PMC4332296_01
(A) Axial PET-CT image showing abnormal tissue in the posterior wall of the bladder with increased FDG uptake (SUV max 7), (B) Axial PET-CT image also demonstrated abnormal uptake (SUV max 5.2) in a millimetre osteolytic focus in the left ischio-pubic branch.
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In addition, focal increased tracer uptake (SUV max 5.2) was detected at the level of an osteolytic lesion located in the left ischio-pubic branch (Figure 1).
(A) VIBE T1 axial image confirms the presence of solid tissue in the posterior wall of the bladder showing contrast enhancement. (B) Axial TSE T2 image with fat suppression shows a hyperintense focus (16 mm) in the left ischio-pubic branch presenting contrast enhancement as shown on VIBE T1 axial image (C) obtained after administration of contrast medium (gadolinium)
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Furthermore, a bone lesion of the left ischio-pubic branch was described, confirming the result of PET-CT (Figure 2).
(A) Axial TSE T2 image with fat suppression showing dishomogeneous hyperintensity in the ischio-pubic branches presenting a swelling with cortical irregularity of the outline. In the axial VIBE T1 image (B), intense and diffuse enhancement in bone structures (yellow arrows) of the pelvis (red arrows) are present.
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The in-course evaluation included a pelvic MRI (October 2013) which showed a disease progression for the evidence of new bone lesions in the right ileo-pubic branch, with involvement of the pubic symphysis and both posterior acetabular pillars, particularly on the left, which was swollen and showed intense contrast enhancement (Figure 3).
(A) Coronal CT image in which a focal structural alteration in the third proximal of the left femur is evident. (B) Coronal TSE T2 image in which an area of hyperintensity (3.2 cm) in the third proximal of the left femur is detected as in the coronal localizer (C).
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That focal structural bone alteration was subsequently confirmed by a second PET-CT study (Figure 4), performed in November 2013, after the fifth cycle of chemotherapy, that also showed a diffuse bone involvement.
(A, B) Axial PET-CT images showing diffuse abnormal uptake in the bone structures of the pelvis (SUV max from 4 to 7) (C) Axial PET-CT image in which a focus of increased tracer uptake is also detected in the left proximal femur (SUV max 3).
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That was associated with cortical irregularity of the outline inside of the rear side and showed tracer uptake with a SUV max value of 2 (Figures 5).