NM injection: tracer injection in left antecubital fossa.
NM bone whole body :
There is intense tracer uptake in the skull, upper thoracic and upper lumbar spine, medial left clavicle, left lower rib cage and left humeral head: glenoid; and relatively mild diffuse increased tracer uptake in the remaining skeleton. Intense bone activity results in a lack of excreted activity in the kidneys and bladder.
SPECT-CT skull shows heterogeneous intense tracer uptake in the skull associated with mixed sclerosis and lucent areas, and patchy ground glass changes.
SPECT-CT thoracic and lumbar spine shows widespread mixed sclerotic and lucent areas and increase trabeculation in the spine, scapulae, humeri, clavicles, sternum and pelvic bones. Intense bone tracer activity as in the above whole body scan.
Marked scoliosis noted.
Conclusions:
Very unusual case. Although the age and sex demographics are unusual, the radiological findings are more in keeping with Paget disease with polyostotic fibrous dysplasias less likely.