Paget Disease

Abstract

We present a case of an 81-year-old man with multifocal Paget disease found on bone scan that was performed for incidentally diagnosed prostate cancer. The subsequent Ga-PSMA (HBED-CC) PET scan also displayed increased uptake in the same distribution. Multiple known tumors display increased Ga-PSMA uptake due to neovasculature. We postulate that increased Ga-PSMA uptake within the pagetoid bone relates to neovascularity known to occur in Paget disease. Such pagetic uptake could result in false-positive studies for bone metastases, particularly in the setting of less typical Paget disease.

18F-PSMA-1007 Uptake in Paget Disease of the Bone: An “Iron Man” Sign

“…In literature, diffuse variable PSMA uptake has been reported in Paget disease of the bone 7,8 . The mechanism of uptake in pagetoid bone is related to endothelial expression of PSMA in neovasculature and increased uptake driven by hyperemia 9 . Correlative CT finding are important for the correct diagnosis that includes diffuse sclerosis, thickened cortex, bone expansion, and coarsened trabeculae.…”

“…7,8 The mechanism of uptake in pagetoid bone is related to endothelial expression of PSMA in neovasculature and increased uptake driven by hyperemia. 9 Correlative CT finding are important for the correct diagnosis that includes diffuse sclerosis, thickened cortex, bone expansion, and coarsened trabeculae. PSMA uptake in the Paget disease is very common and should kept in consideration while reporting 18 F-PSMA PET/CT with prostate cancer to avoid potential pitfall.…”