Pinhole skeletal scintigraphic manifestations of Tietze's disease

Tietze's disease (TD) is a self-limited, non-specific, inflammatory condition of the upper costochondral junction (CCJ). Unlike in many other skeletal diseases, radiography plays a relatively minor role in TD because radiographic changes are frequently obscured by physiological costochondral calcifications. Bone scanning is a sensitive test for TD, but its specificity is low. The present study has been conducted to assess prospectively whether pinhole scintigraphy (PS) can enhance diagnostic specificity in TD. Both planar and PS bone images were obtained in seven ribs of five patients with TD. Scans alterations were analyzed and compared with the radiographic findings. Planar scans showed "hot" 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 acute cases and C- or inverted C-shaped uptake in chronic cases. Radiographically, chondritic sclerosis could be seen when physiological chondral calcifications were minimal or absent, but was observed when the calcification was prominent. The correlation of PS and radiographic findings revealed that C- or inverted C-shaped uptake indeed faithfully reflected the inflammatory process in the CCJ, the medial border of which is concave. The further correlation of magnetic resonance and PS images of two lesions in one patient in whom histological examination was performed showed that C- or inverted C-shaped uptake is closely associated with hypervascularity of TD. Differential diagnosis between TD, fracture and metastasis is discussed.