PMC4746840_01
Anterior (a) and lateral (b) view radiographs of right femur showing intense intramedullary diaphyseal sclerosis (arrow) with bone widening and endosteal thickening (arrowhead) in the proximal femoral shaft
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F1
Radiograph (X-ray) of right thigh [Figure 1a and b, arrows], arrows showed diffuse diaphyseal sclerosis with widening of bone and endosteal hyperostosis.
Anterior (a) and posterior flow (b) images obtained by injection of 20 mCi of 99mTc methylene diphosphonate show no evidence of increased vascularity in the region of both femorii. Furthermore, there is no increased pooling of tracer in the region of both femorii on anterior (c) and posterior (d) blood pool images
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F2
Initial vascular phase and blood pool images at 2 min showed no evidence of increased vascularity or soft tissue tracer pooling [Figure 2a-d].
Anterior and posterior whole body planar images acquired at 3 h show focal intense tracer uptake in right proximal femoral shaft (a and b, arrow), with no increased tracer uptake in the rest of the skeletal system. Faint uptake in the left proximal femoral shaft, appreciated better on planar anterior and posterior images of both femorii (c and d, arrowhead)
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F3
Delayed anterior and posterior planar images showed fusiform-shaped intense area of tracer uptake in the diaphysis of right femur [Figure 3a-d, arrows], corresponding to the site of pain; with similar pattern of tracer localization of lesser intensity in left proximal femoral shaft [Figure 3c and d, arrowheads].
Coronal single photon emission computed tomography image (a) increased focal intense tracer uptake involving diaphysis of both femorii (triangulate - right; arrow - left) proximally, more on the right side, showing intramedullary sclerosis on corresponding low dose coronal CT (b), which is confirmed on fused SPECT/CT images (c)
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F4
Fused single photon emission computed tomography/computed tomography (SPECT/CT) images showed tracer localized to intense sclerosis in the intra-medullary region with associated overlying cortical thickening in bilateral femoral diaphysis [Figure 4a-c, right - triangulate, left - arrow], visualized more prominently on right side.