Skeletal scintigraphy has high sensitivity for detecting the increased vascularity and osteoblastic activity characteristic of Paget’s disease. Scintigraphy is not specific however, and the differential diagnosis of Pagetoid lesions can include metastasis, metabolic bone disease, and fibrous dysplasia.

As in this case, the disease is frequently identified because of an elevation in serum alkaline phosphatase, which reflects the extent and the activity of Paget's.