Clinical Presentation
An 80-year-old man with weight loss, back pain, and a history of prostate cancer.
(A) MIP image from whole-body FDG-PET demonstrates a diffuse shift in moderate radiotracer uptake to skeletal musculature. (B) Fused PET-CT axial slice from the same patient demonstrates marked uptake in the muscles of mastication (arrows).
Differential Diagnosis
• Altered biodistribution from hyperinsulinemia: Diffusely increased activity throughout the skeletal musculature makes this the most likely diagnosis.
• Brown fat hypermetabolism: This can also cause symmetric linear uptake near muscles, but the activity localizes to fat—typically only in the neck, shoulders, mediastinum, and/or spine, not the extremities (see Case 58).
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