Imaging to determine the extent of skeletal involvement in Pagets Disease of Bone

What imaging is recommended to determine the extent of skeletal involvement in Pagets Disease of Bone and for monitoring?

Plain x-rays are used to diagnose PDB, but the extent of PDB involvement is best measured by radionuclide bone scan. Bone scan findings are nonspecific (e.g., may see false positives at osteoarthritic sites); however, it is the most sensitive exam for identifying PDB lesions. Early symptomatic lesions may be apparent on bone scan before x-ray, whereas burned-out pagetic lesions that are easily seen on x-ray may not have increased uptake on bone scan. It is recommended that patients with a newly diagnosed PDB have a bone scan during their initial evaluation, followed by x-rays of involved sites. Computed tomography, magnetic resonance imaging (MRI), and positron emission tomography imaging are not routinely used in PDB.

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