SCINTIGRAPHIC EVALUATION OF METASTATIC OSTEOSARCOMA - THE IMPORTANCE OF SPECT BONE-SCINTIGRAPHY AND CORRELATIVE IMAGING

A 31-year-old man with a history of osteosarcoma and prior resection o il ii-se left distal femur had an acute onset of hemoptysis. Planar sk eletal scintigraphy with Tc-99m MDP showed an area of increased uptake in the region of the posterior left 8th rib, suspicious for a metasta tic lesion. Chest x-ray showed a pulmonary nodule in the left lower lo be, Rib x-rays showed no metastases. Because the patient was scheduled for a thoracotomy to remove the lung lesion, original plans called fo r removal of the left eight posterior rib as as well, Repeat hone scin tigraphy, this time using SPECT, clearly showed that the lesion identi fied on planar imaging was indeed int the pulmonary parenchyma and not in the rib, representing ''shine through.'' This case shows the impor tance of correlative imaging as well as SPECT bone scintigraphy when f indings on the planar study are not clear, and it may affect the patie nt's surgical management.