Primary myelofibrosis

Case contributed by Nick Tarasov
Diagnosis almost certain


Bone scan follow-up of prostatic cancer. No current complaints.

Patient Data

Age: 65
Gender: Male

Delayed phase bone scan

Nuclear medicine

There is increased uptake of Tc99m-MDP in bilateral humeral heads, femoral heads, the left distal femur, proximal tibiae, and distal tibiae. 

The kidneys, bladder , hands, and feet are still visible.

Case Discussion

This bone scan was misdiagnosed as a superscan from prostate cancer metastases,  and the patient stage was incorrectly raised to stage IV. Prostate cancer superscans typically demonstrate increased tracer accumulation in the bones of the axial and proximal appendicular skeleton which can be heterogenous.  The kidneys, soft tissues and the small bones of the hands and feet are not typically well seen on a superscan.

Patients with myelofibrosis may demonstrate increased uptake of Tc99m-MDP at the metaphyseal ends of long bones on bone scan. While increased uptake of Tc99m-MDP usually denotes the increased activity of osteoblasts, in myelofibrosis increased uptake at the epiphyses is thought to relate to increased bone blood flow in the setting of red marrow expansion.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.