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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 999-100
All that avid calvarial uptake need not be pathological


Department of Nuclear Medicine, Nizam's Institute of Medical Sciences , Hyderabad, 500082, India

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How to cite this article:
Rao V, Sudhakar P, Naryan M L, Venugopal N. All that avid calvarial uptake need not be pathological. Indian J Radiol Imaging 2006;16:999

How to cite this URL:
Rao V, Sudhakar P, Naryan M L, Venugopal N. All that avid calvarial uptake need not be pathological. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Jan 19];16:999. Available from: http://www.ijri.org/text.asp?2006/16/4/999/32416
Sir,

Very often patients of primary malignancy during the workup for skeletal metastasis, are found to have a diffuse and intense uptake in the calvarium on Tc 99m MDP Bone Scan. This would throw a strong doubt in the mind of it being metastasis, however plain radiograph skull correlation would put the doubt to rest.

A fifty six year old woman of carcinoma endometrium was referred for radionuclide skeletal scintigraphy during routine follows up. Skeletal scintigraphy was performed with Tc 99m Methylene Diphosphonate and whole body survey done in anterior and posterior projections 3 hrs after the injection. Scan showed a diffuse and avid uptake in the calvarium encompassing both frontal bones except the midline, rest of the skeleton did not show any abnormal uptake to suggest skeletal metastasis (fig.1).

In a known case of primary malignancy the abnormal calvarial uptake on skeletal scintigraphy would be construed as metastasis or, an incidental Paget's disease[1],[2].

However involvement of both frontal bones with photpaenic separation in the midline gives a clue to it being a benign condition "Hyperostosis Frontalis Interna "[3]. Plain radiography of the skull confirms the diagnosis with the classical features of diffuse nodular thickening of the inner table of the frontal bones projecting inside the skull and classically sparing of the midline (fig.2)

An abnormal looking finding on imaging either radio nuclide or radiological is a common occurrence during workup of patients. Despite the clinical background of an existing malignancy and the pretest probability of skeletal metastasis being high, all avid lesions on Tc 99 m MDP bone scans need not be labeled as metastasis [4]. Proper clinical and simple radiographic correlation confirms the exact nature of the abnormality without having to subject the patients for further unnecessary, and costly investigations.

 
   References Top

1.Wellman HN , Schauwecker D , Robb JA : Skeletal scintimaging and radiography in the diagnosis and management of Paget's disease , Clin orthop 127: 55-62, 1977.   Back to cited text no. 1    
2.Harnick HIJ , Bijvoet OLM , Vellenga CJLR : Relation between signs and symptoms in Paget's disease of bone . Q J Med 58 : 133-151 , 1986  Back to cited text no. 2    
3.Heck LL , : Extraosseous localization of phosphate bone agents , Semn Nucl Med 10 : 311-313, 1980 .  Back to cited text no. 3    
4.Orzel J A , Rudd TG ,: Heterotopic bone formation : Clinical , labotratory and imaging correlation , J Nucl Med 26 : 125-132, 1985.  Back to cited text no. 4    

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Correspondence Address:
VVSP Rao
Department of Nuclear Medicine, Nizam's Institute of Medical Sciences , Hyderabad, 500082
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32416

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  [Figure - 1], [Figure - 2]



 

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