title: High-resolution sonography of the rib: can fracture and metastasis be differentiated?
abstract: OBJECTIVE
  Our aim was to evaluate whether high-resolution sonography can provide additional information concerning rib lesions compared with radiography or bone scintigraphy.
  
  
  METHODS
  Fifty-eight patients with high-uptake rib lesions seen on bone scintigraphy were selected. Radiography and rib high-resolution sonography were performed on these patients. High-resolution sonography was performed using a linear 5-12 MHz transducer. By means of clinical history, histopathologic examination, and follow-up observation, these patients were classified into rib fracture (n = 37), rib metastasis (n = 18), or unknown (n = 3) groups. High-resolution sonography images of the 55 proven cases were reviewed for the presence of five representative findings: cortical disruption, callus formation, cortical deformity, mass, or bone destruction. The frequencies of these findings were compared between the groups with fracture and metastasis.
  
  
  RESULTS
  Rib lesions were matched by bone scintigraphy and high-resolution sonography in 53 (96%) of 55 patients and by bone scintigraphy and plain radiography in 23 (42%) of 55 patients. High-resolution sonography revealed 17 (94%) of 18 patients with metastasis and 36 (97%) of 37 patients with rib fractures. Metastatic lesions were seen as mass formation (n = 13) and irregular bone destruction (n = 7) on high-resolution sonography. Fracture was seen as cortical disruption with or without hematoma (n = 17), callus formation (n = 9), or cortical deformity, such as angling or stepping (n = 12).
  
  
  CONCLUSIONS
  High-resolution sonography of the ribs is a useful method of characterizing rib lesions in patients who have hot-uptake lesions on bone scintigraphy.
authors.affiliation: Department of Radiology, Soonchunhyang University, Bucheon Hospital, Gyeonggido, Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Paik
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Chung
authors.forename: Jai Soung
authors.initials: JS
authors.lastname: Park
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Goo
authors.forename: Jung-Gi
authors.initials: JG
authors.lastname: Im
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012253:Rib Fractures / Q000000981:diagnostic imaging*; D012272:Ribs / Q000000981:diagnostic imaging*; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging*; D014463:Ultrasonography