technetium-tc-99m-medronate and Hyperostosis--Sternocostoclavicular

The purpose of this retrospective study was to examine the value of whole-body nuclear medicine imaging and to evaluate the typical scintigraphic pattern of sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO). In this entity the correct diagnosis is frequently missed because of uncharacteristic changes in other imaging modalities.. Forty-nine patients (age range 15-65 years old, mean age 36 years) with sternocostoclavicular hyperostosis (SCCH) and/or pustulotic arthroosteitis (PAO) were examined with whole-body scintigraphy and conventional radiography.. Forty-three of 49 patients with SCCH/PAO showed a characteristic "bullhead"-like high tracer uptake of the sternocostoclavicular region with 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.. Bone scintigraphy is the imaging modality of choice for the diagnosis of skeletal involvement in PAO. Nuclear medicine reveals unexpected locations and shows the typical pattern of focal hot spots of the spine, sacroiliac joints and/or appendicular skeleton in the large 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 radionuclide bone scans and helps to avoid unnecessary biopsies.

Topics: Adolescent; Adult; Aged; Arthritis, Psoriatic; Biopsy; Bone and Bones; Diagnosis, Differential; Female; Humans; Hyperostosis, Sternocostoclavicular; Magnetic Resonance Imaging; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sternoclavicular Joint; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Sternocostoclavicular hyperostosis (SCCH) is a rare disease that is characterized by hyperostosis and soft tissue ossification between the clavicles and the anterior part of the upper ribs. There have been few published reports of 99mTc-MDP bone imaging findings in this disease. Thirty-three patients who were suspected to have SCCH were studied with 99mTc-MDP bone imaging. Bone images were abnormal in 31 (94%) of 33 patients. Chest radiographs were available in 30 patients, but negative in 14 (46%) of them. Bone imaging revealed also radionuclide accumulations in other bones such as the vertebrae, femur or sacroiliac joints in ten (14 sites) of 33 cases. Bone scintigraphy was useful in the diagnosis of sternoclavicular hyperostosis.

Topics: Adult; Bone and Bones; Female; Humans; Hyperostosis, Sternocostoclavicular; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate

Topics: Humans; Hyperostosis, Sternocostoclavicular; Technetium Tc 99m Medronate; Tomography, X-Ray Computed