18 F-NaF PET/CT Imaging of Brain Metastases Matteo Salgarello, PhD,* Gianluigi Lunardi, PharmD,† Alessandro Inno, PhD,† Stefano Pasetto, MPD,‡ Fabrizia Severi, MPD,‡ Giancarlo Gorgoni, PharmD,§ and Stefania Gori, MD† Abstract: 18 F-NaF is a radiopharmaceutical widely used in PET imaging to detect bone metastases. Several cases of 18 F-NaF uptake from brain me- tastases have been described, but a specific protocol for the evaluation of brain metastases with 18 F-NaF has not been developed yet. Here we report images of 18 F-NaF PET/CT, standard CT, and MRI of a brain metastasis in a patient with non–small lung cancer. Through a dynamic acquisition procedure, we have identified the first minutes after injection as the pref- erable time point of imaging acquisition for the study of brain metastases with 18 F-NaF. Key Words: 18 F-NaF, PET, brain metastasis (Clin Nucl Med 2016;41: 564–565) REFERENCES 1. Bastawrous S, Bhargava P, Behnia F, et al. Newer PET application with an old tracer: role of 18 F-NaF skeletal PET/CT in oncologic practice. Radiographics. 2014;34:1295–1316. 2. Segall G, Delbeke D, Stabin MG, et al. SNM practice guideline for sodium 18 F-fluoride PET/CT bone scans 1.0. J Nucl Med. 2010;51:1813–1820. 3. Tripathi M, Jaimini A, Singh N, et al. F-18 flurodeoxyglucose negative, F-18 fluoride accumulating in a brain metastasis in a treated case of carci- noma of the breast. Clin Nucl Med. 2009;34:287–289. 4. Li Y, Tafti BA, Shaba W, et al. Extraosseus uptake of F-18 fluoride in the primary malignancy and cerebral metastasis in a case of non-small-cell lung cancer. Clin Nucl Med. 2011;36:609–611. 5. Wu J, Zhu H, Ji H. Unexpected detection of brain metastases by 18 F-NaF PET/CT in a patient with lung cancer. Clin Nucl Med. 2013;38:e429–e432. 6. Jones RP, Iagaru A. 18 F NaF brain metastasis uptake in a patient with mela- noma. Clin Nucl Med. 2014;39:e448–e450. 7. Gori S, Inno A, Lunardi G, et al. 18 F-sodium fluoride PET-CT for the assess- ment of brain metastasis from lung adenocarcinoma. J Thorac Oncol. 2015; 10:e67–e68. 8. Fortin D. The blood-brain barrier: its influence in the treatment of brain tumors metastases. Curr Cancer Drug Targets. 2012;12:247–259. Received for publication August 10, 2015; revision accepted January 5, 2016. From the Departments of *Nuclear Medicine, †Medical Oncology, ‡Medical Physics, and §Radiopharmacy, Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy. Conflicts of interest and sources of funding: none declared. The study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants involved in the study. Correspondence to: Gianluigi Lunardi, PharmD, Department of Medical Oncology, Sacro Cuore Don Calabria Hospital, Via Don Sempreboni, 5 37024 Negrar, Verona, Italy. E-mail: gianluigi.lunardi@sacrocuore.it. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/16/4107–0564 DOI: 10.1097/RLU.0000000000001186 INTERESTING IMAGE 564 www.nuclearmed.com Clinical Nuclear Medicine • Volume 41, Number 7, July 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.