Eur J Nucl Med Mol Imaging (2016) 43:195–196

DOI 10.1007/s00259-015-3236-x

IMAGE OF THE MONTH

Paget bone disease demonstrated on 68Ga-PSMA ligand PET/CT

C. Artigas 1 & J. Alexiou 2 & C. Garcia 1 & Z. Wimana 1 & F-X. Otte 3 & T. Gil 4 & R. Van
Velthoven 5 & P. Flamen 1

Received: 22 September 2015 / Accepted: 16 October 2015 / Published online: 27 October 2015
# Springer-Verlag Berlin Heidelberg 2015

We present the case of an 87-year-old man with a history
of prostatic adenocarcinoma diagnosed in 2006 and ini-
tially treated locally with high intensity focused ultra-
sound. An increase of prostate-specific antigen (PSA)
values was detected recently and a positron emission/
computed tomography (PET/CT) investigation with the
68
Ga-labelled prostate-specific membrane antigen
(PSMA) ligand [Glu-NH-CO-NH-Lys(Ahx)-HBED-CC]
was performed at our institution [1]. Apart from focal
increased uptake in the prostatic bed, a non-expected
overexpression of PSMA was found involving the prox-
imal phalanx of the fourth finger of the left hand (a). On
the bone scan performed at the time of initial diagnosis,
9 years ago (b), it appeared that an intense 99mTc-HDP
uptake had already been described in the same location,
involving the whole phalanx, with an image suggestive
for bone Paget disease (PD) [2]. On physical examina-
tion the patient had a swollen and non-painful proximal
phalanx with restricted finger motility. A plain X-ray of
the hands was performed (c) confirming the diagnosis of
monostotic PD of the phalanx [3].
PSMA expression in non-prostatic tumor lesions has
already been described and seems to be related to an
overexpression of PSMA in the endothelial cells of tu-
mor neovasculature, probably stimulated by secreted an-
giogenic factors [4, 5]. We hypothesize this mechanism
could also be the reason for 68Ga-PSMA uptake in PD,
as it is known to present with an abnormal bone remod-
eling and increased vascularity. AS bone lesions are the
most frequent site of metastatic disease in prostate can-
cer, it is important to be aware of this possible 68Ga-
PSMA PET/CT false-positive finding.

* C. Artigas
carlos.artigas@bordet.be

1
Department of Nuclear Medicine, Jules Bordet Institute, Université
Libre de Bruxelles, Brussels, Belgium
2
Department of Radiology, Jules Bordet Institute, Université Libre de
Bruxelles, Brussels, Belgium
3
Department of Radiotherapy, Jules Bordet Institute, Université Libre
de Bruxelles, Brussels, Belgium
4
Department of Oncology, Jules Bordet Institute, Université Libre de
Bruxelles, Brussels, Belgium
5
Department of Urology, Jules Bordet Institute, Université Libre de
Bruxelles, Brussels, Belgium
196 Eur J Nucl Med Mol Imaging (2016) 43:195–196

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