CAN (99M)TECHNETIUM METHYLENE DIPHOSPHONATE BONE SCANS OBJECTIVELY DOCUMENT COSTOCHONDRITIS

Study objectives: To determine whether bone imaging with Tc-99m methyl ene diphosphonate is a specific method of making the diagnosis of cost ochondritis in patients with chest pain who rule out for myocardial in farction. Design: Nonblinded prospective controlled study in 20 patien ts and 10 control subjects, Setting: Inpatient medical service of a te rtiary teaching hospital. Patients: Two hundred consenting patients ad mitted to the hospital with chest pain and suspected myocardial infarc tion were examined. Those in whom acute myocardial infarction mas rule d out were evaluated for the clinical signs of costochondritis, ie, te nderness other one or more costochondral junctions, Twenty patients wh o met the clinical criterion gave informed consent and were subjected to bone imaging, Ten control subjects with cancer who did not have cli nical signs of costochondritis underwent bone imaging to rule out meta static disease (normal in all cases). Interventions: Bone imaging with IV Tc-99m methylene diphosphonate. Measurements: Bone scans of the in vestigative patients and the control subjects were read by two indepen dent nuclear medicine specialists, Results: Sixteen of the 20 patients with clinically diagnosed costochondritis showed increased technetium uptake at all costochondral junctions bilaterally; six of them also h ad increased uptake elsewhere on the chest mall (sternum, manubrium, o r first rib), All 10 of the control patients likewise showed increased technetium uptake at all costochondral junctions bilaterally. Conclus ions: Bone imaging with Tc-99m methylene diphosphonate is not a specif ic method of making the diagnosis of costochondritis.