Sodium fluoride (NaF) is a bone-seeking positron-emitting tracer with high sensitivity and specificity for detection of osseous lesions, particularly osteolytic lesions. We believe that NaF positron emission tomography (PET)/computed tomography (CT) scans can provide a more thorough and conclusive evaluation of bone diseases than conventional Technetium-99m-methylene diphosphonate bone scans. Understanding both normal and pathologic patterns is important for the evaluation and interpretation of these studies. Thus, an atlas of NaF positron emission tomography/computed tomography bone scans demonstrating benign, pathologic, and malignant osseous lesions as well as extraosseous lesions will be invaluable in the correct interpretation and diagnosis of osseous lesions.
We report the F-FDG PET/CT appearance of a metastatic biopsy-proven malignant fibroxanthoma of the ankle. A 41-year-old female patient with a history of scleroderma presented with a fungating mass in the left ankle. Shave biopsy of the overlying skin showed atypical fibroxanthoma (AFX). Staging FDG PET/CT demonstrated a hypermetabolic exophytic soft tissue mass in the left ankle with local extension to bone and widespread metastatic disease including pulmonary parenchyma, nodes, bone marrow, and skeletal muscle. While rare, knowledge of the potential aggressive nature of AFX is important for accurate diagnosis.
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