Paget bone disease demonstrated on ⁶⁸Ga-PSMA ligand PET/CT

Excerpt

We present the case of an 87-year-old man with a history of prostatic adenocarcinoma diagnosed in 2006 and initially treated locally with high intensity focused ultrasound. An increase of prostate-specific antigen (PSA) values was detected recently and a positron emission/computed tomography (PET/CT) investigation with the ⁶⁸Ga-labelled prostate-specific membrane antigen (PSMA) ligand [Glu-NH-CO-NH-Lys(Ahx)-HBED-CC] was performed at our institution [1]. Apart from focal increased uptake in the prostatic bed, a non-expected overexpression of PSMA was found involving the proximal phalanx of the fourth finger of the left hand (a). On the bone scan performed at the time of initial diagnosis, 9 years ago (b), it appeared that an intense ^99mTc-HDP uptake had already been described in the same location, involving the whole phalanx, with an image suggestive for bone Paget disease (PD) [2]. On physical examination the patient had a swollen and non-painful proximal phalanx with restricted finger motility. A plain X-ray of the hands was performed (c) confirming the diagnosis of monostotic PD of the phalanx [3]. …