Interesting ImagesAggressive Bone Metastatic Prostate Cancer With Periosteal Reaction in 18F-Choline PET/CTDe Leiris, Nicolas MD∗,†; Ruggeri, Valentin MSc∗; Riou, Laurent PhD†; Laramas, Mathieu MD‡; Djaileb, Loïc MD∗,†Author Information From the ∗Nuclear Medicine Department, CHU Grenoble-Alpes †INSERM, U1039, Radiopharmaceutiques Biocliniques ‡Oncology Department, CHU Grenoble-Alpes, Grenoble, France. Received for publication June 8, 2020; revision accepted September 22, 2020. Conflicts of interest and sources of funding: none declared. Correspondence to: Nicolas De Leiris, MD, Clinique Universitaire de Médecine Nucléaire, Centre Hospitalier Universitaire Grenoble-Alpes, CS 10217, 38043 Grenoble CEDEX 9, France. E-mail: [email protected]. Clinical Nuclear Medicine: February 2021 - Volume 46 - Issue 2 - p e116-e117 doi: 10.1097/RLU.0000000000003384 Buy Metrics Abstract Prostate cancer bone metastases usually appear as osteosclerotic lesions. However, atypical lesions have also been described. We report herein the case of a 65-year-old man treated since 2013 for prostate cancer with early bone metastases. This asymptomatic patient was referred for 18F-choline PET/CT due to a major elevation of prostate-specific antigen to >1500 ng/mL. The results indicated multiple bone lesions, disseminated on the axial skeleton, girdles, and upper extremities of femurs. Interestingly, we described the development of an intensely hypermetabolic spiculated periosteal reaction, evidencing a rapidly progressive disease. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.