Fig. 8

Normal appearance of bone scan and CT scan in a 17-year-old male with mild symmetric uptake in the secondary ossification centers (apophyses). Normal prominent uptake is seen associated with iliac crest apophysis (secondary ossification center) which starts ossifying in this age range and fuses later (until 25 years old). a Axial SPECT image shows symmetric uptake seen in the iliac crest apophyses and subtle uptake associated with small left S1 transverse process apophysis (blue arrow) seen on the corresponding CT (b). c Axial SPECT image shows no significantly increased uptake in the small anterior costal epiphysis seen on axial CT image in the expected location (arrow in d). e Axial SPECT image of a lumbar vertebra with no significant uptake seen on axial CT image at the transverse process apophysis on the left (arrow on f). Familiarization with the normal appearance and location of the secondary ossification centers is important in the interpretation of back pain to avoid confusion with a small avulsion fractures