In a bone scan, is multiple myeloma typically seen as a hot or cold spot?

In a bone scan, multiple myeloma typically presents as a cold spot. This is due to the nature of the disease, which involves the proliferation of abnormal plasma cells within the bone marrow, leading to a reduction in healthy bone formation. The areas affected by multiple myeloma often show decreased metabolic activity when evaluated with a bone scan, resulting in lower radiotracer uptake compared to normal surrounding bone. This lower uptake is visualized as cold spots on the scan.

In contrast, hot spots are indicative of increased bone turnover or lesions, often associated with conditions that lead to bone metastases, arthritis, or infections, where there is significant osteoblastic activity. Warm spots would represent areas of moderate uptake, and variability in presentation can occur depending on the individual case. However, for the typical case of multiple myeloma, the cold spot identification is the common pattern, reflecting the suppression of normal bone activity due to the disease process.