%0 Journal Article
%T Unusual Soft Tissue Uptake of F-18 Sodium Fluoride in Three Patients Undergoing F-18 NaF PET/CT Bone Scans for Prostate Cancer
%A Andrew S. Hawkins
%A Brandon A. Howard
%J Archive of "Nuclear Medicine and Molecular Imaging".
%D 2017
%R 10.1007/s13139-016-0420-2
%X F-18 NaF contrast-enhanced CT (a, d), PET (b, e), and fused PET/CT images (c, f) through the kidneys demonstrate an enhancing, non-calcified NaF avid aortacaval lymph node (long arrow, images a¨Cc) and a less-avidly enhancing NaF avid retrocaval lymph node (long arrow, images d¨Cf) which is separate from physiologic NaF activity seen in the right ureter (short arrow, images d¨Cf; ureteral uptake in (f) is misregistered slightly such that it overlies the psoas muscle). These nodes and NaF avid iliac chain nodes were present in a 71 year old male with a stable prostate cancer metastasis to the acetabulum, not on androgen deprivation therapy, and with slowing rising PSA (10.1 ng/mL at time of the first scan). The nodes¡¯ NaF activity increased on subsequent scans, for example the retrocaval node SUVmax was 7.6 in September 2013 (10.7 mCi F-18 NaF, uptake time 58 min), and SUVmax 12.6 in February 2014 (10.7 mCi F-18 NaF, uptake time 61 min). Both scans were performed according to established guidelines [1]. NaF activity was significantly higher than background blood pool, liver, and spleen activity (SUVmax 1.8, 0.79 and 0.95 respectively) [2]. It is conceivable that malignant infiltration of a lymph node could result in increased NaF deposition due to increased perfusion, as may sometimes be seen with Tc99m methylene diphosphonate bone scans. A follow-up F-18 FDG PET/CT was suggested to assess for hypermetabolic lymph node metastases but was not pursued by the referring oncologist, likely due to patient¡¯s overall clinical stability. Sheth et al. reported NaF uptake in a mediastinal node in a renal cell carcinoma patient and speculated that the etiology may be related to presence of microscopic calcifications [3]. It has been shown that F-18 NaF activity can be elevated in the blood pool and coronary arteries from atherosclerosis and inflammation. However, the true significance of NaF uptake in lymph nodes remains unknown [4
%K F-18 NaF
%K Sodium fluoride
%K PET/CT
%K Soft tissue
%K Prostate cancer
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567614/