Hi
First time poster, long time lurker.
I’ve been asked to perform whole body MRI for a patient with a request of
“?oncogenic osteomalacia”. 38 year old male.
68-citrate PET-CT done recently is negative.
bone endocrine literature says next best test is whole body MRI. Anyone got
any experiences or pearls about a whole body MRI protocol for this
indication?
It sounds like the pre test probability of a positive scan is low.
My local friendly bone endocrinologist about hypophosphataemia says : “Yes,
the working diagnosis is an occult mesenchymal phosphaturic tumour which is
secreting FGF23, as opposed to hereditary hypophosphataemic rickets caused
by a mutation in the FGF23 gene making it resistant to degradation, or in
PHEX, the degrading enzyme. Well recognised that the tumours can be tiny
and hidden in tricky places, eg paranasal sinuses, interdigital web.
Having said that, occasionally these patients do turn out to have genetic
hypophosphataemic rickets which didn’t become apparent till adulthood
(whereas they typically present with rickets in kids after they start to
walk) In my patient we checked FGF23 and PHEX genetics after all the
imaging was negative and she doesn’t have a mutation.”
Thanks in advance
Rob Nairn
Perth Radiological Clinic
Sir Charles Gairdner Hospital
