usefulness of three-phase bone scintigraphy and spect/ct for the diagnosis of bone lesions of systemic sarcoidosis

we report a three-phase bone scintigraphy for the diagnosis of a peripheral bone lesion caused by systemic sarcoidosis. a 32-year-old man with suspected osteomyelitis of the right forefinger underwent three-phase bone scintigraphy with tc-99m hydroxymethylene diphosphonate (hmdp) and single-photon emission computed tomography/computed tomography (spect/ct). the lesion was rich in blood flow according to flow study and blood pool study on bone scintigraphy, and was associated with an osteolytic change on spect/ct imaging performed 3 hours after injection of a radioisotope (ri). whole-body bone scintigraphy indicated multiple high levels of abnormal ri accumulation. the findings of the three-phase bone scintigraphy and spect/ct suggested the presence of systemic sarcoidosis; however, a subsequent 18ffluorodeoxyglucose positron emission tomography/ct (fdg-pet/ct) could not exclude the possibility of multiple metastases from testicular tumors. therefore, testicular enucleation was performed, and the pathological examination confirmed the presence of sarcoidosis.