"Supernormal" bone image in a case of Waldenström macroglobulinemia

A case of Waldenström macroglobulinemia, a rare cause of diffusely increased skeletal uptake and relatively diminished renal uptake of bone seeking radiopharmaceutical, is presented. This pattern has been described in a variety of disorders. An important observation to be made in these cases is the skeletal distribution of the radiopharmaceutical. In diffuse bone metastases from carcinoma, which is the most common cause of these findings, the increased activity is primarily in the axial skeleton. In some of the more uncommon causes, including certain hematologic disorders, however, the increased skeletal uptake is more homogeneous in distribution, with prominent uptake in the skull and distal extremities.