"T1: decreased signal intensity, isointense to muscle, with interspersed foci of normal signal representing maintained yellow marrow (usable criterion to exclude malignant transformation)"
"T2: high intensity changes, heterogeneous and of "speckled" appearance, possibly presenting fibrovascular marrow changes"
"C+ (Gd): enhancement, typically of "speckled" appearance, may be present, indicating increased blood flow in the metabolically active sites"
"As Paget disease most often presents as a continuum rather than distinct phase, sclerotic areas of the blastic (mixed) phase may be more readily detected. They usually present as cortical and trabecular thickening in a disorganised pattern without bony destruction. "
"Typical bone marrow changes in the incipient-active to early mixed phase show heterogenous signal on both T1 and T2-weighted imaging 3:"
"Non-FDG PET-CT (F18-NaF)"
"FDG PET-CT"
"Early phase Paget disease of the skull usually lacks FDG-avidity 4. Encountering a lytic bone lesion (also resembling osteolysis circumscripta) in oncological patients may pose a differential diagnostic dilemma. Finding normal FDG-metabolism may aid in the diagnosis of benign Paget disease and obviate the need for biopsy 5."
"Early phase Paget disease of the skull usually lacks FDG-avidity 4. Encountering a lytic bone lesion (also resembling osteolysis circumscripta) in oncological patients may pose a differential diagnostic dilemma. Finding normal FDG-metabolism may aid in the diagnosis of benign Paget disease and obviate the need for biopsy 5."
"Owing to higher bone uptake of this tracer combined with superior imaging quality (higher signal-to-noise ratio SNR due to faster blood clearance, higher spatial resolution of PET) compared to SPECT (see above), intensity of uptake is even higher and polyostotic disease may be even more evident 5,7."
Expected headings
"SPECT-CT"
"T2: high intensity changes, heterogeneous and of "speckled" appearance, possibly presenting fibrovascular marrow changes"