Can (99m)technetium methylene diphosphonate bone scans objectively document costochondritis?
OBJECTIVE
To determine whether bone imaging with 99mTc methylene diphosphonate is a specific method of making the diagnosis of costochondritis in patients with chest pain who rule out for myocardial infarction.


METHODS
Nonblinded prospective controlled study in 20 patients and 10 control subjects.


METHODS
Inpatient medical service of a tertiary teaching hospital.


METHODS
Two hundred consenting patients admitted to the hospital with chest pain and suspected myocardial infarction were examined. Those in whom acute myocardial infarction was ruled out were evaluated for the clinical signs of costochondritis, ie, tenderness over one or more costochondral junctions. Twenty patients who met the clinical criterion gave informed consent and were subjected to bone imaging. Ten control subjects with cancer who did not have clinical signs of costochondritis underwent bone imaging to rule out metastatic disease (normal in all cases).


METHODS
Bone imaging with I.V. 99mTc methylene diphosphonate.


METHODS
Bone scans of the investigative patients and the control subjects were read by two independent 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 had increased uptake elsewhere on the chest wall (sternum, manubrium, or first rib). All 10 of the control patients likewise showed increased technetium uptake at all costochondral junctions bilaterally.


CONCLUSIONS
Bone imaging with 99mTc methylene diphosphonate is not a specific method of making the diagnosis of costochondritis.
Mendelson
G
G
Department of Medicine, Beth Israel Medical Center, New York, NY 10003, USA.
Mendelson
H
H
Horowitz
S F
SF
Goldfarb
C R
CR
Zumoff
B
B
D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D002637:Chest Pain / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013669:Technetium Tc 99m Medronate; D013991:Tietze's Syndrome / Q000000981:diagnostic imaging*
D013669:Technetium Tc 99m Medronate