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Figure 2. 49-year-old female with stage IV breast cancer. (A) Coronal maximum intensity projection image from FDG PET study shows extensive FDG-avid osseous metastases throughout the spine, pelvis, and ribs. FDG activity in the renal collecting systems, urinary bladder, gastrointestinal tract, and brain is normal. (B) Axial fused FDG PET-CT image of the chest shows an FDG-avid metastasis in the sternum resulting in severe pain (circle). There is a subtle pathologic fracture obscured by the FDG activity. The lesion lies less than 1 cm away from the skin surface. (C) Axial CT image during radiofrequency ablation of the sternal metastasis for pain palliation shows the radiofrequency probe within the lesion (dotted arrow). Because of close proximity of the lesion and the planned radiofrequency ablation zone to the skin surface, a spinal needle was inserted into the subcutaneous tissues anterior to the sternum (solid arrow), and hydrodisplacement was performed to displace the skin away from the sternal metastasis and the ablation zone (*). (D) Follow-up axial fused FDG PET-CT image following treatment shows marked decrease in FDG activity (circle), with residual FDG activity due to the healing pathologic fracture. The patient experienced a moderate reduction in her presenting pain.