Date: 14 Sep 2007

Concurrent metabolic and osseous metastatic disease on a Tc99m-MDP bone scan

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Because of its nonspecific binding, Tc99m-MDP can be used to evaluate both metabolic and metastatic disease in bone. While the typical heterogeneous appearance of metastases is distinct from the homogenous uptake in metabolic bone disease [1], the appearance of confluent metastatic disease (a superscan) can be quite similar [2].

We present the anterior and posterior whole body images of an MDP bone scan (see figure) from a patient with metastatic carcinoid, with known widespread (confluent) bone involvement. It has the general appearance of a superscan, with homogenously increased tracer uptake and nonvisualization of the kidneys. However, while a superscan should have greater uptake in the axial skeleton compared to the appendicular skeleton, this scan is the reverse, raising the suspicion of an overlying metabolic bone disorder. Subsequent laboratory evaluation confirmed secondary hyperparathyroidism. As such, this scan demonstrates that in a patient with both afflictions, metabolic b