Comparison of radionuclide images and radiographs for skeletal metastases from renal cell carcinoma.

68 metastatic bone lesions proven by biopsy, follow-up radionuclide bone imaging, or radiographs in 18 patients with surgically confirmed renal cell carcinoma were retrospectively analyzed. Bone imaging demonstrated 62 lesions (91%): 48 definite, 7 questionable 'hot' lesions, and, 2 definite, 5 questionable 'cold' lesions. The spine was the most common site. 15 patients had more than one metastasis. 27 lesions were undiscovered by radiographs. Serum alkaline phosphatase was elevated in 12 of 18 patients. It is concluded that radionuclide bone imaging is more sensitive than radiographic examination for bony metastasis from renal cell carcinoma, and that it is important to recognize 'cold' metastatic lesions on the bone imaging in patients with renal cell carcinoma.