Increased Activity on Immediate Phase of Bone Imaging Does Not Always Indicate Increased Blood Volume

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Abstract
The immediate Tc-99m MDP image of a neoplastic right wrist mass in a 10-year-old boy demonstrated intense focal accumulation that suggested a very vascular tumor, but delayed images showed only slightly increased activity in the mass. A Tc-99m labeled RBC study was performed to permit whole-body blood pool imaging for other vascular lesions, and it did not demonstrate an increased blood volume in the mass. Biopsy showed the tumor to be a Ewing''s sarcoma, probably of soft tissue origin. The sarcoma was not very vascular. The intense immediate accumulation of Tc-99m MDP in this case may be attributed to increased microvascular permeability.

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