NaF18-PET/CT Imaging of Secondary Hyperparathyroidism

Excerpt

The patient was a 59-year-old man with a history of hypertension and end-stage renal disease (ESRD), undergoing hemodialysis for 14 years. The patient did not have any complaints of bone pain, joint pain, fever or weight loss. The lab values at the time of imaging were calcium 8 mg/dl (normal, 8.5–10.5 mg/dl), phosphorus 2.9 mg/dl (normal, 2.5–4.5 mg/dl), alkaline phosphatase (ALP) 1,042 U/l (normal, 44–147 U/l), bone-specific alkaline phosphatase 146 μg/l (normal, 6.5–20.1 μg/l), parathyroid hormone (PTH) 775.3 pg/ml (normal, 15–88 pg/ml), creatinine 6.55 mg/dl (normal, 0.6–1.3 mg/dl). An NaF-18 positron emission tomography/computed tomography (PET/CT) bone scan was ordered to rule out osteosarcoma or other possible bone malignancies (Fig. 1). Diffuse increased bone remodeling was seen throughout the skeleton, including the proximal and distal skeleton. The calvarium is thickened with increased osteoblastic activity. There was a “rosebead” pattern of uptake at the costochondral junction and increased uptake near the vertebral endplates. No suspicious lesions are present to suggest osseous metastatic disease or primary malignant bone tumor. A lesion representing a brown tumor was observed on the left femoral shaft. He is currently being treated with cinacalcet, hectorol, cholecalciferol and sevelamer.

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