title: Focally increased activity in the lateral aspect of the mid cervical spine on bone scintigraphy is almost always benign in nature.
abstract: OBJECTIVE
  Abnormal bone scan findings in the spine are often nonspecific. The confidence level for the differential diagnosis between metastases and benign or degenerative changes may vary depending on their appearance, location or intensity. The recognition of a specific pattern for certain benign conditions and its subcategorization will increase the credibility of bone scan interpretation while retaining a high level of sensitivity. We report one such finding, focally increased activity on the lateral side of the cervical spine on the posterior view, most common at the C3-C5 level ("mid-cervical-lateral-focus").
  
  
  METHODS
  Of 481 patients with various cancers who had at least 2 whole-body bone scans, 6 months or more apart, 41 patients were judged to show this characteristic "mid-cervical-lateral-focus" on at least one scan. Final diagnosis (metastasis vs. benign) for each "mid-cervical-lateral-focus" was made based on clinical grounds and serial bone scans.
  
  
  RESULTS
  The bone scan showed definite multiple metastases in 15 patients, and the differential diagnosis for the "mid-cervical-lateral-focus" was already clinically irrelevant in these patients. Nevertheless, the "mid-cervical-lateral-focus" was finally judged to be benign in 14 of these 15 patients and in all remaining 26 patients without other obvious metastases. The only "mid-cervical-lateral-focus" judged to be a metastatic focus was not only clinically redundant, but also the most intense among all the "mid-cervical-lateral-foci." in this series (too intense to be interpreted as benign).
  
  
  CONCLUSIONS
  The typical "mid-cervical-lateral-focus" pattern is extremely unlikely to represent metastases (virtually 0% in patients without other obvious metastases). This knowledge helps exclude metastases on bone scans.
authors.affiliation: Division of Nuclear Medicine, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Kim
authors.forename: Suk Chul
authors.initials: SC
authors.lastname: Kim
authors.forename: Borys R
authors.initials: BR
authors.lastname: Krynyckyi
authors.forename: Josef
authors.initials: J
authors.lastname: Machac
authors.forename: Chun K
authors.initials: CK
authors.lastname: Kim
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000556:secondary*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity