discovery of bone metastases from breast cancer may indicate for a patient
  28. know instances where 18F-NaF can better depict lesions than FDG PET/CT
  29. be familiar with benign processes demonstrating increased 18F-NaF uptake
  30. understand SUV limitations in 18F-NaF imaging interpretation
  31. understand possible implications of 18F-NaF uptake in atherosclerotic plaque
  32. 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
  33. know the differences in 18F-NaF and FDG purpose and uptake pattern
  34. know sites for which FDG PET imaging is advantageous
  35. be familiar with the differences in 18F-NaF and FDG prospective evaluations