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"Skull on Fire": Monostotic Paget Disease of the Skull Bone
Stefan Govers, Friso M van der Zant1, Maurits Wondergem1
1From the Department of Medical Imaging, Nuclear Medicine, Northwest Clinics, Alkmaar.
Abstract:
An 81-year-old woman was evaluated for a stroke. CT showed no intracranial abnormalities but diffuse patchy aspect of the neurocranium. An MRI and F-NA PET/CT were performed to differentiate between metastases, Paget disease, hyperostosis frontalis interna, and primary malignancy. MRI yielded no additional findings. F-NA PET/CT showed diffusely increased uptake in the skull and 4 spots with intense uptake. No other suspicious skeletal foci were seen elsewhere. Low-dose CT showed no sign of malignancy elsewhere. Image findings together with elevated serum alkaline phosphatase levels, slightly increased calcium levels, and normal phosphorus levels were interpreted as pathognomic for monostotic Paget.
Insights
This study highlights a rare case of monostotic Paget disease diagnosed using advanced imaging. Fluorine-18 NaF PET/CT and biochemical markers confirmed the diagnosis in an elderly woman presenting with stroke-like symptoms.
Area of Science:
- Radiology
- Nuclear Medicine
- Oncology
Background:
- Stroke evaluation in elderly patients can reveal incidental skull abnormalities.
- Differential diagnosis of diffuse skull lesions includes metastases, Paget disease, and hyperostosis frontalis interna.
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