Can ^99mtechnetium methylene diphosphonate bone scans objectively document costochondritis

Study objectives: 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. Design: Nonblinded prospective controlled study in 20 patients and 10 control subjects. Setting: Inpatient medical service of a tertiary teaching hospital. Patients: 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 hone 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). Interventions: Bone imaging with IV ^99mTc methylene diphosphonate. Measurements: 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.