Acquired hyperostosis syndrome — AHYS — (sternocostoclavicular hyperostosis, pustulotic arthro-osteitis, SAPHO-syndrome): Bone scintigraphy of the anterior chest wall

Abstract

The objective of this report is to provide a description of diagnostically significant scintigraphically recognizable sites and patterns of acquired hyperostosis syndrome (AHYS) on the anterior chest wall (ACW), which is involved in 82% of AHYS patients. In 49/90 of our own AHYS patients, planar bone scans of the ACW were performed with the gamma camera, applying an average of 650 MBq of 99mTc-phosphate complexes. In addition, 53 atraumatic patients with extrathoracic cancer were available for routine whole-body scintigraphy. None of these patients had increased uptake identifiable as metastasis clinically or by imaging modalities in either the ACW or the rest of the skeleton. The scintigraphic involvement of the various morphological ACW structures is described in AHYS. Moreover, attention is called to the diagnostic significance of focal hyperactivities at the anterior end of the 2nd-8th rib of adults, which are in the 5th place with respect to their frequency in AHYS. The diagnostic significance of sternocostal-joint involvement in AHYS can likewise be recognized by bone-scan scintigraphy and will be discussed. Bone scintigraphy is more sensitive than radiomorphological imaging in AHYS. This, however, only applies under three conditions. 1. The increased radiotracer uptake in the upper sternocostoclavicular region must be assessed on both the anterior and the posterior view of the ACW scan. 2. In addition to the anterior view of the routine scintiscan, further anterior scans with reduced scan time of the gamma camera are usually necessary. This ensures better visibility of the involvement of certain morphological structures that are important for AHYS diagnosis. Moreover, a statement can be made about the inflammatory ossifying activity/inactivity of the AHYS on ACW.3. Increased radionuclide uptake in the manubrium sterni and corpus sterni on the anterior scan should be verified by additional lateral or oblique scans of the thorax (sternum).

Successful treatment of a childhood synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome with subcutaneous methotrexate: A case report

“…CT and MRI are helpful in locating the lesions and providing information on adjacent soft tissues, but cannot distinguish between SAPHO lesions, osteomyelitis and malignancy 9 . Bone scintigraphy is important in diagnosing SAPHO syndrome, particularly for detecting early bone involvement 10 . Bacterial cultures are usually negative 2 but both Staphylococcus aureus and Propionibacterium acnes (P. acnes) have been isolated 11 in some cases, but the correlation between the pathogenesis and these agents are still controversial.…”

Sternocostoclavicular Hyperostosis: A Review

“…Scintigraphy is another imaging modality able to identify uptake in characteristic regions when clinically SCCH is mild and radiographic changes are absent or subtly abnormal [Kim et al 2001;Nungu et al 1997;Dehdashti and Siegel, 1989;Sartoris et al 1986]. Increased uptake is almost always found in the sternoclavicular joint area, the costal cartilages of the first and second ribs, and the manubrium [Kalke et al 2001;Dihlmann et al 1997]. The predominant uptake in these areas has lead several authors to label this configuration as the 'bullhead' sign [Freyschmidt and Sternberg, 1998;Dihlmann et al 1997].…”

“…In addition to the somewhat distinctive 'bullhead' sign, scintigraphy also has the advantage of identifying additional sternal and extrasternal involvement, even when the patient is asymptomatic [Kim et al 2001;Freyschmidt and Sternberg, 1998;Dihlmann et al 1997;Fritz et al 1992]. In one series scintigraphic changes in the axial skeleton were noted in up to 67% of patients and in the peripheral joints in 29% [Freyschmidt and Sternberg, 1998].…”

“…In one series scintigraphic changes in the axial skeleton were noted in up to 67% of patients and in the peripheral joints in 29% [Freyschmidt and Sternberg, 1998]. It has been argued that scintigraphy should be considered in patients with anterior chest wall symptoms suspicious for SCCH since it can be useful investigating the extent and intensity of disease [Dihlmann et al 1997].…”

“…As discussed earlier, condensing osteitis of the clavicle is a benign disorder thought to be a mechanical phenomenon [Lissens et al 1990;Sartoris et al 1986;Yood and Goldenberg, 1980]. Changes are restricted to the medial portion of the clavicle with sparing of the sternoclavicular joint [Dihlmann et al 1997;Tait et al 1994;Yood and Goldenberg, 1980]. Differentiating SCCH from the seronegative spondyloarthropathies may be challenging at any stage of the illness since this group of arthritides may involve the joints of the sternoclavicular area and distinguishing features may not appear for years after the onset of inflammation.…”