Novel Musculoskeletal and Orthopedic Applications of 18F-Sodium Fluoride PET

Infection Osteoporosis Osteosarcoma KEY POINTS18 F-sodium fluoride (NaF) PET can detect causes of bone pain and traumatic injuries that cannot be successfully visualized by other modalities such as radiography, bone scintigraphy, computed tomography, and magnetic resonance.Thus, NaF-PET may contribute to the assessment of occult fractures, child abuse, and stress-related injuries.NaF-PET is an excellent modality to assess osteoarthritis, ankylosing spondylitis, and temporomandibular joint dysfunction.More studies are needed to determine its potential role in inflammatory arthropathies such as rheumatoid arthritis and psoriatic arthritis.Complications of orthopedic surgery such as hardware loosening and infection are readily visualized by NaF-PET.Heterotopic ossification after surgery is another possible imaging target that requires further exploration.Metabolic bone diseases such as osteoporosis and Paget disease can be evaluated over time with NaF-PET to determine effects of pharmacologic interventions such as bisphosphonates and teriparatide.NaF-PET may have a role in assessing primary bone tumors such as osteosarcoma, helping to determine response to treatment and guiding patient management decisions.