Figure 4

Diffuse sclerosis, resulting from the patient’s high osseous tumor burden and associated high radium-223 uptake. Diffuse osseous sclerosis on CT imaging of the spine (A), bilateral ilia (B), and bilateral femoral heads (B) is shown. This sclerosis occurred because of the patient’s high volume of bony metastatic disease and consequential high radium-223 uptake. We believe that this combination of high osseous tumor burden and high radium-223 uptake, resulting in diffuse sclerosis, contributed to our patient’s transfusion dependence, which has persisted in the absence of continued radium-223 therapy or systemic disease progression.