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F18 NaF bone scan rib fracture uptake in breast cancer



60 year old lady with a history of right breast cancer status post right brea1st lumpectomy, chemotherapy, radiotherapy and Femara.  What is the most likely cause of the uptake in the ribs on this F18 NaF bone scan?


New abnormal tracer uptake is seen at the anterior ends of the right 7th and left 9th ribs. 


F18 NaF bone scan rib fracture uptake in breast cancer


NaF PET/CT is superior to Tc-99m MDP planar imaging.  Clinical history is important for accurate image interpretation. Correlative imaging where available is often helpful. Clinical examination if possible may also contribute to accurate interpretation. In this case note the fracture on CT images that corresponds to the tracer uptake.


Metastases, fractures, prmary bone malignancy, infection, fibrous dysplasia, rare osteoid osteoma


AJR Am J Roentgenol. 2009 Jul;193(1):5-13. CT of rib lesions. Levine BD et al. 

Radiographics. 2010 May;30(3):737-49. Radiologic diagnosis of osteoid osteoma: from simple to challenging findings. Chai JW et al.

J Nucl Med. 2015 Dec;56(12):1862-8. Prospective Comparison of 99mTc-MDP Scintigraphy, Combined 18F-NaF and 18F-FDG PET/CT, and Whole-Body MRI in Patients with Breast and Prostate Cancer. Minamimoto R et al.

Radiographics. 1999 Sep-Oct;19(5):1125-42. Keep your eyes on the ribs: the spectrum of normal variants and diseases that involve the ribs. Guttentag AR et al.

F18 NaF bone scan rib fracture uptake in breast cancer F18 NaF PET, CT and fused.

F18 NaF PET, CT and fused.


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