Abstract
The diagnosis of Paget’s bone disease (PD) is often reached fortuitously with X-ray or scintigraphy. The peculiar distribution of the bone tracer in some skeletal locations, such as vertebra, may be highly suggestive of this disorder. Indeed, there are two distinct vertebral images on the bone scan highly specific of PD: the “clover” and the “heart” images. It has been previously reported that the specificity of these images for PD diagnosis is very high, nearly 100%, then suggesting that these findings could be patognomonic of this process. We have recently observed a 55-year-old male patient with back pain secondary to a vertebral metastasis due to a hepatocellular carcinoma. Initially, the bone scan showed the characteristic “clover” image at T-12 level and he was misdiagnosed with PD. Afterwards, the MRI suggested the diagnosis of a vertebral metastasis, and a computed tomography-guided needle biopsy further confirmed the diagnosis. In view of the present data, this image cannot be considered as patognomonic of PD.
References
Rotés-Sala D, Monfort J, Solano A, Miralles E, Vila J, Carbonell J (2004) The clover and heart signs in vertebral scintigraphic images are highly specific of Paget’s disease of bone. Bone 34:605–608
Kim CK, Estrada WN, Lorberboym M, Pandit N, Religioso DG, Alavi A (1997) The “mouse face” appearance of the vertebrae in Paget’s disease. Clin Nucl Med 22:104–108
Johnson PJ (2001) The role of serum alpha-fetoprotein estimation in the diagnosis and management of hepatocellular carcinoma. Clin Liver Dis 5:145–159
Nakanishi K, Kobayashi M, Takahashi S et al (2005) Whole body MRI for detecting metastatic bone tumor: comparison with bone scintigrams. Magn Reson Med Sci 4:11–17
Park SW, Lee JH, Ehara S et al (2004) Single shot fast spin echo diffusion-weighted MR imaging of the spine; Is it useful in differentiating malignant metastatic tumor infiltration from benign fracture edema? Clin Imaging 28:102–108
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This work is original and the authors meet the criteria for authorship, including acceptance of responsibility for the scientific content of the manuscript. There are no potential conflict of interest.
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Reyes, R., Peris, P., Monegal, A. et al. Vertebral “clover” scintigraphic image in a vertebral metastasis misdiagnosed with Paget’s disease. Clin Rheumatol 27, 1585–1586 (2008). https://doi.org/10.1007/s10067-008-1001-2
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DOI: https://doi.org/10.1007/s10067-008-1001-2