Paget disease

Case contributed by Dr Christopher Chen

Presentation

Low back pain. Elevated alkaline phosphatase.

Patient Data

Age: 70 years
Gender: Male
ct

L4 vertebral body (first vertebrae on scroll) has cortical and trabecular thickening. The right ilium adjacent to the sacroiliac joint and sacrum has coarsened trabecular markings and subtle bony expansion. Sacroiliac joint space narrowing. Partial ankylosis of the right anterior sacroiliac joint. 

Nuclear medicine

Image 1 and 2: Mild hyperemia over the L4 vertebral body, right sacral ala and right ilium adjacent to the sacroiliac joint. 

Image 3: Focal intense uptake centered on the L4 vertebral body. Increased tracer activity in the sacrum and right ilium adjacent to the sacroiliac joint. Mild activity in the right mandible likely from an odontogenic process. Degenerative arthopathy in bilateral sternoclavicular joints. 

Case Discussion

The combination of early hyperemia and intense uptake on the delayed images in the same locations is consistent with active Paget's disease. There is increased radiotracer uptake in all phases of the disease except sometimes in the late sclerotic stage. 

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