Fig. 2
From: A patient with a history of breast cancer and multiple bone lesions: a case report
Radiographic imaging. Timing is indicated by arrows with capital letters in Fig. 1a. a Technetium-99m-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy with multiple hot lesions in the os ilium and acetabulum on the right-hand side. Note diffuse uptake in the calvarium and focally pronounced uptake at the tip of the ribs, suggestive of hyperparathyroidism. b 18F-Fluorodeoxyglucose positron emission tomography demonstrates multiple metabolically active bone lesions in correspondence with technetium-99m-3,3-diphosphono-1,2-propanodicarboxylic acid scan, but additional fluorodeoxyglucose-positive lesions were detected, such as in the glenoid on the left-hand side (arrow). c On this 18F-fluoride-positron emission tomographic scan, all lesions demonstrate fluoride uptake as proof of mineralization. Note fluoride uptake in flat bones and in costochondral junctions (similarly to technetium-99m-3,3-diphosphono-1,2-propanodicarboxylic acid whole-body scintigraphy) thought to be indicative of hyperparathyroidism and brown tumors. d Follow-up 18F-fluorodeoxyglucose positron emission tomography with no fluorodeoxyglucose-avid lesions demonstrating a complete response 23 weeks after parathyroidectomy. Initial 18F-fluorodeoxyglucose positron emission tomography/computed tomography shows an additional fluorodeoxyglucose-positive lesion in the left glenoid (e) not depicted in former technetium-99m-3,3-diphosphono-1,2-propanodicarboxylic acid scanning. The lesion exhibits sharply demarcated borders and evidence of subperiosteal bone resorption on computed tomography (f, arrow) thought to be pathognomonic for hyperparathyroidism. The lesion shows fluoride uptake in 18F-fluoride positron emission tomography/computed tomography (g) and demonstrates progressive sclerosis of the central matrix in computed tomography (h, arrow) after initiation of therapy. In 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging 23 weeks after parathyroidectomy, neither abnormal fluorodeoxyglucose uptake nor signal abnormalities are detected in the glenoid in T1-weighted (i) and T2-weighted images (j)