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Stippled Ribs: A Potential Pitfall in Bone Scan Interpretation

Nuclear Medicine Department, William Beaumont Hospital, Royal Oak, Michigan

Correspondence: For reprints contact: D. Fink-Bennett, MD, Nuclear Medicine Dept., William Beaumont Hospital, 3601 West 13 Mile Rd., Royal Oak, MI 48072.

ABSTRACT

A retrospective evaluation of 100 consecutive bone scans was performed to determine the incidence and clinical importance, if any, of increased uptake at the insertion of the iliocostalis thoracis portion of the erector spinae muscle group (rib stippling). Rib stippling was deemed present if a focal area of increased technetium-99m methylene diphosphonate ([^99mTc]MDP) was identified with in the posterior angle of three or more consecutive ribs. Seven of 100 (three bilateral, four unilateral) patients demonstrated rib stippling. Foci intensity was less than the scapular tips, but greater than the adjacent ribs. No patient had a history of chest trauma, pain and/or an abnormal radiograph. Even though increased uptake within the posterior angle of the ribs is an uncommon finding (7%). Its recognition as a normal bone scan finding is important to prevent bone scan misinterpretations. Its characteristic scintigraphic appearance and location should serve to differentiate it from the increased uptake of trauma and/or tumor.