Spinal Uptake Mimicking Metastasis in SPECT/CT Bone Scan in a Patient With Superior Vena Cava Obstruction Olivier Rager, MD,* Rene´ Nkoulou, MD,* Valentina Garibotto, MD,* Sana Boudabbous, MD,Þ and Daniel Arditi, MDÞ Abstract: A 46-year-old female patient with a mediastinal neuroendocrine carcinoma complicated by superior vena cava syndrome was referred for a bone metastatic workup. Bone scan with SPECT/CT showed several vertebral fixations without alterations on the unenhanced CT, but a CT scan with in- jection of contrast media showed vertebral densities matched to the lesions described on the SPECT/CT. This pattern confirmed presence of collateral paths through vertebral veins due to superior vena cava syndrome. Lack of metastases was confirmed by MRI. Key Words: SPECT/CT, bone scan, superior vena cava obstruction (Clin Nucl Med 2013;38: 908Y909) REFERENCES 1. Gosselin MV, Rubin GD. Altered intravascular contrast material flow dynamics: clues for refining thoracic CT diagnosis. AJR Am J Roentgenol. 1997;169: 1597Y1603. 2. Thomas N, Oliver TB, Sudarshan T. Vanishing bone metastasesVa pitfall in the interpretation of contrast enhanced CT in patients with superior vena cava obstruction. Br J Radiol. 2011;84:e176Ye178. 3. Eckenhoff JE. The vertebral venous plexus. Can Anaesth Soc J. 1971;18: 487Y495. 4. Stanford W, Jolles H, Ell S, et al. Superior vena cava obstruction: a venographic classification. AJR Am J Roentgenol. 1987;148:259Y262. 5. Trigaux JP, Van Beers B. Thoracic collateral venous channels: normal and pathologic CT findings. J Comput Assist Tomogr. 1990;14:769Y773. 6. Sheth S, Ebert MD, Fishman EK. Superior vena cava obstruction evaluation with MDCT. AJR Am J Roentgenol. 2010;194:W336YW346. 7. Blake GM, Frost ML, Fogelman I. Quantitative radionuclide studies of bone. J Nucl Med. 2009;50:1747Y1750. 8. Brenner AI, Koshy J, Morey J, et al. The bone scan. Semin Nucl Med. 2012; 42:11Y26. INTERESTING IMAGE 908 www.nuclearmed.com Clinical Nuclear Medicine & Volume 38, Number 11, November 2013 Received for publication March 28, 2013; and revision accepted June 20, 2013. From the *Nuclear Medicine Department and †Department of Radiology, Faculty of Medicine, Geneva University Medical Center, University of Geneva, Geneva, Switzerland. Conflicts of interest and sources of funding: none declared. Reprints: Olivier Rager, MD, Nuclear Medicine Department, Faculty of Medicine, Geneva University Medical Center, University of Geneva, rue Gabrielle-Perret-Gentil, 4, CH-1211 Geneva, Switzerland. E-mail: olivier.rager@hcuge.ch. Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0363-9762/13/3811Y0908 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.