A characteristic scintigraphic pattern of focally intense skeletal tracer uptake surrounded by less prominently increased uptake has been described for osteoid osteomas. Demonstration of this finding is useful in the evaluation of patients with suspected osteomas. Pinhole magnification scintigraphy was significantly more effective than high-resolution planar scintigraphy at revealing this pattern in 19 osteoid osteomas of the appendicular skeleton. A similar advantage was not observed for vertebral osteoid osteomas. The absence of the characteristic pattern aided in differentiating other pathology from osteoid osteomas in seven patients. The authors recommend that skeletal scintigraphy of patients with suspected osteoid osteomas include pinhole magnification imaging.