RSNA 2011 

Abstract Archives of the RSNA, 2011


LL-ERS-TH3A

The Meaning of Increased Uptakes at the Costochondral Junctions on Bone Scans in Acute Traumatic Chest Injury: Correlation of Findings at US and MR Imaging

Scientific Informal (Poster) Presentations

Presented on December 1, 2011
Presented as part of LL-ERS-TH: Emergency Radiology  

Participants

Wook Jin, Abstract Co-Author: Nothing to Disclose
Ka Eun Lee MD, Presenter: Nothing to Disclose
You Jung Yang, Abstract Co-Author: Nothing to Disclose
So Young Park, Abstract Co-Author: Nothing to Disclose
Hyun Cheol Kim, Abstract Co-Author: Nothing to Disclose
Dal Mo Yang MD, PHD, Abstract Co-Author: Nothing to Disclose
Ji Seon Park MD, PhD, Abstract Co-Author: Nothing to Disclose
Kyung Nam Ryu MD, PhD, Abstract Co-Author: Nothing to Disclose

PURPOSE

We prospectively evaluated the causes and meanings of focal, increased uptakes at the costochondral junctions (CCJs) in traumatic chest injury on bone scan (BS) by comparing with the sonography (US) and magnetic resonance (MR) imaging.

METHOD AND MATERIALS

This prospective study was performed after the study protocol was approved by the institutional review board. Informed consent was obtained from all subjects or their guardians. This study included 9 patients (5 male and 4 female; mean age, 52 years) underwent BS due to recent trauma and showing hot uptakes at CCJs on BS. US and MRI were performed in these all patients. Two radiologists evaluated all US and MR imaging findings by means of consensus. On BS, uptake counts (CTS) were measured at CCJs and nearby anterior arcs of the ribs after drawing of the region of interest and the ratios of CCJ CTS to nearby anterior arc CTS (CCJ-AA ratios) were calculated by one nuclear medicine specialist.  

RESULTS

In nine patients, a total of 27 ribs showed focal, increased uptakes at CCJs – two in the third ribs; three, the fourth ribs; nine, the fifth ribs; nine, the sixth ribs; and four, the seventh ribs. There were 19 right- and 8 left-sided CCJs with focal, increased uptakes. According to our criteria, there were 7 bone bruise and 18 fractures in the anterior arcs of the ribs near CCJs and the causes of 2 CCJ uptakes were undetermined. The results of paired t-test for comparisons between ribs with focal, increased uptakes and normal-looking uptakes were statistically significant in both CCJ CTS and CCJ-AA ratios (p < .05). The Mann-Whitney test showed significant differences for the CCJ-AA ratio from edema and fractures (p < .05). There were no ribs showing CCJ fracture, costal cartilage contusion, or costal cartilage fracture.  

CONCLUSION

Focal, increased uptakes at CCJs on bone scan after chest trauma were not due to CCJ separation or costal cartilage fracture, but mostly due to bone bruise or fractures in anterior arcs of the ribs near CCJs. Additionally, the CCJ-AA ratio was higher in fracture than that of bone bruise. This might be helpful for accurate and differential diagnosis of fracture from bone bruise in the ribs on bone scan.

CLINICAL RELEVANCE/APPLICATION

Quantification of CCJ-AA ratio could a diagnostic method for differentiation of fracture from bone bruise, which may subsequently aid in patient management and solving a legal problem.

Cite This Abstract

Jin, W, Lee, K, Yang, Y, Park, S, Kim, H, Yang, D, Park, J, Ryu, K, The Meaning of Increased Uptakes at the Costochondral Junctions on Bone Scans in Acute Traumatic Chest Injury: Correlation of Findings at US and MR Imaging.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11009444.html