Abstract
Objectives: To assess the clinical significance and single-photon emission computed tomography/computed tomography (SPECT/CT) features of atraumatic costal cartilage fracture (CCF) in patients with malignant tumors.Methods: This was a retrospective review of 38 tumor patients with atraumatic CCF referred to SPECT/CT, who were served as the study group (SG). The features of SPECT/CT of atraumatic CCF were assessed. Another 100 tumor patients who underwent chest SPECT/CT and did not have CCF were randomly selected as the control group (CG). In all patients (SG + CG), the diagnostic powers in the detection of atraumatic CCF were computed among CT, SPECT, and SPECT/CT. The final diagnosis was based on pathological findings and radiologic follow-up of at least 1 year.Results: On SPECT/CT images of atraumatic CCF in the SG, fracture lines, irregular calcification, deformation, and swelling were, respectively, noted in 26.3, 47.4, 34.2, and 18.4% of lesions; low, moderate, and high uptake were, respectively, noted in 13.2, 52.6, and 34.2% of lesions. In all patients (SG + CG), the diagnostic powers in the detection of atraumatic CCF of CT, SPECT, and SPECT/CT were as follows: sensitivity 63.2, 100.0, and 92.1%; specificity 86.0, 81.0, and 94.0%; negative predictive value 86.0, 100.0, and 96.9%; positive predictive value 63.1, 66.7, and 85.4%; and area under the curve value 0.746, 0.905, and 0.931.Conclusions: Atraumatic CCF has certain characteristic appearances on SPECT/CT. It should be enrolled in the differential diagnoses when costal cartilages of patients with malignant tumors show abnormal elevated 99mTc-MDP uptake on scintigraphy. Single-photon emission computed tomography/CT has excellent diagnostic power in detecting atraumatic CCF.
Highlights
Costal cartilage fracture (CCF) is a rare complication of chest trauma and usually occurs in blunt injuries, which can contribute to rib cage instability
We report a series of patients with cancer with atraumatic CCF detected by 99mTc-MDP SPECT/computed tomography (CT), which were routinely performed for the evaluation of bone metastases
Lesions were most frequently found in costal cartilages 5–7, accounting for 86.8% (33/38) of CCF lesions, 8 in the fifth, 15 in the sixth, and 10 in the seventh costal cartilages
Summary
Costal cartilage fracture (CCF) is a rare complication of chest trauma and usually occurs in blunt injuries, which can contribute to rib cage instability. Some studies [4,5,6,7] have proved that computed tomography (CT), magnetic resonance imaging, and ultrasonography are useful in the detection of CCF. These imaging evaluations of CCF can often be disturbed by irregular calcification in costal cartilages. The value of single-photon emission computed tomography/CT (SPECT/CT) in detecting CCF has rarely, if ever, been described in literature
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