18F-NaF uptake in dentomaxillofacial bones as a result of oral alterations: a positron emission tomography/computerized tomography scanning study



18F-NaF is a bone scanning radiotracer that reflects changes in bone metabolism, and it is applied in oncology to scan bone tumors or metastasis. Dentomaxillofacial alterations can lead to 18F-NaF uptake and could lead to false-positive results in PET/CT examinations. Hence, the objective of this research was to verify if the uptake of 18F-NaF in the mandible or maxilla is correlated to the presence of odontogenic alterations, which could lead to false-positive results in positron emission tomography/computerized tomography (PET/CT) examinations.


42 patients who underwent 18F-NaF PET/CT examinations and panoramic radiographs to detect bone metastasis and to assess oral conditions before oncologic treatment were included. Edentulous patients and patients with neoplasms in the maxillofacial area, and those whose imaging examinations had technical failures were excluded from the study.


A total of 252 areas from panoramic radiographs and PET/CT examinations were assessed. It was observed that the presence of periodontal bone loss resulted in a higher number of cases with false negatives. Accuracy, sensitivity, and specificity of 18F-NaF uptake—regardless of the type of odontogenic origin alteration—were 76.2%, 53.3%, and 89.4%, respectively.


18F-NaF uptake in the maxilla or mandible could be influenced by oral alterations in the alveolar bones. The alterations in the oral cavity that lead to 18F-NaF accumulation should be recognized by medical radiologists to prevent false-positive results in PET/CT examinations using the tracer 18F-NaF.

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Correspondence to Luciana Munhoz.

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Conflict of interest

Luciana Munhoz, Mayara Aguilar Dias de Brito, Marcelo Taiti Sapienza and Emiko Saito Arita declares no conflicts of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Ethics approval was obtained obtained in the Ethics Committee of Dentistry and Medical School (number 1641/2020), and the Declaration of Helsinki guidelines were followed in this investigation.

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Munhoz, L., de Brito, M.A.D., Arita, E.S. et al. 18F-NaF uptake in dentomaxillofacial bones as a result of oral alterations: a positron emission tomography/computerized tomography scanning study. Oral Radiol (2021). https://doi.org/10.1007/s11282-020-00509-z

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  • Oral diagnosis
  • Oral imaging
  • Radioactive tracers
  • Fluoride radioisotopes
  • Panoramic radiograph
  • Positron emission tomography/computed tomography