Diagnostic uncertainty of isolated skull lesion in prostate cancer- Role of SPECT/CT

Skeletal involvement is the second most common site of metastases after lymph nodal metastases in patients with prostate cancer. The skeletal metastases from prostate cancer are osteoblastic in nature and show increased tracer avidity on the bone scan. Focal tracer avid lesion in skeleton especially in skull requires the careful examination by further investigation. The patients with skull metastases are commonly asymptomatic at presentation, but some may have the mass lesion effect .The occurrence of solitary skull metastatic lesion is rare and the metastasis in the existing tracer uptake should be ruled out with the help of high resolution or hybrid imaging modality. We present a known case of prostate cancer who presented with pain in the right temporal region and highlight the  utility of the single photon emission computed tomography/computed tomography (SPECT/CT) imaging in localization and characterization of the isolated focal tracer uptake in the skull region found in bone scan.