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Artifact of cold lesions on skull SPECT of a patient with Paget's disease secondary to pixel overflow.

Various SPECT imaging artifacts have been described. One of them is pixel overflow caused by excessive radiotracer deposition in bone, resulting in areas of very low or absent activity on SPECT. Paget's disease of bone is characterized by intense and extensive radiotracer localization on bone imaging. A patient with Paget's disease is described whose planar bone scintigraphy and radiography showed osteoblastic and sclerotic areas of the skull, whereas SPECT showed photopenic and photon-deficient areas interposed with diffuse uptake in the skull. This indicates that bone SPECT might give artifacts of cold lesions secondary to pixel overflow as a result of excessive radiotracer deposition.