The clover and heart signs in vertebral scintigraphic images are highly specific of Paget's disease of bone

Rotés-Sala, D; Monfort, Jordi; Solano, A.; Miralles, E. Martínez; Vila, Judith R.; Carbonell, Jordi

doi:10.1016/j.bone.2003.10.014

Cited by 18 publications

(7 citation statements)

References 2 publications

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“…In certain sites the scintigraphic features of PDB are highly specific. These are “clover” or “mickey mouse sign” and the “heart sign” when PDB affects the spine (72,73). This observation can be of value in the differential diagnosis with vertebral metastases but false positive results have been described (74).…”

Section: Results and Recommendationsmentioning

confidence: 99%

“…These are "clover" or "mickey mouse sign" and the "heart sign" when PDB affects the spine. (72,73) This observation can be of value in the differential diagnosis with vertebral metastases but falsepositive results have been described. (74) Several investigators have compared the performance of bone scanning with plain X-rays in the evaluation of PDB.…”

Section: Radionuclide Bone Scintigraphymentioning

confidence: 97%

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Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Ralston

Corral‐Gudino

Cooper

et al. 2019

Journal of Bone and Mineral Research

117

137

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An evidence based clinical guideline for the diagnosis and management of Paget’s disease of Bone (PDB) was developed using GRADE methodology, by a Guideline Development Group (GDG) led by the Paget’s Association (UK). A systematic review of diagnostic tests, pharmacological and non-pharmacological treatment options was conducted which sought to address several key questions of clinical relevance. Twelve recommendations and five conditional recommendations were made but there was insufficient evidence to address eight of the questions posed. The following recommendations were identified as the most important. Radionuclide bone scans, in addition to targeted radiographs, are recommended as a means of fully and accurately defining the extent of the metabolically active disease in patients with PDB.Serum total alkaline phosphatase (ALP) is recommended as a first line biochemical screening test in combination with liver function tests in screening for the presence of metabolically active PDB.Bisphosphonates are recommended for the treatment of bone pain associated with Paget’s disease. Zoledronic acid is recommended as the bisphosphonate most likely to give a favourable pain response.Treatment aimed at improving symptoms is recommended over a treat-to-target strategy aimed at normalising total ALP in PDB.Total hip or knee replacements are recommended for patients with PDB who develop osteoarthritis in whom medical treatment is inadequate. There is insufficient information to recommend one type of surgical approach over another. The guideline was endorsed by the European Calcified Tissues Society, the International Osteoporosis Foundation, the American Society of Bone and Mineral Research, the Bone research Society (UK) and the British Geriatric Society. The GDG noted that there had been a lack of research on patient-focused clinical outcomes in PDB and identified several areas where further research was needed.

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Section: Results and Recommendationsmentioning

confidence: 99%

Section: Radionuclide Bone Scintigraphymentioning

confidence: 97%

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Ralston

Corral‐Gudino

Cooper

et al. 2019

Journal of Bone and Mineral Research

117

137

View full text Add to dashboard Cite

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“…Scintigraphy demonstrates increased uptake in all the affected vertebral components [46, 47] because of its sensitivity to osteoblastic activity and can be very useful in showing activity in the posterior neural arch. As a whole body imaging modality, it also provides information about the overall distribution of the disease.…”

Section: Imaging Manifestationsmentioning

confidence: 99%

“…However, increased activity on bone scintigraphy is usually non-specific and requires comparison with radiographs/CT. Various patterns of uptake are described on bone scintigraphy in PD [21, 46, 48, 49], all of which are non-specific.…”

Section: Imaging Manifestationsmentioning

confidence: 99%

The spine in Paget’s disease

et al. 2007

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Paget's disease (PD) is a chronic metabolically active bone disease, characterized by a disturbance in bone modelling and remodelling due to an increase in osteoblastic and osteoclastic activity. The vertebra is the second most commonly affected site. This article reviews the various spinal pathomechanisms and osseous dynamics involved in producing the varied imaging appearances and their clinical relevance. Advanced imaging of osseous, articular and bone marrow manifestations of PD in all the vertebral components are presented. Pagetic changes often result in clinical symptoms including back pain, spinal stenosis and neural dysfunction. Various pathological complications due to PD involvement result in these clinical symptoms. Recognition of the imaging manifestations of spinal PD and the potential complications that cause the clinical symptoms enables accurate assessment of patients prior to appropriate management.

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“…Two distinct pathognomic vertebral bone scan images are highly specific for PD. One is the "clover" image, affecting both vertebral pedicles and the spinous process and the other is the "heart" image, affecting the vertebral body and the spinous process 7,10,12) . Previously reported specificity of these images for vertebral Paget's disease diagnosis is 100%.…”

Section: Discussionmentioning

confidence: 99%

Monostotic Paget's Disease of the Lumbar Spine Mimicking Vertebral Metastasis: A Case Report

2011

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Paget's disease of the bone is the second-most-common metabolic bone disease. However, it is rarely found in the Far East. Vertebral Paget's disease usually occurs at multiple vertebral levels, with less than 20% of vertebral Paget's disease being monostotic. Here, we present a rare case of monostotic vertebral Paget's disease, which we initially misdiagnosed as a spinal metastasis. A 34-year-old man was admitted with a one-month history of lower back pain. Initially, computed tomography of the lumbar spine showed an osteolytic change of the L4 and mild expansion of the L4 vertebral body. Subsequently, magnetic resonance imaging showed a highly homogenously enhanced L4 vertebral body. We performed positron-emission tomography, bone scan, and tumor marker evaluation. However, we could not detect any likely primary origin of the spinal metastasis. Therefore, we carried out a needle bone biopsy under fluoroscopic guidance, and the bone specimen revealed Paget's disease of the bone.

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The clover and heart signs in vertebral scintigraphic images are highly specific of Paget's disease of bone

Cited by 18 publications

References 2 publications

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

Diagnosis and Management of Paget's Disease of Bone in Adults: A Clinical Guideline

The spine in Paget’s disease

Monostotic Paget's Disease of the Lumbar Spine Mimicking Vertebral Metastasis: A Case Report

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