Superscan caused by renal osteodystrophy: Observed on 18F FDG PET/CT scan

Ghesani, Nasrin; Jung, Jin Hyang; Patel, Shyam; Ramchand, Tekchand

doi:10.4103/0972-3919.121981

Cited by 10 publications

(3 citation statements)

References 7 publications

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“…Similarly, metabolic superscan has been described on FDG PET imaging in patients imaged for malignant diseases. [ 9 , 10 ] Ghesani et al [ 9 ] described superscan caused by renal osteodystrophy on F-18 FDG PET/CT in a patient with carcinoma of the breast. Our patient does not have any malignant disease; hence, skeletal uptake of F-18 FDG can be fully attributed to renal osteodystrophy rather than marrow metastases which may produce metastatic superscan.…”

Section: Discussionmentioning

confidence: 99%

Renal osteodystrophy presenting as a metabolic superscan on F-18 FDG PET/CT

Lawal

Ankrah²,

Ololade³

et al. 2017

Medicine

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Rationale:F-18 Fluoro Deoxyglucose positron emission tomography and computed tomography (F-18 FDG PET/CT) is a useful modality in the evaluation of patients with malignancies. Increased incidence of lympho-proliferative disorders has been reported in individuals with long-standing end-stage renal disorders treated with renal replacement therapy.Patient concerns:A 30-year-old male on peritoneal dialysis on account of end-stage renal disease. He had acute rejection of an earlier transplanted renal allograft. He was referred for an F-18 FDG PET/CT based on a clinical suspicion of lymphoma on account of bilateral inguinal lymphadenopathy associated with bilateral pedal swelling.Diagnosis:Renal osteodystrophy was diagnosed based on diffusely intense F-18 FDG uptake in the axial skeleton, focal uptake in the costochondrial junctions and linear cortical uptake in the appendicular skeleton. No findings suggestive of lymphoma was seen.Interventions:A diagnosis of renal osteodystrophy with no evidence of a lymphoma prevented futile biopsy of inguinal lymphadenopathy. Patient continued with peritoneal dialysis with no further interventionOutcomes:Regular follow-up of patient to monitor calcium, phosphate and parathyroid hormone levels. Treatment will be indicated when laboratory results as well as clinical signs and symptoms are suggestive.Lesson:Metabolic bone disorder such as is seen in renal osteodystrophy should be considered in the differential diagnoses in patients with diffusely increased bone uptake on F-18 FDG PET/CT scan.

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Section: Discussionmentioning

confidence: 99%

Renal osteodystrophy presenting as a metabolic superscan on F-18 FDG PET/CT

Lawal

Ankrah²,

Ololade³

et al. 2017

Medicine

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“…Diffuse 18 FDG uptake in the skeleton and bone marrow as superscan pattern on PET scan has been reported in multiple malignant disorders, including lymphoma and leukemia,[67] multiple myeloma,[8] and metastasis like prostate cancer[910] as well as other hematologic conditions, for example, following administration of granulocyte colony-stimulating factor. [11] This finding is also observed in metabolic disorders such as renal osteodystrophy[12] and parathyroid carcinoma. [13] In this case, although some uptake in the brain and excretion via the urinary system are present, the uptake in the skeleton is sufficiently high and homogeneous that conforms, to a large extent, to the definition of superscan and bears a striking resemblance to an NaF PET scan, an exceptionally rare finding.…”

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confidence: 84%

Diffuse skeletal uptake on ¹⁸F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography scan in a patient with acute lymphoblastic leukemia: A typical superscan pattern resembling naf positron emission tomography scan

2019

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A 65-year-old patient with acute lymphoblastic leukemia presented for an 18fluoro-2-deoxy-d-glucose positron emission tomography computed tomography (18FDG PET) after several courses of chemotherapy for metastatic evaluation. Unexpectedly, on 18FDG PET scan, no discernible uptake was observed in the visceral organs, but instead, the skeleton/bone marrow showed homogenously intense metabolic activity. The distribution of 18FDG observed on the scan was remarkably similar to that on the NaF PET scan, indicating a superscan appearance.

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“…In renal osteodystrophy, there is an increase in bone turnover as a result of chronic hypocalcemia. 12 It has been postulated that the diffuse osseous FDG hypermetabolism in axial and appendicular skeleton in metabolic superscan is due to the increment in osteoblastic activity and bone turnover induced by hypersecretion of parathormone, 11,13,17 leading to an increase of chemisorption onto the calcium hydroxyapatite crystal. Superscan in FDG PET/CT is not always metastatic in origin, and careful assessment is essential in differentiating pathologic from benign superscan to avoid a diagnostic pitfall.…”

mentioning

confidence: 99%

Metabolic Superscan on 18F-FDG PET/CT in a Patient With Secondary Hyperparathyroidism

Mohd Rohani,

Bujang,

Rosdi

et al. 2023

Clin Nucl Med

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Superscan on PET/CT has been reported in the literature and mainly involved metastatic diseases. We report an uncommon case of a metabolic superscan on 18F-FDG PET/CT in a 56-year-old man with end-stage renal disease on hemodialysis who presented with secondary hyperparathyroidism. Parathyroid scintigraphy showed 2 lesions posteroinferior to both thyroid lobes, suggestive of parathyroid adenoma/hyperplasia. FDG PET/CT performed to assess for pulmonary nodules revealed diffuse FDG hypermetabolism involving the visualized skull, mandible, spine, sternum, ribs, and appendicular skeleton without corresponding CT lesion with no urinary radiotracer excretion, consistent with metabolic superscan secondary to renal osteodystrophy.

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Superscan caused by renal osteodystrophy: Observed on 18F FDG PET/CT scan

Cited by 10 publications

References 7 publications

Renal osteodystrophy presenting as a metabolic superscan on F-18 FDG PET/CT

Renal osteodystrophy presenting as a metabolic superscan on F-18 FDG PET/CT

Diffuse skeletal uptake on ¹⁸F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography scan in a patient with acute lymphoblastic leukemia: A typical superscan pattern resembling naf positron emission tomography scan

Metabolic Superscan on 18F-FDG PET/CT in a Patient With Secondary Hyperparathyroidism

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Superscan caused by renal osteodystrophy: Observed on 18F FDG PET/CT scan

Cited by 10 publications

References 7 publications

Renal osteodystrophy presenting as a metabolic superscan on F-18 FDG PET/CT

Renal osteodystrophy presenting as a metabolic superscan on F-18 FDG PET/CT

Diffuse skeletal uptake on 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography scan in a patient with acute lymphoblastic leukemia: A typical superscan pattern resembling naf positron emission tomography scan

Metabolic Superscan on 18F-FDG PET/CT in a Patient With Secondary Hyperparathyroidism

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Diffuse skeletal uptake on ¹⁸F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography scan in a patient with acute lymphoblastic leukemia: A typical superscan pattern resembling naf positron emission tomography scan