PMC3425223_01
FDG PET-CT transaxial images showing moderate hypermetabolic activity in the posterior pelvis bone and soft tissue with linear needle tracts on CT
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F1
Transaxial PET images at the level of the pelvis (Figure 1, bottom image) demonstrated moderate hypermetabolic activity in the right posterior iliac bone and right sacrum with mild increased activity in the left posterior iliac bone and left sacrum. PET-CT fusion images at the same level (Figure 1, middle image) showed hypermetabolic activity extending beyond the sacral and iliac bones, predominantly in the gluteal muscles and subcutaneous tissues, but additionally anterior to the right sacrum. CT images (Figure 1, top image) showed parallel linear osseous defects involving both the cortex and medulla tilted medially on both sides through the posterior iliac bones and sacrum causing a "sergeant stripes" appearance on CT.
PMC3425223_02
Maximum intensity projections of the PET images demonstrating prominent increased FDG uptake in the bilateral sacroiliac regions
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F2
Maximum intensity projections of the PET images [Figure 2] demonstrated prominent increased uptake in the bilateral sacroiliac regions with maximum SUV 10.8.
FDG PET-CT transaxial images showing increased FDG uptake in the bilateral iliac bones and sacrum with prominent hypermetabolic activity extending beyond the borders of the bone in the musculature and subcutaneous tissues
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F3
FDG uptake in the bilateral iliac bones and sacrum. Fusion images [Figure 3, middle image] showed prominent hypermetabolic activity extending beyond the borders of the bone, in particular, involving the left iliacus muscle where the harvesting needle penetrated the left iliac wing. On CT [Figure 3, top image], needle tracts are again seen angled medially and there was destruction of the right posterior iliac bone from repeated bone marrow aspirations.