CTICasesPolyostotic Paget's Disease of the Spine and Pelvis
Imaging findings
Sagittal and axial CT images of the spine demonstrate marked cortical thickening and prominent trabeculation within multiple contiguous vertebral bodies. Pelvic CT and radiographs show typical bone expansion, cortical thickening of the ilioischial and iliopectineal lines, and mild bowing of the right femur, consistent with mixed lytic and plastic phases of Paget's disease.
Key takeaways
Paget's disease is a chronic disorder of disorganized bone remodeling that leads to bone expansion and weakness. When affecting the spine, polyostotic Paget's disease can involve multiple contiguous levels, demonstrating dramatic cortical expansion and a classic "picture frame" appearance on CT that should not be mistaken for aggressive osteolytic or osteoblastic metastatic disease.
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