Vertebral Hemangioma Sparing in a 99mTc-PSMA Superscan

We report a case of a 60-year-old man with biopsy-proven prostate adenocarcinoma who underwent 99mTc-PSMA scintigraphy during evaluation for potential 177Lu-PSMA radioligand therapy. The scan demonstrated diffuse skeletal radiotracer accumulation resembling a bone scan. A focal photopenic defect in the thoracic spine corresponded on SPECT/CT to a vertebral hemangioma of the T9 body. An elongated, ventrally deviated (hook-like) xiphoid process, considered a benign anatomic variant, was also identified. This case underscores the importance of recognizing atypical 99mTc-PSMA distribution patterns and correlating functional with anatomic imaging to avoid misinterpretation and optimize diagnostic accuracy.