Share this article on:

Superscan-like Hypermetabolic Lesions on Delayed FDG PET/CT Imaging in a Patient With Lung Cancer

Cheng, Gang MD, PhD*; Alavi, Abass MD (Hon), PhD (Hon), DSc (Hon); Lim, Esther MD*; Akers, Scott R. MD, PhD*

doi: 10.1097/RLU.0b013e31825b23d5
Interesting Images

A 69-year-old man with a lung mass underwent multiple-time-point FDG PET/CT imaging for diagnostic evaluation. The initial PET imaging (performed at 1 hour after tracer injection) revealed equivocal bone marrow uptake in the right iliac bone and proximal femurs in addition to lung and mediastinal lesions. The 3-hour delayed PET imaging, however, demonstrated widespread bone marrow metastases. Biopsies of the right lung mass and right iliac bone marrow were later performed and revealed a poorly differentiated squamous cell carcinoma in both sites. This case indicates the value of delayed FDG PET in detecting superscan-like hypermetabolic bone marrow lesions in patients with lung cancer.

From the *Department of Radiology, Philadelphia VA Medical Center; and †Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA.

Received for publication January 31, 2012; revision accepted March 6, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Scott R. Akers, MD, PhD, Department of Radiology, Philadelphia VA Medical Center, 3900 Woodland Ave, Philadelphia, PA 19104. E-mail:



Back to Top | Article Outline


1. Constable AR, Cranage RW. Recognition of the superscan in prostatic bone scintigraphy. Br J Radiol. 1981; 54: 122–125.
    2. Buckley O, O’Keeffe S, Geoghegan T, et al.. 99mTc bone scintigraphy superscans: a review. Nucl Med Commun. 2007; 28: 521–527.
      3. Kim D-W, Kim CG, Park S-A, et al.. Metabolic super scan in F-FDG PET/CT imaging. J Korean Med Sc. 2010; 25: 1256–1257.
        4. Basu S, Alavi A. Bone marrow and not bone is the primary site for skeletal metastasis: critical role of [18F]fluorodeoxyglucose positron emission tomography in this setting. J Clin Oncol. 2007; 25: 1297.
          5. Zhuang H, Pourdehnad M, Lambright ES, et al.. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med. 2001; 42: 1412–1417.
            6. Alkhawaldeh K, Bural G, Kumar R, et al.. Impact of dual-time-point (18)F-FDG PET imaging and partial volume correction in the assessment of solitary pulmonary nodules. Eur J Nucl Med Mol Imag. 2008; 35: 246–252.
              7. Kumar R, Loving VA, Chauhan A, et al.. Potential of dual-time-point imaging to improve breast cancer diagnosis with (18)F-FDG PET. J Nucl Med. 2005; 46: 1819–1824.
                8. Mavi A, Basu S, Cermik TF, et al.. Potential of dual time point FDG-PET imaging in differentiating malignant from benign pleural disease. Mol Imaging Biol. 2009; 11: 369–378.
                  9. Xiu Y, Bhutani C, Dhurairaj T, et al.. Dual-time point FDG PET imaging in the evaluation of pulmonary nodules with minimally increased metabolic activity. Clin Nucl Med. 2007; 32: 101–105.

                    FDG PET/CT; superscan; bone marrow metastasis; lung cancer

                    © 2012 Lippincott Williams & Wilkins, Inc.