Diagnostics of Paget’s disease of bone with X-ray, SPECT/CT, PET/CT and MRI – review of literature Michał M. Skoczylas, Bożena Birkenfeld, Marcin Sawicki, Anna Walecka Pomeranian Medical University in Szczecin, Poland Key words Paget disease, diagnostics, hybrid imaging, radiography, magnetic resonance imaging Conclusions The individual components of the multimodal imaging complement each other and are used for diagnosing and assessement the course of the disease and its treatment. Some examples of the application of the above methods described in the literature also present diagnostic problems, in particular regarding differential diagnosis. Objective Paget’s bone disease can be diagnosed and monitored using several methods including imaging with projectional radiography, single- photon emission computed tomography, positron emission tomography–computed tomography and magnetic resonance imaging. Radiography enables visualization of osteolytic, osteosclerotic or mixed changes in the skull (including mandible and also shading of the paranasal sinuses) and other bones, mainly spine, pelvis and femur. All of these changes together with osteolysis circumscripta should be differentiated with a variety of other lesions characteristic for hyperparathyroidism, inflammation, neoplasms and some types of anemia. Methods The study has a form of review of literature on the topic of diagnostics of Paget disease. Results Magnetic resonance imaging can show bone involvement in wider scope, especially hypervascularity and oedema of bone. Scintigraphy shows increased uptake of the radiotracer in the affected parts of bones with high sensitivity but low specificity. Whole body bone scanning can depict specific problems resulting from disease-related bone involvement, e.g. ocular disorders. The exact location of the radiotracer accumulation can be determined on the basis of SPECT/CT. Additionally PET/CT with different tracer (FDG or F18) enables finding focal changes of the disease but should be differentiated with a variety of other tumors. Even with this method, a false negative result was found in a person with Paget’s disease. Particular attention should be paid to pathological fractures and the development of osteosarcoma, which are possible to observe by all above methods. Bone scan with osteoporosis circumscripta, Paget disease https://radiopaedia.org/cases/os teoporosis-circumscripta-2 X-ray demonstrating osteosarcoma in Paget disease https://radiopaedia.org/cases/os teosarcoma-in-paget-disease Whole body bone scan presenting in axial skeleton and lower limbs bones https://radiopaedia.org/cases/polyostotic-paget-disease

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Page 1: Diagnostics of Paget’s disease of bone with X-ray, SPECT ... · Diagnostics of Paget’s disease of bone with X-ray, SPECT/CT, PET/CT and MRI –review of literature MichałM. Skoczylas,

Diagnostics of Paget’s disease of bone with X-ray, SPECT/CT, PET/CT and MRI– review of literature

Michał M. Skoczylas, Bożena Birkenfeld, Marcin Sawicki, Anna WaleckaPomeranian Medical University in Szczecin, Poland

Key wordsPaget disease, diagnostics, hybrid imaging, radiography, magnetic resonance imaging

ConclusionsThe individual components of the multimodalimaging complement each other and are usedfor diagnosing and assessement the course ofthe disease and its treatment. Some examplesof the application of the above methodsdescribed in the literature also presentdiagnostic problems, in particular regardingdifferential diagnosis.

Objective

Paget’s bone disease can be diagnosed andmonitored using several methods includingimaging with projectional radiography, single-photon emission computed tomography, positronemission tomography–computed tomography andmagnetic resonance imaging. Radiographyenables visualization of osteolytic, osteoscleroticor mixed changes in the skull (including mandibleand also shading of the paranasal sinuses) andother bones, mainly spine, pelvis and femur. All ofthese changes together with osteolysiscircumscripta should be differentiated with avariety of other lesions characteristic forhyperparathyroidism, inflammation, neoplasmsand some types of anemia.

Methods

The study has a form of review of literature on the topic of diagnostics

of Paget disease.

Results

Magnetic resonance imaging can show bone involvement in wider scope, especially hypervascularity and oedema of bone. Scintigraphy shows increased uptake of the

radiotracer in the affected parts of bones with high sensitivity but low specificity. Whole body bone scanning can depict specific problems resulting from disease-related bone

involvement, e.g. ocular disorders. The exact location of the radiotracer accumulation can be determined on the basis of SPECT/CT. Additionally PET/CT with different tracer

(FDG or F18) enables finding focal changes of the disease but should be differentiated with a variety of other tumors. Even with this method, a false negative result was found in

a person with Paget’s disease. Particular attention should be paid to pathological fractures and the development of osteosarcoma, which are possible to observe by all above

methods.

Bone scan with osteoporosis circumscripta, Paget disease

https://radiopaedia.org/cases/osteoporosis-circumscripta-2

X-ray demonstratingosteosarcoma in Paget disease

https://radiopaedia.org/cases/osteosarcoma-in-paget-disease

Whole body bone scan presenting in axial skeleton and lower limbs bones

https://radiopaedia.org/cases/polyostotic-paget-disease