Osteonecrosis of the Femoral Head as a Potential Pitfall in 18F-PSMA-1007 PET

Abstract PSMA-targeted PET agents are mainly involved for prostate cancer; however, unspecific bone uptakes can be challenging for the clinician. We report the case of a 71-year-old man with history of recurrent prostate cancer initially treated by surgery and radiation therapy. 18 F-PSMA 1007 PET/CT was performed. Beside hyperfixing lymph nodes, focal uptake was found in right femoral head with shell subchondral hypofixation and no morphologic correlate on CT. MRI found bilateral osteonecrosis of the femoral head. This case emphasizes that osteonecrosis of the femoral head can mimic a metastasis uptake, even with normal CT, without however the fixation being constant.