Superscan due to metastatic prostate cancer

Case contributed by Dr Zeyad Al-Ogaili

Presentation

Prostate cancer. On chemo and hormonal therapy. Follow up bone scan.

Patient Data

Age: 75
Gender: Male
Nuclear medicine

Staging bone scan

The initial staging study demonstrate multiple, irregular, randomly distributed foci of hight grade activity involving the spine, ribs, sternum, pelvic and femoral bones. The findings are in keeping with multiple osteoblastic metastasis.

The follow up bone scan shows uniform increased density of the axial and proximal appendicular skeleton resulting in excellent bone detail. The previously seen multiple discrete lesions are no longer appreciable. There is, however, no significant renal or soft tissue activity. The findings are consistent with "Super Scan" due to extensive osteoblastic metastasis.

Case Discussion

Bone scintigraphy is one of the most frequently performed of all radionuclide procedures. The procedure is performed with technetium-99m– labelled diphosphonates, which accumulate in the bones. The degree of radiotracer uptake in the bones depends primarily on two factors: blood flow and, perhaps more importantly, the rate of new bone formation

The normal scintigraphic findings on bone scan show symmetric distribution of activity throughout the skeletal system in healthy adults. Urinary bladder activity, faint renal activity, and minimal soft-tissue activity are also normally present

A bone scan is extremely sensitive tool for detecting osteoblastic metastasis and is therefore used as part of the routine staging for patient with breast, prostate and lung cancer. The usual pattern consists of increased radiotracer deposition in areas of osteoblastic reparative activity in response to tumor osteolysis. The presence of multiple, randomly distributed areas of increased uptake of varying size, shape, and intensity is highly suggestive of bone metastases.

When the metastatic process is diffuse, virtually all of the radiotracer is concentrated in the skeleton, with little or no activity in the soft tissues or urinary tract. The resulting pattern, which is characterized by excellent bone detail, is frequently referred to as a superscan. A superscan may also be associated with metabolic bone disease. Unlike in metastatic disease, however, the uptake in metabolic bone disease is more uniform in appearance and extends into the distal appendicular skeleton. Intense calvarial uptake that is disproportionate to that in the remainder of the skeleton is another feature of a metabolic superscan.

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Case information

rID: 24878
Case created: 17th Sep 2013
Last edited: 1st Mar 2016
Inclusion in quiz mode: Included

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