Anterior and posterior whole-body (WB) views demonstrate normal salivary, hepatic, enteric, and myocardial activity with widespread abnormal patchy marrow uptake (arrows).

Differential Diagnosis

•  MIBG scan showing metastatic neuroblastoma (NB): The presence of cardiac uptake and the lack of normal skeletal uptake make the neuroendocrine-avid MIBG scan most likely. In a young child, NB is most commonly seen. The bone uptake is abnormal.

•  Iodine 131 scan showing metastatic thyroid carcinoma: This can look similar to an MIBG scan, with no normal marrow uptake. However, normal cardiac activity should not be seen, and recurrence is also typically seen in the neck.

•  Octreotide scan showing metastatic tumor: This can also be used for neuroendocrine tumor imaging and also does not have normal marrow uptake. However, intense normal spleen and renal cortical uptake is characteristic, and there would be no normal cardiac activity.