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IMAGE INTERPRETATION · BONE IMAGING

Photopenic Bone Lesions: Multiple Myeloma

Whole-body bone scintigraphy — photopenic (cold) skeletal lesion
Whole-body bone scintigraphy — photopenic (cold) skeletal lesion

CC BY-SA 3.0 · Wikimedia Commons · source file

Question

A bone scan shows a focal area of DECREASED (photopenic or 'cold') uptake in the lumbar spine in a patient with known multiple myeloma. Why might myeloma lesions appear COLD on bone scan?

  1. AMultiple myeloma produces predominantly osteolytic lesions with little osteoblastic response
  2. BMultiple myeloma suppresses thyroid function, reducing MDP uptake
  3. CMyeloma lesions have increased blood flow that washes out the tracer
  4. DMultiple myeloma causes diffuse marrow infiltration that blocks tracer delivery
Show the answer and explanation

A. Multiple myeloma produces predominantly osteolytic lesions with little osteoblastic response

Multiple myeloma is a predominantly osteolytic malignancy — it destroys bone by stimulating osteoclasts without triggering a significant osteoblastic response. Since Tc-99m MDP localizes via osteoblastic activity (chemisorption onto hydroxyapatite during bone formation), purely lytic lesions with no osteoblastic response will show little or no tracer uptake — appearing cold (photopenic). This is why conventional bone scan has lower sensitivity for myeloma (~50–70%) compared to FDG PET/CT or whole-body MRI, which are preferred for myeloma staging.

More bone imaging images

Three-phase bone scan showing increased flow/blood pool in soft tissues with normal delayed bone uptake — pattern of cellulitisCellulitis vs Osteomyelitis on Three-Phase Bone Scan Normal whole-body Tc-99m MDP bone scan — anterior and posterior projectionsNormal Physiologic Uptake on a Bone Scan Tc-99m MDP bone scan showing uptake in the tibial regionShin Splints on Bone Scan: Medial Tibial Stress Syndrome Tc-99m MDP bone scan — femoral head and neck regionAvascular Necrosis of the Femoral Head on Bone Scan Three-phase bone scintigraphy — serial imagesFlare Phenomenon on Bone Scan After Chemotherapy Whole-body Tc-99m MDP bone scan in a patient with prostate cancerBone Scan for Staging High-Risk Prostate Cancer
← Paget’s Disease of Bone on Bone ScanCellulitis vs Osteomyelitis on Three-Phase Bone Scan →

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