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Indium-111-Leukocyte and Technetium-99m-Sulfur Colloid Uptake in Paget's Disease

Department of Radiology, Division of Nuclear Medicine, The Mount Sinai School of Medicine, New York
Memorial Sloan Kettering Cancer Center, New York, New York

Correspondence: For correspondence or reprints contact: Abdelhamid H. Elgazzar, MD, The Mount Sinai Medical Center, Box 1141, One Gustave L. Levy Place, New York, NY 10029-6574.

ABSTRACT

We report a case of polyostotic Paget's disease of bone that caused an unusual pattern of accumulation of ¹¹¹In leukocytes that mimicked, at some sites, uptake of osteomyelitis, which was suspected in this patient. Technetium-99m sulfur colloid scan clarified the nature of ¹¹¹In-leukocyte accumulation as secondary to expanded active bone marrow uptake in some pagetic bones. Additionally, a spectrum of ¹¹¹In-leukocyte and ^99mTc-sulfur colloid uptake was noted in the bones involved by the disease that represented uptake by pagetic foci at different pathologic phases of the disease.

This case suggests that Paget's disease should be considered as a diagnostic possibility for areas of ¹¹¹In-leukocyte accumulation, particularly when expanded uptake is seen. When suspected, correlation with bone marrow scan and/or standard radiographs should be obtained. Recognizing that Paget's disease cannot only cause absent but also expanded bone marrow (depending on the disease stage) and consequently abnormal ¹¹¹In leukocyte uptake, should help avoid interpretational confusion.

Key Words: indium-111 leukocyte • technetium-99m sulfur colloid • osteomyelitis • Paget's disease