We prospectively evaluated the use of combined 18 F-NaF/ 18 F-FDG PET/CT in patients with breast and prostate cancer and compared the results with those for 99m Tc-MDP bone scintigraphy and whole-body MRI. Methods: Thirty patients (15 women with breast cancer and 15 men with prostate cancer) referred for standard-ofcare bone scintigraphy were prospectively enrolled in this study. 18 F-NaF/ 18 F-FDG PET/CT and whole-body MRI were performed after bone scintigraphy. The whole-body MRI protocol consisted of both unenhanced and contrast-enhanced sequences. Lesions detected with each test were tabulated, and the results were compared. Results: For extraskeletal lesions, 18 F-NaF/ 18 F-FDG PET/CT and whole-body MRI had no statistically significant differences in sensitivity (92.9% vs. 92.9%, P 5 1.00), positive predictive value (81.3% vs. 86.7%, P 5 0.68), or accuracy (76.5% vs. 82.4%, P 5 0.56). However, 18 F-NaF/ 18 F-FDG PET/CT showed significantly higher sensitivity and accuracy than whole-body MRI (96.2% vs. 81.4%, P , 0.001, 89.8% vs. 74.7%, P 5 0.01) and bone scintigraphy (96.2% vs. 64.6%, P , 0.001, 89.8% vs. 65.9%, P , 0.001) for the detection of skeletal lesions. Overall, 18 F-NaF/ 18 F-FDG PET/CT showed higher sensitivity and accuracy than whole-body MRI (95.7% vs. 83.3%, P , 0.002, 87.6% vs. 76.0%, P , 0.02) but not statistically significantly so when compared with a combination of whole-body MRI and bone scintigraphy (95.7% vs. 91.6%, P 5 0.17, 87.6% vs. 83.0%, P 5 0.53). 18 F-NaF/ 18 F-FDG PET/CT showed no significant difference from a combination of 18 F-NaF/ 18 F-FDG PET/ CT and whole-body MRI. No statistically significant differences in positive predictive value were noted among the 3 examinations. Conclusion: 18 F-NaF/ 18 F-FDG PET/CT is superior to whole-body MRI and 99m Tc-MDP scintigraphy for evaluation of skeletal disease extent. Further, 18 F-NaF/ 18 F-FDG PET/CT and whole-body MRI detected extraskeletal disease that may change the management of these patients. 18 F-NaF/ 18 F-FDG PET/CT provides diagnostic ability similar to that of a combination of whole-body MRI and bone scintigraphy in patients with breast and prostate cancer. Larger cohorts are needed to confirm these preliminary findings, ideally using the newly introduced simultaneous PET/MRI scanners.

Ga-DOTA TATE uptake in normal and abnormal structures is highly variable in patients with NET. SUV is a useful measure for characterizing benign versus malignant lesions. Anatomical and clinical correlation may be necessary to characterize foci of intermediate uptake.

The biodistribution of (18)F-FPPRGD2 in cancer patients is similar to that of other RGD dimer peptides and it is suitable for clinical use. The lack of significant correlation between (18)F-FPPRGD2 and (18)F-FDG uptake confirms that the information provided by each PET tracer is different.

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The superior timing resolution and resulting TOF capability of the new PET/MRI scanner improved PET image quality in this cohort by reducing artifacts compared to non-TOF PET/MRI, TOF PET/CT, and non-TOF PET/CT.