Bone Scan with Confusing Appearance: Superscan or Metabolic Disorder

Stefan Gratz*, 1, 2, Wolf Kaiser2, Thomas M. Behr1
1 Department of Nuclear Medicine of the Philipps University, Marburg, Germany
1 Department of Nuclear Medicine, Stuttgart, Germany

© 2018 Gratz et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Nuclear Medicine, Seelbergstraße 11, D-70372 Stuttgart, Germany; Tel: 011 - 49 - 711-5538241; Fax: 011 - 49 - 711-5538246; E-mail:


We present a patient with metastatic prostate cancer with known bone involvement and unknown osteomyelofibrosis. It has the general appearance of a superscan, with homogeneously increased tracer uptake and no visualization of the kidneys. However, while a superscan should have greater uptake in the axial skeleton compared to the appendicular skeleton, this scan is reverse, raising the suspicion of an overlying metabolic bone disorder. Subsequent laboratory-, bioptical findings confirmed a myeloproliferative syndrome with osteomyelofibrosis. As such, this scan demonstrates that in a patient with both affiliations, metabolic bone disease can override even severe osseous metastases on a bone scan.

Keywords: Prostate cancer, metastasis, metabolic disorder, bone scan.