Tc99m-MDP bone scintigraphy demonstrates symmetric, linear, vertically oriented increased uptake through the sacral alae and a horizontal lesion through the sacral body (circle). A punctate focus at right T12 is likely degenerative.

Differential Diagnosis

•  Sacral insufficiency fracture: Linear vertical uptake involving both sacral alae with horizontal uptake through the sacral body (“Honda” sign) is virtually pathognomonic for this entity.

•  Sacroiliitis: