Paget's disease in the hand: correlation of magnetic resonance imaging with histology

A 62-year-old white woman was seen initially with a 4-month history of swelling over the dorsum of her wrist and thumb pain at the basal joint. Radiographs revealed pantrapezial arthritis and a marked increase in the radiodensity of the capitate. Tomograms showed slight enlargement of the capitate, and magnetic resonance imaging revealed a dramatic decrease in the signal intensity on T1- and T2-weighted images. A biopsy of the capitate was done at the time of thumb carpometacarpal joint arthroplasty. Active Paget's disease was diagnosed. It is postulated that loss of marrow fat in active Paget's disease decreased the T1- and T2-weighted signals in a manner similar to processes, such as Gaucher's disease and osteonecrosis.