Learning Resources
Clinical Cases
Skeletal Cases
Case 1: Metastatic Disease

Case 1: Metastatic Disease

Clinical History

Patient: 72-year-old male History: Newly diagnosed Prostate Cancer (Gleason 4+4=8), PSA 45 ng/mL Indication: Staging for distant metastases

Imaging Findings

Technique: Whole Body Bone Scan (Tc-99m MDP)

Planar Images (Anterior & Posterior)

The scan reveals multiple, intense, focal areas of increased radiotracer uptake (“hot spots”) involving:

  • Multiple bilateral ribs
  • Thoracic and Lumbar spine (vertebral bodies)
  • Right hemipelvis (ilium) and left ischium
  • Proximal left femur

The kidneys are faintly visualized (normal excretion), but renal uptake is somewhat diminished relative to bone uptake (suggesting high skeletal burden).

Whole body bone scan showing metastases

Diagnosis

Findings:

  • Random, multifocal distribution specifically affecting the axial skeleton.
  • Typical “metastatic pattern”.

Interpretation: Diffusely metastatic bony disease.

Learning Points

  1. Distribution: Metastases typically affect the red marrow-containing axial skeleton (spine, pelvis, ribs, skull, proximal femurs/humeri).
  2. Pattern Recognition: Random, asymmetric, multifocal uptake is the classic appearance.
  3. Superscan vs. High Burden: A true “superscan” (diffuse involvement) might show absent kidneys. Here, high burden is key.
  4. Differential: Degenerative change correlates with joint spaces (knees, spine facets, shoulders). Trauma aligns with ribs (linear vertical alignment).