Medical Radiology and Radiation Safety. 2017. Vol. 62. No. 3. P. 78-83

DOI: 10.12737/article_5927fdaf3ad417.71072643

SPECT/CT in the Diagnosis of Paget’s Disease (Clinical Case)

A.S. Krylov, A.B. Bludov, A.D. Ryzhkov, S.V. Shiryaev, M.O. Goncharov

N.N. Blokhin Russian Cancer Research Center Moscow. Russia, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

A.S. Krylov – PhD Med., Radiologist, member of the European Association of Nuclear Medicine and Molecular Imaging (EANMMI); A.B. Bludov – PhD Med., Researcher; A.D. Ryzhkov – Dr. Sc. Med., Senior Researcher; S.V. Shiryaev – Dr. Sc. Med., Head of Lab., President of the OSMI, Member of the European Association of Nuclear Medicine and Molecular Imaging (EANMMI), Member of the American College of Nuclear Medicine and Molecular Imaging (ACNMMI), Member of the Society of Nuclear Medicine and Molecular Imaging (SNMMI); M.O. Goncharov – Radiologist


This article describes the clinical case of diagnosis of Paget’s disease in asymptomatic patients using hybrid imaging modality SPECT/CT. The literature data of Paget’s disease diagnosis using SPECT/CT are rare.

Paget’s disease is a disease of unknown etiology, which can affect one or more bones. The essence of the process lies in the pathological bone restructuring, characterized by continuous change in processes of resorption and osteosynthesis in the same bone structure. Pathophysiologically Paget’s disease is characterized by three successive phases: 1) the initial stage or osteolytic destruction; 2) an intermediate stage or a stage of mixed bone destruction characterized by a combination of osteolytic areas with increasing osteosclerosis; 3) stabilization or a stage of osteosclerosis with increasing density of the affected bone due to its rough trabecular conversion.

In the diagnosis of Paget’s disease radionuclide scanning is a highly sensitive but low specific method, while the hybrid imaging method of SPECT/CT is characterized by high sensitivity and specificity, allowing at the same time to quantify the activity of the process and estimate structural changes in the bone with the possibility of differential diagnosis with other pathological processes.

Key words: SPECT/CT, Page’s disease, bone scan, clinical case


  1. Seton M. Paget’s disease: epidemiology and pathophysiology. Curr. Osteoporos. Rep. 2008. Vol. 6. 4. P. 125-129.
  2. Healy G.M., Woods C., Heffernan E., McKenna M.J. Paget’s disease of bone: progress towards remission and prevention. Ir. Med. J. 2015. Vol. 108. No. 10. P. 316-317.
  3. Haslam S.I., Van Hul W., Morales-Piga A. et al. Paget’s disease of bone: vidence for a suspectibility locus on chromosome 18q and for genetic heterogenecity. J. Bone Mineral Res. 1998. No. 13. P. 911-917.
  4. Korsakova Yu.L. Paget’s disease: current treatment modalities. Modern Rheumatol. J. 2010. No. 2. P. 11-17. (In Russian).
  5. Cundy T., Rutland M.D., Naot D., Bolland M. Evolution of Paget’s disease of bone in adults inheriting SQSTM1 mutations. Clin. Endocrinol. (Oxf). 2015. Vol. 83. No. 3. P. 315-319.
  6. Katayama Y., Kohso K., Nishimura A. et al. Detection of measles virus mRNA from autopsied human tissues. J. Clin. Microbiol. 1998. Vol. 36. No. 1. P. 299-301.
  7. Rodionova S.S., Kolondaev A.F. Paget’s disease. Moscow: GEOTAR Media, 2008. 54 p. (In Russian).
  8. Theodorou D.J., Theodorou S.J., Kakitsubata Y. Imaging of Paget disease of bone and its musculoskeletal complications: review. AJR Amer. J. Roentgenol. 2011. Vol. 196. Suppl. 6. P. 64-75.
  9. Minenkov G.O., Shalabayev B.D. Computed tomographic criteria for the diagnosis of variable manifestations of Paget’s disease in the cerebral cranium and facial bones. Vestnik Rentgenologii i Radiologii. No. 4. P. 56-58. (In Russian).
  10. Al Nofal A.A., Altayar O., BenKhadra K., Qasim Agha O.Q. et al. Bone turnover markers in Paget’s disease of the bone: A Systematic review and meta-analysis. Osteoporos. Int. 2015. Vol. 26. No. 7. P. 1875-1891.
  11. Vellenga C.J., Bijvoet O.L., Pauwels E.K. Bone scintigraphy and radiology in Paget’s disease of bone: a review. Amer. J. Physiol. Imaging. 1988. No. 3. P. 154-168.
  12. Balani A., Marda S.S. Images in clinical medicine. Paget’s Disease of Bone. N. Engl. J. Med. 2016. Vol. 374. No. 13. P. 1264-1276.
  13. Rozhinskaja L.Ja. Paget’s disease. Osteoporosis and osteopathy. 2007. Vol. 2. No. 2. P. 29-31. (In Russian).
  14. Kutin A.A. Late diagnosis of Paget’s disease. Clinical practice. 2010. Vol. 2. No. 2. P. 37-40. (In Russian).
  15. Farid K., Caillat-Vigneron N. SPECT-CT improves the identification of Paget’s disease of bone. Joint Bone Spine. 2010. Vol. 77. No. 4. P. 370-371.
  16. Atlas of Skeletal SPECT/CT Clinical Images. IAEA Human Health Series 34. IAEA. Vienna. 2016. P. 12-13.

For citation: Krylov AS, Bludov AB, Ryzhkov AD, Shiryaev SV, Goncharov MO. ESPECT/CT in the Diagnosis of Paget's Disease (Clinical Case). Medical Radiology and Radiation Safety. 2017;62(3):78-93. Russian. DOI: 10.12737/article_5927fdaf3ad417.71072643

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