Physician Home | Clinical Data | PET Case Studies | Breast Cancer | Case #19

History
Patient presents with increasing back pain 2 weeks post fall. Whole body planar bone imaging performed.

Tc-99m MDP Bone Scan Results
Abnormal activity at L2 vertebral body. Possible metastasis versus post-traumatic fracture. Correlation with MRI recommended. Minimal focal activity in the left 7th rib suspicious for metastatic disease versus trauma. Degenerative changes in the bilateral acromeoclavicular and glenohumeral regions.

MRI Results
MRI of the lumbar spine is suspicious for possible bone marrow metastases. FDG PET scan ordered for restaging prior to treatment planning.

FDG PET Scan Results
No evidence of abnormality. (Since FDG imaging can be negative in sclerotic bone lesions, further evaluation with Na¹⁸F was recommended.) Na¹⁸F PET Scan ordered to confirm the presence and extent of bone marrow metastasis prior to treatment planning.

Na¹⁸F PET Scan Bone Results
Abnormal uptake consistent with metastatic disease in the vertebral body of L2. Additional foci noted in vertebral bodies L3, L5, superior and plate of L4 and right transverse process of L3 consistent wtih metastatic disease. Innumerable lesions are identified in the pelvis that are only appreciated in retrospect on CT. Focal uptake in left 7th rib and right glenoid consistent with metastatic disease. Additional focus of activity seen in the proximal metaphysis of right femur that is faintly visualized, if at all, on the bone scan.

Change in Patient Management
Patient received appropriate treatment with systemic therapy after accurate identification of the presence and extent of bone disease.

Courtesy of
David Haseley, MD & Gustavo Mercier, MD, Seattle Nuclear Medicine, Seattle, Washington