the " super scan " of bone scintigraphy is defined as a bone image that " looks too good . " its characteristics include intense activity in the bones and diminished renal parenchymal activity ( 1 ) . ( 2 ) had reported the case of f - fluorodeoxyglucose positron emission tomography ( fdg pet ) super scan involving skeletons , similar to the super scan of bone scintigraphy . a " hepatic super scan " by fdg pet has been reported in a patient with hodgkin disease who had unusually elevated hepatic radioactivity , in addition to the multiple areas of focal uptake in the chest , mediastinal , left axillary , and abdominal lymph nodes , and the adrenal glands . here we report a case of f - fdg pet / ct super scan showing extensive hypermetabolic lesions throughout the skeletons and liver . contrary to the intense hypermetabolism of skeletons and liver , the skeletal muscles of limbs , mediastinum , bowel , and especially brain showed very low fdg uptake . subsequent diagnostic ct imaging of chest and abdomen revealed 3.8 cm sized mass in left lower lung with multiple lymph nodes and hepatic metastasis . excision biopsy of supraclavicular lymph node was performed and histopathologic diagnosis was small cell lung cancer . the patient 's mental status was clear and he underwent f - fdg pet / ct ( biograph sensation 16 , siemens medical systems , usa ) for staging of lung malignancy , 1 hr after injection of 444 mbq ( 12 mci ) f - fdg . f - fdg pet / ct demonstrated focal hypermetabolic lung mass in left lower lobe with diffuse and intense hypermetabolism throughout the skeleton and liver . interestingly , skeletal muscles of limbs , mediastinum , bowel , and especially brain showed very low fdg uptake ( fig . 1 ) . this patient had no medications could disturb cerebral glucose metabolisms , such as corticosteroids and sedatives . a super scan is well - known phenomenon which is characterized by a strikingly high bone to soft tissue ratio on skeletal scintigraphy , with a uniform symmetrical increase in bone uptake and absent renal visualization ( 4 ) . the super scan is associated with various malignancies , and most commonly in carcinomas of the prostate , stomach and breast ( 5 ) . metastasis from lung cancer rarely causes a super scan , although multiple bone metastases or bone marrow involvement frequently occur in patients with lung cancer ( 6 ) . sy et al . ( 7 ) hypothesized that the increased uptake of radiopharmaceutical by diseased bone results in reduced phosphate excretion , thereby producing faint renal images in the bone scintigraphy . first , even though this is not uncommon feature in patients with extensive metastasis , intense and diffuse hypermetabolism throughout the skeleton and liver was demonstrated . the similar findings had reported in other cases of fdg pet super scan , however , this case had shown the best contrast between metastatic organs and non - metastatic organs ( 2 , 3 , 8) . second , fdg uptakes in skeletal muscles of limbs , mediastinum , bowel , and especially brain were remarkably low and this is the unique characteristic of the present case . the faint visualization of the brain , renal cortex , and soft tissue might be the result of extraordinarily high uptake of fdg by bony and hepatic metastatic lesions . low brain uptake of fdg has been reported when using corticosteroids and sedatives , and these conditions should be taken into consideration ( 9 , 10 ) . the present patient had no medications could disturb cerebral glucose metabolisms , such as corticosteroids and sedatives . because of some characteristics in common with super scan on skeletal scintigraphy , this case could be considered as ' metabolic super scan ' .