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

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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.

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