Medicina Nuclear e Radioterapia

Abnormal Appearance of Spinal Hemangioma Mimicking Metastasis in Bone Scintigraphy and SPECT-CT: Case Report

Abstract

Jomon Raphael, Julie Hephzibah, Sunithi Mani, Nylla Shanthly and Regi Oommen

Study design: Case reports of abnormal appearance of hemangioma in thoracolumbar spine in bone scintigraphy. Objective: To report an unusual presentation of spinal hemangioma mimicking metastasis in bone scintigraphy and SPECT-CT. Summary of back ground data: Spinal hemangiomas are usually incidental findings. Most of them are asymptomatic and bone scintigraphy will be normal in majority of them. In the back ground of an underlying malignancy, an abnormal hot spot in bone scan always arouse a high suspicion of bone metastasis. Methods: Two middle aged ladies, treated for carcinoma cervix and carcinoma breast respectively, were undergoing regular follow ups. One patient had complaints of back pain on and off and her bone scan showed abnormal increase in tracer uptake in L1 vertebra suspicious of metastasis. Second lady had suspected intra abdominal metastatic disease and her bone scan showed abnormal increase in tracer uptake in thoracolumbar spine mimicking metastasis. Results: Both patients underwent further detailed evaluations and MRI study of spine was reported as hemangioma and PET-CT ruled out the possibilities of recurrent or metastatic malignancy. During further follow up, both patients were disease free. Conclusion: Hemangioma of spine appearing as a hot spot in bone scan is rare. In the back ground of a malignancy, a ‘hot’ lesion can be studied better with metabolic imaging with PET – CT which could dispel the suspicion of a metastatic focus quite clearly. MRI could also give a diagnostic clue.