The Bone Scan

(A) Patient with metastatic carcinoma of the lung. Note the multiple areas of increased bone agent uptake in a pattern consistent with metastasis as well as several photopenic areas in the sternum and left sacroiliac joint. (B) A 64-year-old diabetic woman with cellulitis and ulcer of the right great toe on physical examination. Note the nonvisualization of the distal right great toe consistent with biopsy-proven osteomyelitis.

A 6-year-old boy who presented with painless right-sided limp for 3 days, fever, elevated ESR, and a normal white blood cell count. The radiograph on the same date as the bone scan was normal. (A) Sequential anterior flow images show increased flow to the right proximal femur. (B) Blood pool images show increased blood pool activity in the same area. (C) Delayed images also show increased activity in the right proximal femur consistent with acute osteomyelitis.

Toddler's fracture in an 18-month-old boy who presented with inability to bear weight, swelling, and point tenderness over the right tibia. An initial radiograph was interpreted as normal. A bone scan was then performed which demonstrated uncharacteristic increased activity extending beyond the metaphysis. Because of this finding and the patient's age, a differential, including toddler's fracture was suggested. A repeat radiograph with oblique positioning demonstrated a toddler's fracture.

(A) These images depict a 76-year-old male with a history of bilateral hip replacements 24 years earlier and a bilateral revision 4 years ago. Note the active bone agent uptake within heterotopic bone superiorlateral to the prostheses bilaterally consistent with an active process. (B) This image is a plain radiograph depicting the heterotopic bone formation corresponding to findings on bone scan.

These images depict a 15-year-old boy diagnosed with dermatomyositis at age 6. Note multiple sites of soft-tissue uptake corresponding to clinically evident abnormalities.

A 2-month-old girl who presented with multiple bruises. There was clinical suspicion of nonaccidental trauma. Rib radiographs were negative for fractures. Note the multiple right-sided rib fractures on bone scan, always suspicious for child abuse in a child of this age.

A 57-year-old woman with a history of lung cancer metastatic to the brain (after left craniotomy). Note the increased uptake along the periosteal margins of the long bones characteristic for pulmonary hypertrophic osteoarthropathy.

(A) These images depict a 39-year-man with new-onset right hip pain, pain in the left hip for a few years, pain in the left shoulder for 3 months, and pain in the right shoulder for 2 years. Note the absence of activity in the right femoral head consistent with early avascular necrosis. There is a combination of cold and hot areas in both shoulders and left femoral head consistent with revascularization and reossification phase of avascular necrosis. (B) A 25-year-old woman with right hip pain for 1 month and the left hip for 3 years. Note the combination of a cold area with increased uptake in bilateral hips characteristic of avascular necrosis.

An 84-year-old man with low back and right hip pain after left arthroplasty 4 months earlier. (A) Note the increased uptake across the sacrum in an “H” pattern consistent with recent sacral compression fracture with shearing forces on the sacroiliac joints. (B) CT image shows osteoporosis and did not demonstrate this recent fracture.

A 14-year-old boy who had a Salter Type II fracture (metaphyseal fracture extending to the physis) of the distal right femur 1 year before imaging. Note the absence of the normal epiphyseal plate activity in the distal right femur suggesting growth arrest.

A 13-year-old female dancer with right hip pain. Note the increased uptake in the right ischium consistent with an avulsion fracture.

A 14-year-old girl with right leg pain. Note the fusiform increased uptake in the distal right tibia consistent with a stress fracture.

This anatomic drawing is used by technologists and physicians to mark the location of pain, swelling, or ulcer and is helpful in correlating bone scan findings to involved sites.