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

Objectives 18 F-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 18 F-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 18 F-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. Methods 42 patients who underwent 18 F-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. Results 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 18 F-NaF uptake—regardless of the type of odontogenic origin alteration—were 76.2%, 53.3%, and 89.4%, respectively. Conclusion 18 F-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 18 F-NaF accumulation should be recognized by medical radiologists to prevent false-positive results in PET/CT examinations using the tracer 18 F-NaF.