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Figure 4. (a) Whole body skeletal survey with 99Tcm MDP showed focal uptake of tracer in the skull, proximal end of left femur, sacrum and right ischium. Non-visualization of right ilium was consistent with history of surgery. (b) 99Tcm(V)DMSA whole body scan at 3 h post injection showed uptake at similar sites. (c) The MRI coronal short tau inversion recovery image reveals hyperintense marrow signal at the proximal end of left femur. (Continued)(d, e) The patient received further chemotherapy and improved symptomatically. A repeat 99Tcm(V)DMSA whole body scan revealed much less concentration in the skull and proximal end of left femur, the sacral concentration was not seen. In view of the clinical and scan findings further chemotherapy was advised. (f) The bone scan after four cycles of chemotherapy continued to show increased uptake at the metastatic sites consistent with the "flare phenomenon".
