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Figure 8. Diffuse prostatic metastases producing a "super scan". Anterior (left) and posterior (right) total body scans show intense uniform concentration in the vertebral column, pelvis and sternum. The usual soft tissue background and kidneys are not visible by comparison. Enhanced uptake in the skull and ribs is also present, but in this illustration is overwhelmed by the spine and pelvis.

Photopenic defects are an important sign of tumor presence and should be considered with the same gravity as focal increases in activity. They are probably due to vascular compromise as a result of tumor compression of the small marrow vessels.

Since photopenic or "cold" lesions are harder to resolve than the typical "hot" lesion, those "cold" lesions that are detected are relatively large (Fig. 9).

Figure 9. Photon deficient metastasis. This patient with carcinoma of the prostate had a solitary asymptomatic lesion (arrow) in the thoracic spine at staging. Six months later he developed upper back pain and the bone scan was normal except for a photopenic focus in a thoracic vertebra (arrow), which corresponded to the site of pain. A scan four months later revealed widespread metastatic disease.

Figure 9. Photon deficient metastasis. This patient with carcinoma of the prostate had a solitary asymptomatic lesion (arrow) in the thoracic spine at staging. Six months later he developed upper back pain and the bone scan was normal except for a photopenic focus in a thoracic vertebra (arrow), which corresponded to the site of pain. A scan four months later revealed widespread metastatic disease.

Back Pain Relief

Back Pain Relief

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