Sacral Hemangioma Mimicking Bone Metastasis on 18F-PSMA-1007 PET/CT

A 74-year-old man with prostate cancer was referred for an 18 F-PSMA-1007 PET/CT scan for restaging due to a progressive rise in serum prostate-specific antigen levels. 18 F-PSMA-1007 PET/CT showed a focal intense activity in the left sacral ala. The sacral lesion corresponded to a hemangioma, which was initially detected on pelvic MRI 6 months ago and remained stable in size. A second 18 F-PSMA-1007 PET/CT performed 8 months after the first PET/CT showed no significant changes in size, density, and activity of the sacral lesion. This case indicates that hemangioma should be included in the differential diagnosis of PSMA-avid sacral lesions.