Bone Scan-Which spots are Worse, White or Black?

Help!!! I had a bone scan today and made the tech show me the films. OMG. The whole thing was black...hips, spine, skull, ribs. Guess she was surprised when I did a sit up and jumped off the table. So, I went on the internet to research how to read a bone scan and it says that white spots can be cancer and black spots are cancer. It's like Catch 22, you just can't win.
Does anybody know which is worse? Or are they equally bad?

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Here's something:

A bone scan looks for changes or abnormalities in the bones. It is also called a radionuclide scan, or a scintigram. It is usually done in the medical physics department, nuclear medicine department, or x-ray department of the hospital. A bone scan can look at a particular joint or bone. In cancer diagnosis, it is more usual to scan the whole body. The scan involves one injection, but apart from that, it is painless.

The scan uses a large camera called a gamma camera. Gamma cameras pick up radioactivity. To have the scan, you first have a radioactive substance called a radionuclide injected into your bloodstream. You only need a very small amount of this radioactive substance - not enough to do you any harm. The radionuclide travels through the blood and collects in your bones. More of it tends to collect in areas where there is a lot of activity in the bone. 'Activity' means the bone is breaking down, or repairing itself. These areas of activity are picked out by the camera. Doctors call them 'hot spots'. Below is an example of a bone scan showing dark areas (hot spots) in some places.

Having 'hot spots' doesn't necessarily mean that there is cancer in your bones. Bone can break down and repair for other reasons. For example, if you have arthritis or an old fracture this will also show up on the scan.


Did you talk to your radiologist yet, or see the report? I used google images to check this out and some spots that looked to me like cancer were actually old breaks or injuries. I don't think the untrained eye is very good at distinguishing those dark spots that are mets vs those that are there for other reasons. For instance, I wonder what bisphosphonates do to bone scans?

The fact that the whole thing was black, instead of having discrete spots of greater uptake, makes me think that what you were seeing is not mets (maybe just the way the scan was done?). Check out google images under 'bone scan breast cancer in bones' and you'll see what I mean.


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Important thing to know is that bone scans are done in 2 types of imaging black or white. If you don't know which way your scan was imaged you may be seeing the opposite image which means black is good. I find these peeks we take a bad thing and i am also guilty of doing it. Do not always believe what you think you see...It takes a trained eye. Praying for you, Yoie

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Generally I like to face things with my eyes open -- getting shots by needle, having teeth drilled, a wound sewed up.

However, I have found that to the untrained eye, the cancer scans are so alarming that I have been choosing not to look at that. I have lots and lots in my bones.

So meanwhile, I'm feeling mostly good and have been enjoying life four years since diagnosis of bone mets.

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My scans were always bright where the cancer was. I was alarmed at how bright it was right down between my legs, and the tech laughed and said that was where all the dye was concentrated in the bladder! So maybe on your scan whichever color it is near the bladder is the color that the cancer would be?!

I also insist on looking. It's my body, my life, and I want to know.

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I take a look when I want to scare my grandkids, the bone scan for the skeleton and especially the CT scans where I show them my guts! I find them fascinating albeit a bit creepy.

In my scan they show the tracer as white hot spots. They were in the exact areas the oncologist said they were. The ones in the hands, feet and ankles were most likely from arthritic changes as breast cancer very seldom finds a home below the knees or elbows.

If we try and interpret them ourselves we should be getting the big money that the radiologists get.

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That's why radiologists read these scans -- they are indeed tricky. So after 4 years of medical school, 5 years of residency, and usually a fellowship in a certain type of radiology (like nuclear, such as bone scans), they are then trained to read our scans. CT scans also show bone involvement, so often radiologists look at the bone scan and the CT scans to compare areas, as a bone scan can be nonspecific. That's what they often do with my scans which show...."widespread osseous disease...." My limited understanding, and I am not a radiologist, is that white spots can indicate lytic mets, and black spots can indicate osteoblastic mets or mets in the process of healing. Other processes like arthritis can cause abnormal bone scans, and this is the reason for comparing spots to CT scans or even x-rays. So it is confusing because there are different types of bone mets and also other problems that cause abnormal findings. Complicated!!

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OK you've convinced me that I am not competent to read a bone scan. You ladies are really my life savers always! Don't know what I'd do without you.
Thanks a million. (But if all that black is really, really bad I'm going to post a big I told you so :))

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Agreed, I am not competent to read my bone scans however I do know the pain is in the areas where the Radiologist and Oncologist said I have bone cancer - head, neck, spine, ribs and pelvis. The bone cancer shows up white on mine and this was pointed out to me on the screen.

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Personally, I always want to look, but don't like the way I look like a huge marshmallow man with bones on the CT. I hate that it shows fat.

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