Case 1

CLINICAL DETAILS:

 Raised alk phos. ? Paget's. ? metastatic disease.

NM BONE SCAN

Prominent abnormal uptake is visible in the right hemipelvis, the whole of the sacrum and the whole of L3 including the spinous process. Abnormal uptake is also seen in the upper thoracic spine probably also involving an entire thoracic vertebra. Less prominent uptake is seen in the proximal end of the left ulna and right femur.

COMMENT:

In every bone mentioned, the appearances are typical for Paget's disease.

Case 2

CLINICAL DETAILS:

? Metastasis

NM BONE SCAN:

There are multiple focal areas of increased uptake throughout the skeleton with particularly prominent lesions in the upper cervical spine, lower cervical spine, throughout the thoracolumbar spine and pelvis. Lesions are also seen in the shaft of the right femur.

COMMENT:

The appearances are those of widespread metastatic bone disease.

Case 3

CLINICAL DETAILS:

 ? Bony metastasis.

NM BONE SCAN:

There are several focal areas of increased uptake in the lower thoracic and upper lumbar spines and also the ribs. In particular there is hotspots in the region of the right pedicle of T11 and the left pedicles at T12 and L1. Activity running along the shaft of ribs can be seen involving the right 5th and 8th and left 12th ribs. The anterior ends of the right 6th, 7th and 9th ribs. The posterior arch of the right 12th rib also looks prominent. There is an additional abnormal focus involving the left posterior iliac crest and also possibly the left anterior iliac crest.

COMMENT:

These appearances strongly suggest metastatic bone disease.

Case 4

CLINICAL DETAILS:

Metastasis in liver. Left sided chest pain lower ribs. Raised ALP. ? bony metastasis.

NM BONE SCAN:

The scan shows multiple areas of abnormal uptake within the axial skeleton. The most prominent are in T5, T11, S1, right SI joint, right ischium, left superior pubic ramus, right 7th posterior rib and 9th left posterior rib.

CONCLUSION: 

The scan findings are suggestive of multiple metastases.

Case 5

CLINICAL DETAILS:

Lumbar pain. ? metastatic disease.

NM BONE SCAN:

The scan shows multiple focal areas of abnormally increased tracer uptake in the spine, particularly lower thoracic, upper lumbar and sacral region, multiple ribs (right 9th posterior and left 7th posterior), right ischium and acetabulum, head of humerus and scapula.

COMMENT:

The scan findings indicate widespread metastatic disease.

Case 6

CLINICAL DETAILS:

Gross osteoporosis. Acute backpain. ? metastasis

NM BONE SCAN:

There is intensely increased but rather symmetrical uptake of tracer at the level of T11 and is probably due to vertebral collapse. The rest of the spine shows inhomogeneity of tracer uptake in the lower cervical and lumbar region along with a prominent kyphoscoliosis. Both sternoclavicular joints are symmetrically hot. Some irregularity of uptake is also seen in both shoulders, wrists and left knee.

COMMENT:

These findings are suggestive of degenerative changes all over the body and no definite evidence of metastatic bone disease is noted.

Case 7

CLINICAL DETAILS:

? Myeloma. ? Metastasis

NM BONE SCAN: 

No significant skeletal abnormalities are present, this does not however exclude myeloma. Both renal parenchymae show increased uptake probably the consequence of hypercalcaemia.

BONE SCANS ARE NORMAL IN MYELOMA

Case 8

CLINICAL DETAILS:

Carcinoma of the lung ? metastasis

NM BONE SCAN:

There is abnormal uptake in the mid thoracic spine and to a lesser extent the lower thoracic spine with some poorly defined increased uptake also in the upper lumbar spine. There is a history of previous multiple osteoporotic fractures and these abnormalities are probably related to these and to degenerative disease although current plain radiographs were not obtained. More worrying however is a well defined focus of increased uptake in the lower end of the sternum. This unfortunately was also not x-rayed. There is a somewhat dubious hot spot in the right ischium of doubtful significance. A previous right knee joint replacement is noted.

COMMENT:

Further imaging of the sternum is indicated.

Case 9

CLINICAL DETAILS:

Low back pain ? mets.

NM BONE SCAN:

There is increased activity in the superior part of the right SI joint. Plain films of this region are normal. No other abnormality can be seen in the skeleton.

COMMENT:

The likelihood of metastatic disease is low. Nevertheless early follow up is suggested.

Case 10

Case 11

CLINICAL DETAILS:

Unexpected collapse of C3. Pain in right humerus.

NM BONE SCAN:

There is no significant area of abnormal uptake throughout the spine, especially the cervical region but very minor changes which are compatible with degenerative changes are present. The uptake in the right shoulder, both knees and feet are also compatible with degenerative/arthritic pathology. On reviewing the x-ray of the cervical region, there is no convicing evidence to suggest collapse of C3 vertebra.

COMMENT:

The scan findings are negative for metastatic disease of the skeleton.

Case 12

CLINICAL DETAILS:

 ? Metatasis.

NM BONE SCAN:

There is generalised poor concentration of tracer in the skeleton giving rise to a low target to background ratio. There is evidence of degenerative disease involving the lower thoracic spine, lumbar spine and especially both knees, but otherwise the scan is unremarkable with no evidence of metastases.

Case 13

CLINICAL DETAILS:

 Bone pain anterior chest. ? metastatic disease.

NM BONE SCAN:

The scan shows symmetrical uptake of tracer throughout the skeleton and no area of significant abnormality could be seen.

COMMENT:

The scan findings are negative for metastatic bone disease.