Case Author(s): J. Philip Moyers, MD and Jerold Wallis, M.D. , 10/3/95 . Rating: #D2, #Q3

Diagnosis: Prostate Carcinoma, metastatic to liver

Brief history:

Prostate carcinoma


Anterior and posterior whole body delayed images

View main image(bs) in a separate image viewer

View second image(ct). Single axial image from a contrast enhanced CT of the abdomen

Full history/Diagnosis is available below

Diagnosis: Prostate Carcinoma, metastatic to liver

Full history:

69-year old man with known prostatic carcinoma diagnosed in March 1992. Radical prostatectomy was performed in June 1992. The patient is currently under treatment with leuprolide (LupronŽ), and has otherwise not had chemotherapy. The patient has known hepatic and osseous metastatic disease.


22.0 mCi Tc-99m MDP i.v.


Multiple areas of increased uptake consistent with osseous metastases are demonstrated, including the right femoral neck, L2, the left scapula, and several sites in the pelvis. Also noted is an abnormal focus of increased activity in the right upper quadrant of the abdomen. Correlation with the CT scan dated 8-17-95 demonstrates diffuse hepatic metastases. A single very large hepatic metastasis is demonstrated in the medial segment of the left hepatic lobe, which likely corresponds to the abnormal focus of increased soft tissue tracer uptake.


There are many causes of abnormal soft tissue uptake on bone scintigraphy. Bone scintigraphy agents have historically included a variety of Tc-99m labeled phosphate and diphosphonate compounds, with current use of methylene diphosphonate (MDP) and hydroxymethylene diphosphonate (HMDP). Like the early agent pyrophosphate (still used for myocardial infarct imaging), these radiopharmaceuticals tend to localize in areas of dystrophic calcification or necrotic tissues. Metastatic adenocarcinomas from ovarian, breast and GI malignancies commonly undergo necrosis and develop dystrophic calcification.


1) Mettler FA. Essentials of Nuclear Medicine Imaging. 1991, 3rd edition.

2) Datz FL. Handbook of Nuclear Medicine, Mosby Yearbook Publishers, 1993, 2nd edition.


CT scan dated 8-17-95 demonstrates diffuse hepatic metastatic disease.

Major teaching point(s):

Evaluation of soft tissue uptake on bone scintigraphy can sometimes be a clue in evaluation of disease processes. In this case, abnormal uptake is demonstrated within the axial skeleton as well as the right upper quadrant. If one attributes both findings to a single pathologic process, the diagnosis of metastatic disease involving the liver and bone becomes highly likely.

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Neoplasm, Neoplastic-like condition)

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Case number: bs039

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