18F Sodium Fluoride (NaF) PET Bone Imaging

Reacquaint yourself with 18F NaF

18F sodium fluoride (NaF) is a highly sensitive bone-seeking PET biomarker used in the detection of skeletal metastases. In February 2011, the FDA approved a New Drug Application (NDA) for 18F NaF from the National Cancer Institute (NCI) for the use in PET bone imaging. Cardinal Health submitted a Abbreviated New Drug Application in December of 2011 which is under review with the FDA.


PET/CT imaging with 18F NaF may be a good alternative to traditional bone scans

Bone metastasis is the most common malignant bone tumor and often occurs in patients with solid tumor cancers such as breast, lung and prostate. When compared with other imaging modalities used for bone scans, 18F NaF with PET and PET/CT shows very high sensitivity.2,3,4,5

PET/CT bone scans can be used to:

  • Identify bone metastases as early as possible
  • Determine the full extent of disease
  • Evaluate complications of the malignancy
  • Guide biopsy, if needed
  • Monitor response to therapy2


Clinical benefits

  • Bone uptake of 18F NaF is two times higher than for 99mTc medronate3, 5
  • Rapid clearance5 and low protein binding4,5,7
  • High bone to background ratios3,5
  • Shorter study times3,4,5
  • Shorter radiation exposure4


Coverage and reimbursement

18F NaF PET bone scans are covered by the Centers for Medicare and Medicaid Services (CMS), only through the Coverage with Evidence Development program. The 18F NaF National Oncologic PET Registry (NaF NOPR) collects data to determine the impact of NaF PET bone scans on patient management for both Initial and Subsequent Treatment Strategy for suspected or biopsy proven bone metastases. For more information on the NaF NOPR, please visit www.cancerpetregistry.org.6


1 Segall et al, Sodium 18F-Fluoride PET/CT Bone Scans 1.1
2 Even-Sapir, E. Imaging of Malignant Bone Involvement by morphologic, scintigraphic, and hybrid modalities. J Nuc Med 2005; 46:1356-1367.
3 Schirrmeister, H et al. Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography. J Clin Oncol. 1999; 17(8): 2381-2389
4 Frederick, DG et al.  Skeletal PET with 18F-Fluoride: Applying New Technology to an Old Tracer. J Nucl Med 2008; 49:68–78.
5 Even-Sapir, E et al.  The Detection of Bone Metastases in Patients with High-Risk Prostate Cancer: 99mTc-MDP Planar Bone Scintigraphy, Single- and Multi-Field-of-View SPECT, 18F-Fluoride PET, and 18F-Fluoride PET/CT. J Nucl Med 2006; 47:287–297.
6 Medicare Coverage Database - www.cms.gov