Diagnosing Tietze's Syndrome Requires a Combination of Imaging Modalities

A new study suggests that the only way to diagnose Tietze's syndrome, a painful disorder of the costal cartilage, is to use X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine in combination as the only way to effectively diagnose the disease.

Tietze's syndrome can mimic a heart attack, pulmonary blood clots, or even psychologic stress. Diagnosing the disorder is frequently a case of ruling out what disorders a patient does not have, and reaching a diagnosis by exclusion. Depending on which expert one speaks to, the recommendation for the best diagnostic tool varies wildly from xeroradiographs to CT scans.

In a May-June 2009 article in the journal Clinical and Experimental Rheumatology, a team of researchers from the University of Foggia (Italy) described how they evaluated 30 patients with rheumatologic disorders of the sternocostoclavicular joint. These included Tietze syndrome, SAPHO (synovitis-acne-pustulosis-hyperostosis osteomyelitis) syndrome, and a variety of other costal cartilage related ailments.

The researchers compared CT, MRI, and bone scintigraphy for all patients and found that each technique painted only a partial picture. Radiography revealed sclerosis of the clavicula in only eight patients and sclerosis of the sternum in three. The CT scan fared slightly better at 13 patients, but showed cortical bone erosions in over three-quarters of patients. The MRI scan was sensitive to showing soft tissue swelling in over half the patients. There were varying levels of effectiveness with techniques showing joint space narrowing, bone erosion, and ligament ossification.

The researchers concluded that diagnosing Tietze's disease and other rheumatic disorders of the sternocostoclavicular joint presents a difficult diagnostic picture. One technique, according to the researchers, is not enough to decisively diagnose a condition. They suggest that all available techniques be used in combination--X-ray, CT, MRI, and nuclear medicine.

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University of Foggia