Spectrum of False Positive F-sodium Fluoride (NaF) Bone PET/CT Findings in Oncology Imaging; A Narrative Pictorial Review of Cases from a Single Institution

Fluorine-18-sodium fluoride (F-NaF) is a positron emission tomography (PET) bone imaging agent mainly used for oncology staging but may also be used in the evaluation of benign bone and joint pathology conditions. Fluorine-18-NaF is an excellent bone-seeking agent with high bone uptake owing to favorable biodistribution with rapid single-pass extraction, limited plasma protein binding and prompt renal clearance. Fluorine-18-NaF PET/computed tomography (CT) is highly sensitive in identifying both sclerotic and lytic bone metastatic lesions. Occasionally F-NaF uptake in benign bone lesions can mimic malignantpathology. In these cases, the pattern of F-NaF uptake may elicit a specific diagnosis and correlation with clinical information and morphological information from correlative CT is essential for a correct diagnosis. In the present article, we present a series of clinical cases demonstrating examples of F-NaF uptake in benign lesions which can simulate malignant pathology in patients undergoing cancer staging.