The headless bone scan: an uncommon manifestation of metastatic superscan in carcinoma of the prostate

Abstract

Five cases of metastatic prostatic carcinoma are presented. In each case, skeletal metastases were extensive, but the calvaria was not involved, resulting in a headless appearance. The mechanism for this scintigraphic manifestation is presented, and its value is emphasized.

Metastatic superscan on 99m Tc-MDP bone scintigraphy in a case of carcinoma colon: Common finding but rare etiology

“…Common causes include malignancies like prostate cancer, breast cancer, and lung cancer. [1234] Hematological conditions like leukemia, lymphoma, myelofibrosis, Waldenstrom's macroglobulinemia have been reported to be associated with a superscan. [56] It can also be seen in metabolic bone diseases like renal osteodystrophy, Paget's disease and hyperparathyroidism.…”

“…[1] Apart from prostate cancer, which is the most common condition associated with a superscan, other malignancies like breast cancer, lung cancer[1234] can cause superscan appearance on bone scintigraphy. Here we present a case of colon carcinoma with metastatic superscan on 99m Tc-MDP bone scintigraphy, a very rare cause for metastatic superscan.…”

Pitfalls and Limitations of Radionuclide Planar and Hybrid Bone Imaging

“…45 Occasionally, a bone scan in the presence of widespread metastases may have a "headless" appearance owing to calvarial sparing by metastatic disease. 46 On occasion, uniform uptake and absence of discrete hot spots in a superscan of malignancy may lead to a false-negative interpretation for metastases. 47 In addition, a superscan pattern may also be seen in metabolic bone disease.…”

Altered Biodistribution of Radiopharmaceuticals Used in Bone Scintigraphy

“…31 Other reported metabolic causes of superscan include hyperthyroidism, 32,33 acromegaly, 34 hypervitaminosis A 35 and D, 36 and fluorosis. 12 Superscan Due to Metastatic Disease Superscans due to widespread osseous metastases occur most frequently in the context of breast 17,37 and prostate cancer 11,19,38,39 but may also be seen in lung, 11 genitourinary tract, 40 gastrointestinal (GI) tract, 41,42 head and neck, 43 and occasionally hematological malignancies. 16,18,[44][45][46][47] Not surprisingly, metastatic superscans are indicators of poor prognosis.…”