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.