PMC3180722_01
Tc-99m MDP whole body images show multiple sites of increased tracer uptake, including the skull and facial bones, multiple ribs, pelvis and bones of both lower limbs. The "pirate sign" indicates involvement of the right sphenoid wing
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F1
Multiple sites of increased skeletal tracer uptake were detected in the skull, left mandible, multiple ribs, pelvis and both lower limbs [Figure 1].
Hybrid SPECT/CT fusion to determine the extent of skull and facial bone involvement shows intense tracer uptake in the sphenoid, ethmoid and frontal bones
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F2
Single-photon emission computed tomography/computerized tomography (SPECT/CT) of the skull was performed for evaluation of the extent of skull bone involvement and showed involvement of the right sphenoid, ethmoid and frontal bones and left mandible, with evidence of bone expansion [Figure 2].
Non-contrast CT scan of the chest shows bony expansion and deformity of the right ribs, where intense osteoblastic activity was detected
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F3
CT component of SPECT-CT [Figure 3] shows bony expansion with ground glass appearance involving right sided ribs.