PINHOLE SKELETAL SCINTIGRAPHIC MANIFESTATIONS OF TIETZES DISEASE

Tietze's disease (TD) is a self-limited, nonspecific, inflammatory con dition of the upper costochondral junction (CCJ). Unlike in many other skeletal diseases, radiography plays a relatively minor role in TD be cause radiographic changes are frequently obscured by physiological co stochondral calcifications. Bone scanning is a sensitive test for TD, but its specificity is low. The present study has been conducted to as sess prospectively whether pinhole scintigraphy (PS) can enhance diagn ostic specificity in TD. Both planar and PS bone images were obtained in seven ribs of five patients with TD. Scan alterations were analysed and compared with the radiographic findings. Planar scans showed ''ho t'' areas in the region of the CCJ in all seven ribs, these hot areas lacking textural patterns. However, the magnified PS images of the CCJ showed two characteristic uptake patterns: drumstick-like uptake in a cute cases and C- or inverted C-shaped uptake in chronic cases. Radiog raphically, chondritic sclerosis could be seen when physiological chon dral calcifications were minimal or absent, but was obscured when the calcification was prominent. The correlation of PS and radiographic fi ndings revealed that C- or inverted C-shaped uptake indeed faithfully reflected the inflammatory process in the CCJ, the medial border of wh ich is concave. The further correlation of magnetic resonance and PS i mages of two lesions in one patient in whom histological examination w as performed showed that C- or inverted C-shaped uptake is closely ass ociated with hypervascularity of TD. Differential diagnosis between TD , fracture and metastasis is discussed.