18F sodium fluoride PET/CT detects osseous metastases from breast cancer missed on FDG PET/CT with marrow rebound.

Intense FDG uptake by bone marrow following recent chemotherapy limits evaluation for osseous metastases. The impact of marrow rebound on accuracy of (18)F-fluoride PET/CT is unclear. A 73-year-old woman with breast cancer presented for restaging FDG PET/CT, which showed intense activity throughout almost the entire axial skeleton and no osseous metastases. An (18)F-fluoride PET/CT performed 7 days later identified multiple osseous metastases in the spine, ribs, and pelvis. This case demonstrates that (18)F-fluoride PET/CT should be considered for the evaluation of osseous metastases in patients with rebound marrow uptake on FDG PET/CT.