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18F Sodium Fluoride PET/CT Detects Osseous Metastases From Breast Cancer Missed on FDG PET/CT With Marrow Rebound

Avery, Ryan MD,; Kuo, Phillip H. MD, PhD

doi: 10.1097/RLU.0b013e3182996138
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Intense FDG uptake by bone marrow following recent chemotherapy limits evaluation for osseous metastases. The impact of marrow rebound on accuracy of 18F-fluoride PET/CT is unclear. A 73-year-old woman with breast cancer presented for restaging FDG PET/CT, which showed intense activity throughout almost the entire axial skeleton and no osseous metastases. An 18F-fluoride PET/CT performed 7 days later identified multiple osseous metastases in the spine, ribs, and pelvis. This case demonstrates that 18F-fluoride PET/CT should be considered for the evaluation of osseous metastases in patients with rebound marrow uptake on FDG PET/CT.

From the Department of Medical Imaging, The University of Arizona Medical Center, Tucson, AZ.

Received for publication February 7, 2013; revision accepted April 8, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Phillip H. Kuo, MD, PhD, Department of Medical Imaging, University of Arizona, 1501 N. Campbell Avenue, PO Box 245067, Tucson, AZ 85724-5067. E-mail:

© 2013 by Lippincott Williams & Wilkins