J. Freyschmidt et A. Sternberg, THE BULLHEAD SIGN - SCINTIGRAPHIC PATTERN OF STERNOCOSTOCLAVICULAR HYPEROSTOSIS AND PUSTULOTIC ARTHROOSTEITIS, European radiology, 8(5), 1998, pp. 807-812
Objective: The purpose of this retrospective study was to examine the
value of whole-body nuclear medicine imaging and to evaluate the typic
al scintigraphic pattern of sternocostoclavicular hyperostosis (SCCH)
and/or pustulotic arthroosteitis (PAO). In this entity the correct dia
gnosis is frequently missed because of uncharacteristic changes in oth
er imaging modalities. Materials and methods: Forty-nine patients (age
range 15-65 years old, mean age 36 years) with sternocostoclavicular
hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO) were examin
ed with whole-body scintigraphy and conventional radiography. Result:
Forty-three of 49 patients with SCCH/PAO showed a characteristic ''bul
lhead''-like high tracer uptake of the sternocostoclavicular region wi
th the manubrium sterni representing the upper skull and the inflamed
sternoclavicular joints corresponding to the horns (= bullhead sign).
Scintigraphy revealed additional skeletal manifestations (spondylitis,
sacroiliitis, osteitis) in 33 of 49 patients with SCCH and/or PAO. Co
nclusions: Bone scintigraphy is the imaging modality of choice for the
diagnosis of skeletal involvement in PAO. Nuclear medicine reveals un
expected locations and shows the typical pattern of focal hot spots of
the spine, sacroiliac joints and/or appendicular skeleton in the larg
e majority of cases in combination with a bullhead-like tracer uptake
of the sternocostoclavicular region. The bullhead sign is the typical:
and highly specific scintigraphic manifestation of SCCH and PAO in ra
dionuclide bone scans and helps to avoid unnecessary biopsies.