Multiple "cold" areas demonstrated on bone scintigraphy in a patient with neuroblastoma

A "cold" or photopenic defect on bone scintigraphy is a well recognized phenomenon and has been described in several conditions affecting bone. An unusual case of multiple "cold" defects in a patient with stage IV neuroblastoma is presented. A follow-up scan with the patient in clinical remission shows resolution of these "cold" defects. The patient subsequently relapsed and again multiple new "cold" defects were noted on bone scintigraphy. The possible etiology of "cold" defects is discussed.