Detection of occult bone metastases can be critical in determining the management of patients with renal cell carcinoma, especially when standard of care imaging techniques test negative.

18F-NaF PET/CT is significantly more sensitive at detecting renal cell carcinoma (RCC) skeletal metastases than conventional than bone scintigraphy or computed tomography (CT), according to an article published online ahead of print in the Annals of Oncology.

Researchers assessed the sensitivity of 18F-labelled sodium fluoride in conjunction with positron emission tomography/computed tomography (18F-NaF PET/CT) for detecting bone metastases compared to imaging with bone scinigraphy or CT.

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They used an adaptive two-stage trial design, which was stopped after the first stage because of statistical efficacy.

Ten patients with stage 4 RCC and bone metastases were imaged with 18F-NaF PET/CT and 99mTc-labelled methylene diphosphonate (99mTc-MDP) bone scintigraphy, including pelvic single photon (SPECT).

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A total of 77 lesions were diagnosed as malignant: 100% were identified by 18F-NaF PET/CT, 46% by CT, and 28% by bone scintigraphy/SPECT.

Standard-of-care imaging with CT and bone scintigraphy identified 65% of the metastases reported by 18F-NaF PET/CT.


  1. Gerety EL, Lawrence EM, Wason J, et al. Prospective study evaluating the relative sensitivity of 18F-NaF PET/CT for detecting skeletal metastases from renal cell carcinoma in comparison to multidetector CT and 99mTc-MDP bone scintigraphy, using an adaptive trial design. Annals of Oncol. 2015. [epub ahead of print]. doi: 10.1093/annonc/mdv289.