"Always Look Outside the Bones", a pictorial review in the Nuclear Medicine Department

Objectives: Extra-osseous uptake on a bone scan is uncommon but can be of important clinical significance. When they are present, it is important for the radiologist to recognize and provide a differential for these findings. We discuss the various spectrum of conditions and lesions that can demonstrate physiologic extra-osseous uptake on Tc-99m-MDP scintigraphy, and provide several case examples from our institution. Methods/Results 1. To discuss a variety of conditions that can present with extra-osseous uptake on Tc-99m-MDP scintigraphy. 2. To demonstrate these findings and correlate with other imaging studies including MRI, CT and plain radiographs. 3. We discuss the importance of attention to extra-osseous uptake when evaluating a Tc-99m-MDP scintigraphy study and the mechanism and clinical significance of these findings. The differential can include but is not limited to:

Supporting Images Figure 1. Whole body bone-scan shows MDP uptake in the liver corresponding to an inflammatory myofibroblastic tumor of the liver on CT scan of the abdomen. Conclusion Tc-99m MDP scintigraphy is one of the most common nuclear medicine procedures performed. We review and provide examples of some of these extra-osseous lesions. By understanding the physiologic and imaging characteristics of extra-osseous lesions, this can help the radiologist better determine the significance of these findings.

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