Renal metastases shown by 99mTc-methylene diphosphonate scintigram which failed to detect vertebral metastases

A patient with breast metastases is presented showing increased nodular renal uptake of tracer on bone scintigraphy that also demonstrated rib metastases and a large metastasis in the pelvis. However, vertebral body metastases were not shown when clearly demonstrated on CT with even partial compression on a thoracic spine film. Most of the renal lesions were hypoechoic on sonography, showed hypoattenuation areas on plain CT and after contrast enhancement but no calcification could be demonstrated. This case once again illustrates the value of scrutinizing the soft tissues on scintigraphy but also the possibility of showing some metastases on CT not visible on scintigraphy.