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Osteolytic lesions typically are not demonstrated by bone scan.


I probably overstated this, and checked some literature to be more certain. Here is a link that suggests 50% of lytic lesions in multiple myeloma are visualized by bone scan.

http://www.auntminnie.com/index.aspx?sec=ser&sub=def&...

For myeloma or very lytic aggressive lesions, however, bone scan is less sensitive. Multiple myeloma lesions are detected about 50% of the time on bone scan, as compared to an 80% detection on skeletal survey. Because of this, skeletal scintigraphy is probably not the procedure of choice for evaluating the presence of skeletal involvement in patients with multiple myeloma or lymphoma.

Also, literature I tried to dig up suggests that lytic lesions in breast cancer are often demonstrated by bone scan 70% of the time or greater when compared to CT standard. In comparison to FDG or F-18 PET scans, bone scan is inferior in detection of osteolytic lesions. FDG PET in particular more sensitive in osteolytic lesions, and less sensitive to osteoblastic lesions. F-18 PET bone scan similar to general bone scan, but spatial resolution much better, accounting for superior detection of both osteoblastic and osteoclastic lesions.

Here is the link for reference regarding lesion phenotype sensitivity by specific imaging modality in 84 patients, I just can't copy and paste key points.

http://books.google.com/books?id=dbm3jZ9LhggC&pg=PA401&a...
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