Atypical Hemangioma Mimicking Metastasis on 18F-Sodium Fluoride Positron Emission Tomography-Computed Tomography and Magnetic Resonance Imaging: Gallium-68-Prostate-Specific Membrane Antigen Positron Emission Tomography Improves the Specificity of Bone Lesions.

Vertebral hemangioma is a benign condition, but sometimes, it might represent as diagnostic dilemma especially in elderly patient mimicking serious pathology like metastasis. We report a case of a 66-year-old man with prostate cancer. 18F-sodium fluoride positron emission tomography-computed tomography (F-NaF PET-CT) demonstrates increased radiotracer uptake at body of D4 vertebra. Magnetic resonance imaging shows features of atypical hemangioma; however, metastasis cannot be ruled out. To rule out bone metastasis, gallium-68-prostate-specific membrane antigen PET-CT is performed which shows no abnormal lesion. Eight-month follow-up by F-NaF PET-CT showed persistent osteoblastic lesion at D4 without any significant change thus, confirming the initial diagnosis of atypical hemangioma.