Which imaging modalities are most effective for confirming a diagnosis of Paget's disease of bone?

The most effective imaging modalities for confirming a diagnosis of Paget's disease of bone are plain radiography and bone scintigraphy. Plain X-rays typically reveal characteristic features such as bone enlargement, cortical thickening, trabecular coarsening, and areas of sclerosis and lysis, which are diagnostic hallmarks of Paget's disease NICE CKS Greenspan 2025. Bone scintigraphy is highly sensitive for detecting the extent and activity of the disease, often identifying affected sites before radiographic changes become apparent NICE CKS Winn et al. 2017. Additionally, computed tomography (CT) can provide detailed assessment of complex anatomical areas and help differentiate Paget's disease from other bone pathologies, while magnetic resonance imaging (MRI) is useful mainly to evaluate complications such as sarcomatous transformation or neurological involvement but is not routinely required for diagnosis NICE CKS Lombardi et al. 2022. Therefore, the diagnostic approach prioritizes plain radiographs for initial confirmation, supplemented by bone scintigraphy to assess disease distribution and activity, with CT or MRI reserved for specific clinical indications.