A Study of Cases with Rib Metastasis Difficult to Distinguish from Microfractures on Bone Scintigraphy

A retrospective study of about 10,000 cases at Kawasaki Medical School Hospital on whom bone scans were performed over a six year period revealed five cases in which metastasis was mistaken for a benign rib lesion. This mistake occurred because the accumulation pattern of the radionuclide in the rib region on the bone scan indicated a so-called "hot spot" observed with microfractures rather than the rod-like increased accumulation along costal bones that is coincident with the finding of bone metastasis. This experience suggests that solitary hot spots in the rib region on bone scans should be diagnosed carefully, as such an accumulation is most frequently associated with a benign etiology but rarely may be a malignant lesion