Focal 99mTc-MDP Uptake in Liver in Bone Scintigraphy in Patient with Hepatocellular Carcinoma: A Rare Case Report

Background: 99mTc-methylene diphosphonate (99mTc-MDP) bone scintigraphy is widely applied in the evaluation of both benign and malignant skeletal disorders. Nevertheless, extra-osseous accumulation of the radiotracer is an uncommon finding. Understanding the underlying pathophysiological mechanisms of such uptake is essential, as in certain contexts it may carry important diagnostic implications. In other cases, alterations in tracer biodistribution may have limited clinical relevance but can markedly compromise image interpretation. The purpose of this case report is to highlight these atypical patterns in order to minimize diagnostic errors and provide valuable clinical insights. Case Presentation: A 45-year-old woman with a history of hepatocellular carcinoma (HCC), previously managed with multiple cycles of chemotherapy, presented with low back pain and paresthesia characterized by burning sensations in both lower limbs. A 99mTc-MDP bone scan was performed to exclude potential skeletal metastases. Unexpectedly, the scan demonstrated prominent radiotracer accumulation in segments V, VI, and VII of the right hepatic lobe. Conclusion: This report discusses potential mechanisms contributing to such pronounced hepatic uptake. In this patient, the findings are most likely attributable to necrotic hepatic changes secondary to prior chemotherapy for HCC.