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Solitary Hot Spots in the Ribs on Bone Scan: Value of Thin-Section Reformatted Computed Tomography To Exclude Radiography-Negative Fractures

Niitsu, Mamoru; Takeda, Tohoru

Journal of Computer Assisted Tomography: July/August 2003 - Volume 27 - Issue 4 - pp 469-474
Thoracic Imaging

Purpose: The purpose of this study was to classify solitary, scintigraphy-positive and radiography-negative rib lesions and to clarify the features of rib fractures by using thin-section reformatted helical computed tomography (CT).

Methods: Forty-seven patients whose whole-body bone scans showed a solitary hot spot in a rib as their first abnormal scintigraphic finding and whose plain radiograph showed negative or indeterminate results were examined by thin-section reformatted CT. Final diagnosis was based on follow-up over a 20-month period.

Results: The final diagnosis included 17 cases of fractures where CT findings were fracture line, focal sclerosis, and callus formation. Fourteen ribs demonstrated intramedullary, focal osteosclerosis, and 8 ribs did not demonstrate any abnormalities. Four metastatic lesions appeared as intramedullary mixture of osteolysis and osteosclerosis, or bone destruction. Four intramedullary lesions with cystic appearance remained unchanged.

Conclusions: Thin-section reformatted helical CT delineated minute, radiographically occult fractures of the rib. Excluding fractures, helical CT can avoid further unnecessary examinations.

From the Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, Japan.

Address correspondence and reprint requests to Dr. Mamoru Niitsu, Department of Radiology, Institute of Clinical Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki 305-8575, Japan. E-mail: mniitsu@md.tsukuba.ac.jp

© 2003 Lippincott Williams & Wilkins, Inc.