An Overlooked Signal on Routine Bone Scans: Soft Tissue Uptake, Mortality and Cardiovascular-Kidney-Metabolic Burden

Soft tissue-to-bone ratio above 0.5 on routine whole-body bone scintigraphy in 8,769 Austrian patients without cardiac uptake is linked to higher all-cause mortality (aHR 1.73).

• Why it matters: Clinicians often dismiss soft tissue signal on scans lacking cardiac uptake as background, leaving uncertainty about whether it predicts mortality and cardiovascular-kidney-metabolic risk.
• What they did: In a retrospective cohort (Austria, 2010–2020), blinded observers measured STBR continuously and at a prespecified threshold of 0.5, then used Cox models adjusted for 10 risk factors.
• The result: STBR >0.5 was associated with MACE (aHR 1.51) and heart failure hospitalization (aHR 1.31), and STBR tracked CKM burden from 0.32 at stage 0 to 0.41 at stage 4 (rho=0.30; P<0.001).

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