Skeletal PET with 18 F-fluoride: applying new technology to an old tracer

Although 18F-labeled NaF was the first widely used agent for skeletal scintigraphy, it quickly fell into disuse after the introduc-tion of 99mTc-labeled bone-imaging agents. Recent comparative studies have demonstrated that 18F-fluoride PET is more ac-curate than 99mTc-diphosphonate SPECT for identifying both malignant and benign lesions of the skeleton. Combining 18F-fluoride PET with other imaging, such as CT, can improve the specificity and overall accuracy of skeletal 18F-fluoride PET and probably will become the routine clinical practice for 18F-fluoride PET. Although 18F-labeled NaF and 99mTc-diphosphonate have a similar patient dosimetry, 18F-fluoride PET offers shorter study times (typically less than 1 h), resulting in a more efficient workflow, improved patient convenience, and faster turnarounds of reports to the referring physicians. With the widespread avail-ability of PET scanners and the improved logistics for the deliv-ery of 18F radiopharmaceuticals, prior limitations to the routine use of 18F-fluoride bone imaging have largely been overcome. The favorable imaging performance and the clinical utility of 18F-fluoride PET, compared with 99mTc-diphosphonate scintigraphy, support the reconsideration of 18F-fluoride as a routine bone-imaging agent