Bone marrow metastasis (BMM) of solid tumors is a rather rare but a relatively early phenomenon. Stem cells expressing CD44, a hyaluronic acid cell surface receptor, has been accused for the early deposition of malignant cells in the bone marrow  BMM poses a clinical challenge to the oncologist in tailoring chemotherapy options and dosing especially when complete blood counts are compromised. Therefore, early diagnosis of BMM of solid tumors is of utmost importance depending on the primary solid tumor. For decades, conventional methods such as bone scintigraphy, MR, CT and also FDG PET and FDG PET/CT have been used to show bone and bone marrow metastasis. These imaging modalities can be divided into two groups based on the differences in physical and biological principles as those which detect disease site at bone marrow and osteoblastic reaction after invasion of surrounding bone by the pathologic process. The former one was further subclassified into two groups as those that visualize lesions as negative focal marrow defects seen on BMS or MR and those that directly visualize abnormal tissue such as with FDG PET/CT . In addition to imaging modalities other methods such as low mean platelet volume (MPV) and meticulously prepared touch imprint smears  or circulating tumor cells (CTCs)  have been studied in demonstrating BMM. FDG PET/CT has the advantage of giving information about primary tumor site, lymph node status, and other organ metastasis in a single study, which has been regarded as a “quantum jump” in nuclear medicine. In addition, it has directed attention to the bone marrow not only to search for unsuspected deposits but also to perform high yield bone marrow biopsies at least in lymphomas and multiple myeloma [4, 5].