Presentation
Raised ALP with predominantly bone isoenzyme ?cause
Patient Data
On early phase blood pool imaging, there is hypervascularity of the entire left hemipelvis.
On delayed phase imaging, there is moderate to intense heterogenous increased tracer uptake throughout the entire left hemipelvis. On low-dose CT, the hemipelvis demonstrates cortical thickening and coarsened trabeculation. Findings are consistent with Paget disease.
Mild-moderately increased periarticular uptake at the right acromioclavicular joint, sternoclavicular joints and the knees consistent with osteoarthritis.
Case Discussion
Nuclear medicine bone scan is sensitive for the detection of active Paget disease, which typically demonstrates hypervascularity on early phase imaging and increased tracer distribution on the delayed phase. Bone scan served as a useful screening test in this patient with elevated ALP to determine the cause of the abnormality.
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