Does this help? How?
Not really. Both myeloma and skeletal metastases can have increased activity. A normal bone scan despite extensive radiographic abnormality would favour multiple myeloma.
When multiple rib-hotspots line up (as is the case on the right 3rd, 4th and 5th ribs) what is the most likely aetiology?
Fractures.
The patient was injected with 99m-Technetium MDP and initial dynamic (not shown) and whole body blood pool images obtained. Whole body imaging were obtained 3 hours later.
With respect to the left femoral head there is increased focal uptake involving the greater and lesser trochanters suspicious for fracture. The distribution of uptake does not fit a usual pattern for neck of femur fracture. Physiological bladder and pudendal uptake is noted.
On the whole body blood pool images increased perfusion at the proximal left femur was seen. Delayed whole body images demonstrate multiple focal intensities of tracer involving the medial end of the left clavicle as well as the 2nd and 5th ribs anteriorly. There are further areas of focal intensity involving the right 3rd, 4th, 5th, 6th and 7th ribs anteriorly as well as increased tracer uptake in the vertebral body of T9.