Detection of Paget´s disease during labeled leukocytes scintigraphy – case report

Czech version

Authors: I. Štufková ¹; L. Fil ¹; O. Lang ^1,2
Authors‘ workplace: Oddělení nukleární medicíny, Oblastní nemocnice Příbram, a. s., Příbram, ČR ¹; Klinika nukleární medicíny, 3. LF UK a FNKV, Praha 10, ČR ²
Published in: NuklMed 2018;7:68-73
Category: Casuistry

Overview

Aim:

To present an incidental detection of Paget´s disease on a leukocytes scan indicated for a detection of inflammation because of repeated increase of inflammatory markers with arthralgia.

Case report:

60y-old female was sent to leukocytes scintigraphy to exclude an infective focus. She had a long lasting arthritis of small and large joints with a persistent elevation of inflammatory markers. Reactive arthritis caused by infective focus was considered. Neither focal increase in soft tissue nor in painful joints was detected during the scan (¹¹¹In-labeled leukocytes), instead, the defect in accumulation was clearly displayed in the left hemi pelvis. Added three-phase bone scan revealed increased blood flow, blood-pool as well as late accumulation of ^99mTc-HDP at this location. Low-dose CT as a part of SPECT/CT imaging and supplementary X-ray displayed diffusely increased bone density with a widening of iliac bone. Paget´s disease was finally confirmed based on these findings together with biochemical markers of increased bone turnover.

Conclusion:

We present a case of labeled leukocytes accumulation defect in the left hemi pelvis caused by Paget´s disease. We recommend to consider this disease at the differential diagnosis of leukocytes accumulation defect in axial bones except of osteomyelitis or malignant disease.

Key words:

Paget´s disease, ¹¹¹In-labeled leukocytes defect, axial bones

Sources

Klener P. Vnitřní lékařství, 1. vydání, Galén a Karolinum, Praha 1999, 949 stran
Vallet M, Ralston SH. Biology and Treatment of Paget´s Disease of Bone. J. Cell. Biochem. 2016;117:289–299
Langston AL, Campbell MK, Fraser WD, et al. Clinical determinants of quality of life in Paget´s disease of bone. Calcif Tissue Int 2007;80:1–9
Mays S. Archaeological skeletons support a northwest european origin for Paget´s disease of bone. J Bone Miner Res 2010;25:1839–1841
Van Staa TP, Selby P, Leufkens HG, et al. Incidence and natural history of Paget´s disease of bone in England and Wales. J Bone Miner Res 2002;17:465–471
Tan A, Ralston SH. Clinical presentation of Paget´s disease: Evaluation of a contemporary cohort and systematic review. Calcif Tissue Int 2014;95:385–392
Thakur ML, Lavender JP, Arnot RN, et al. Indium-111-labeled autologous leukocytes in man. J Nucl Med 1977;18:1012-1019
Palestro CJ. Radionuclide Imaging of Musculoskeletal Infection: A Review. J Nucl Med 2016; 57:1406–1412
Palestro CJ, Love C, Bhargava KK. Labeled leukocyte imaging: current status and future directions. Q J Nucl Med Mol Imaging. 2009;53:105–123
Palestro CJ, Kim CK, Swyer AJ, et al. Radionucide Diagnosis of Vertebral Osteomyelitis: Indium-111-Leukocyte and Technetium-99m-Methylene Diphosphonate Bone Scintigraphy. J NucIMed 1991;32:1861-1865
Elgazzar AH, Dannoon S, Sarikaya I et al. Scintigraphic Patterns of Indium-111 Oxine-Labeled White Blood Cell Imaging of Gram-Negative versus Gram-Positive Vertebral Osteomyelitis. Med Princ Pract 2017;26:415–420
Dunn EK, Vaquer RA, Strashun AM. Paget´s Disease: A cause of photopenic skeletal defect in indium-111 WBC scintigraphy. J Nucl Med 1988; 29: 561-563
Datz FL, Throne DA. Cause and significance of cold bone defects on indium-111 labeled leukocyte imaging. J Nucl Med 1987; 28: 820-823
Mok YP, Carney WH, Fernandez-Ulloa M. Skeletal photopenic lesions in In-111 WBC imaging. J Nucl Med 1984; 25:1322-1326
Borin BF, Abghari R, Sarkissian A. Skeletal photopenic appearance of Paget´s disease with Indimum-111 white blood cell imaging. Clin Nucl Med 1987;12:783-784
Elgazzar AH, Yeung HW, Webner PJ. Indium-111-Leukocyte and Technetium-99m-Sulfur Colloid Uptake in Paget‘s Disease. J Nucl Med 1996;37:858-861
Bertoldi I, Cantarini L, Filippou G, et al. Paget’s disease. Reumatismo, 2014; 66:171-183
Fogelman I, Coffier BD, Brown ML. Bone Scintigraphy: Part 3. Bone Scanning in Metabolic Bone Disease. J Nuci Med 1993;34:2247-2252

Labels

Nuclear medicine Radiodiagnostics Radiotherapy

Assessment of ¹¹C-methionine for PET/CT examination of patients with a brain tumor – group of 16 patients

Central venous catheter mimicking metastasis on a bone scan – advantage of a hybrid imaging

Article was published in

Nuclear Medicine

2018 Issue 4