Therapy-induced bone changes in oncology imaging with ¹⁸F-sodium fluoride (NaF) PET-CT

¹⁸F-Sodium fluoride (¹⁸F-NaF) is a PET tracer that is mostly used in the evaluation of bone metastasis in oncology cases. Recently, ¹⁸F-NaF PET/CT is gaining wide popularity owing to its higher sensitivity over the other conventional bone tracer with higher and rapid single-pass extraction, negligible plasma protein binding, rapid blood, and renal clearance. In the era of constant evolution of cancer therapy regimens, considerable bone health impact is seen in the form of avascular necrosis, insufficiency fractures, among others. A significant number of these therapy-induced changes show high bone turnover and thereby ¹⁸F-NaF accumulation, mimicking metastatic lesions. This article summarizes and illustrates the pattern and morphological features of ¹⁸F-NaF PET/CT findings in these changes in the context of clinical and therapeutic history.