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Age / Sex : 54 / F
Chief complaint : Pelvic pain ( 1 month ago)
PHx : Hypoparathyroidism
What is your diagnosis?
Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer)
Courtesy : 한 석(Seok, Hahn), 인제대학교 해운대 백병원 (Inje University Haeundae Paik Hospital)
Diagnosis: Paget's disease
Discussion
Findings
Predominant osteosclerosis with cortical and trabecular thickenings involving the sacrum and L5.
- Decreased capacity of bone marrow
- Prominent regional yellow marrow
- No evidence of cortical destructions or soft tissue lesion
Images
1. Plain films and CT
Lytic phase : Well defined osteolysis
Mixed phase (the vast majority of cases) : Coarsening and thickening of the trabecular pattern and cortex
Blastic phase : Development of osteosclerosis, bone enlargement
2. MRI (bone marrow evaluation)
Lytic phase : Heterogeneous SI on both T1WI and T2WI, containing small to extensive yellow marrow on T1WI
Mixed phase : Yellow marrow SI is maintained (actually has more fat than found in the uninvolved bone, a finding that represents the atrophic marrow)
Blastic phase : Low SI on T1WI and T2WI (representing sclerosis)
References
1. Radiologic spectrum of Paget disease of bone and its complications with pathologic correlation, RadioGraphics 2002; 22:1191-1216
2. 근골격 영상의학, 대한근골격영상의학회
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