Dual-tracer imaging of malignant bone involvement using PET

Despite widespread use of PET/CT in oncological imaging, bone scintigraphy has remained the mainstay of imaging osseous involvement in certain malignancies such as advanced breast cancer. Osseous lesions and particularly blastic metastases may have low or variable uptake on 18F-FDG PET. 18F-fluoride PET has higher sensitivity and superior resolution and specificity compared to bone scintigraphy, but the associated cost has hindered its clinical application. Dual-tracer imaging using combined 18F-fluoride and 18F-FDG is an alternative cost-effective approach for imaging both osseous and extra-osseous involvement using PET/CT as a single PET/CT examination. Here, we discuss the technical aspects and clinical applications of combined 18F-fluoride and 18F-FDG PET/CT and review the data regarding feasibility and validation for this approach and it’s potential for improving patient care. © 2015, Italian Association of Nuclear Medicine and Molecular Imaging.