PMC6180829_01
Whole-body bone scintigraphy demonstrates increased radiotracer activity in bilateral shoulders, wrists, hips, knees and ankles, most severe in the knees (arrows).
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Bone scintigraphy demonstrated increased radiotracer activity in bilateral shoulders, wrists, hips, knees and ankles, most severe in the knees (Figure 1).
(a) Right and (b) left anteroposterior radiographs of the knees were normal. Radiograph of bilateral knees and pelvis was normal (not shown).
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Radiographs of the above-mentioned areas were all normal (Figure 2).
(a) Coronal T
1 and (b) short tau inversion-recovery (STIR) images demonstrate patchy marrow and subperiosteal signal abnormality hypointense on T
1 and hyperintense on STIR in bilateral distal femoral metaphysis (arrows). (c) Bilateral femurs and (d) tibia/fibula post contrast-enhanced fat-suppressed coronal T
1 images demonstrate intense subperiosteal and metaphyseal marrow enhancement in bilateral distal femurs and proximal tibiae (arrows).
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Subsequent contrast-enhanced MRI of both femurs demonstrated intense metaphyseal signal abnormality and enhancement in bilateral proximal and distal femurs and proximal tibiae (Figure 3). Subperiosteal signal abnormality and enhancement along the metaphysis of both femurs and tibiae was also observed (Figure 3).
(a) Coronal T
1, (b) coronal short tau inversion-recovery and (c) contrast-enhanced fat-suppressed coronal T
1 images obtained after 8-month treatment with supplemental vitamin C therapy demonstrate normal marrow signal and enhancement throughout both femurs.
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MRI of both femurs. Metaphyseal abnormalities seen on initial MRI had completely resolved on the follow-up MRI examination (Figure 4).