title: Ribbing disease (multiple diaphyseal sclerosis): imaging and differential diagnosis.
abstract: OBJECTIVE
  This study describes the clinical presentation and the course of Ribbing disease in six patients and illustrates imaging features on plain radiography, conventional and computed tomography, and 99mTc-methylene diphosphonate bone scans.
  
  
  METHODS
  Between 1982 and 1990, six female patients presented with painful bony lesions that were believed to be Ribbing disease. Ten bones were affected: both tibiae in three patients, a unilateral tibia in one, both femora in one, and a unilateral femur in one. Plain radiographs and either conventional or computed tomography were available for all patients and 99mTc-methylene diphosphonate bone scans, for five patients. All patients underwent open biopsy and/or surgical decompression.
  
  
  RESULTS
  The diagnosis was reached in all patients through a combination of clinical findings (lack of systemic signs of infection or laboratory values suggesting metabolic bone disease), imaging, histologic evaluation, and specimen cultures. Radiographs and tomographic studies showed benign-appearing endosteal and periosteal cortical thickening. Intense uptake of radionuclide tracer was confined to the shaft of all involved bones. All pathologic specimens revealed nonspecific changes that included a slow increase in the mass of cortical and endosteal bone. These specimens also assisted in excluding neoplastic or infectious causes for the new bone formation.
  
  
  CONCLUSIONS
  Ribbing disease is a rare disorder that, on imaging studies, may simulate stress fracture, chronic infection, bone-forming neoplasia, or a systemic metabolic or endocrine disorder. Clinical and imaging features may suggest the correct diagnosis.
authors: UCLA School of Medicine, Department of Radiological Sciences 90095-6952, USA.
authors: L L
authors: LL
authors: Seeger
authors: K C
authors: KC
authors: Hewel
authors: L
authors: L
authors: Yao
authors: R H
authors: RH
authors: Gold
authors: J M
authors: JM
authors: Mirra
authors: V P
authors: VP
authors: Chandnani
authors: J J
authors: JJ
authors: Eckardt
mesh_terms: D000328:Adult; D003966:Camurati-Engelmann Syndrome / Q000175:diagnosis; D003937:Diagnosis, Differential; D018483:Diaphyses / Q000473:pathology; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D010026:Osteosclerosis / Q000175:diagnosis*; D011877:Radionuclide Imaging; D013669:Technetium Tc 99m Medronate; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D013669:Technetium Tc 99m Medronate