Diffuse Idiopathic Skeletal Hyperostosis Can Resemble Metastases on Bone Scan

This report describes Tc-99m MDP uptake in diffuse idiopathic skeletal hyperostosis (DISH). DISH produces ossification of the anterolateral aspect of vertebral bodies by an unknown mechanism. The disease is not frequent in the nuclear medicine literature although the total incidence is in the region of 6%. DISH can be diagnosed on plain radiography because it produces flowing ossification, large osteophytes, bony ankylosis, and only mild decrease in intervertebral disk heights. This case demonstrates that DISH can produce a scintigraphic pattern that resembles metastases.