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Vanishing Bone Metastases in 18F-FDG PET/CT
Alida Ainouche1, David Morland, Carole Durot2
1From the Service de Médecine Nucléaire, Institut Jean Godinot.
Clinical Nuclear Medicine
|May 21, 2020
Summary
Sclerotic bone lesions in a lymphoma patient were initially suspected as metastases. However, further review revealed they were caused by abnormal contrast filling, not actual bone metastases.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- A 36-year-old woman with a history of large B-cell lymphoma presented with concerning sclerotic bone lesions.
- These lesions were identified on a contrast-enhanced CT scan of the thoracic vertebrae.
Observation:
- Fluorodeoxyglucose-positron emission tomography (F-FDG PET) revealed no abnormal uptake in the affected vertebrae.
- Coupled unenhanced CT showed normal vertebral density, questioning the metastatic nature of the lesions.
- A critical re-evaluation of the contrast-enhanced CT identified left brachiocephalic vein stenosis.
Findings:
- The vein stenosis caused retrograde contrast material flow into the accessory hemiazygos vein.
- This abnormal flow pattern led to contrast filling within the vertebral capillary spaces.
- The contrast enhancement mimicked the appearance of sclerotic bone metastases.
Implications:
- This case highlights the importance of comprehensive image review and understanding vascular anatomy.
- It demonstrates a rare pseudo-metastatic finding that can be mistaken for true bone metastases.
- Accurate differentiation is crucial for appropriate patient management and avoiding unnecessary oncological treatment.
