Dynamic Contrast-Enhanced MR Imaging of Tietze's Syndrome: a Case Report

Dong Chan Kim; Sang Yoon Kim; Bong Man Kim

doi:10.13104/imri.2020.24.1.55

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Kim, Kim, and Kim: Dynamic Contrast-Enhanced MR Imaging of Tietze's Syndrome: a Case Report

Case Report

iMRI 2020;24(1):55-60.

Published online: 19 January 2020

DOI: https://doi.org/10.13104/imri.2020.24.1.55

Dynamic Contrast-Enhanced MR Imaging of Tietze's Syndrome: a Case Report

Dong Chan Kim, Sang Yoon Kim, Bong Man Kim

Department of Radiology, Dankook University Hospital, Cheonan, Korea

Correspondence to: Sang Yoon Kim, M.D. Department of Radiology, Dankook University Hospital, 201, Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea. Tel. +82-41-550-6921 Fax. +82-41-552-9674 E-mail: minipacs@dkuh.co.kr

Received 15 December 201916 January 2020 Accepted 17 February 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Tietze's syndrome is an inflammatory condition associated with painful swelling of the costochondral, costosternal, and sternoclavicular joints. Tietze's syndrome has been mostly attributed to microtrauma until now; however, this etiology is currently disputed. The diagnosis is based on clinical findings, although a few studies suggest the advantages of imaging. We report a case of Tietze's syndrome with a review of radiological findings, especially magnetic resonance imaging (MRI) with dynamic contrast enhancement.

Keywords: Tietze's, syndrome, Joint diseases, Magnetic resonance imaging, Dynamic contrast enhancement

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Fig. 1.

The ⁹⁹mTc-MDP bone scan shows a focal increase in MDP uptake at the anterior end of left 3rd rib (arrow) and the right 4th rib (open arrow) on the anterior static image.

Fig. 2.

Axial CT images (bone window setting) show enlargement of subchondral bone with sclerotic changes at the anterior end of the (a) right 4th (open arrow) and (b) left 3rd (arrow) ribs.

Fig. 3.

Conventional MRI combined with dynamic contrast-enhanced images and kinetic curves. MR fat-suppressed T2-weighted images (a) show enlargement of subchondral bone with bone marrow edema in the anterior end of left 3rd rib (arrow). Regions of interest (b) are placed in the subchondral bone marrow and the capsular component of the left 3rd costochondral joint to calculate the kinetic variables in the DCE-MRI. Kinetic curves (c) of the capsular component (◆) and the subchondral bone marrow (■) suggest an early steep and strong enhancement, followed by a transition to a stable level or a slight decline. In contrast, the kinetic curve in the subchondral bone marrow of the contralateral joint (▲) shows early enhancement followed by a rapid wash-out phase. Precontrast axial T1-weighted fat-suppressed images (d) and the 5-min delayed enhanced T1-weighted fat-suppressed images (e) show thick enhancement at the capsular component of left 3rd costochondral joint (arrows).

Fig. 4.

18F-FDG PET/CT images reveal mild FDG uptake in the (a) right 4th costochondral junction (open arrow) and (b) left 3rd costochondral junction (arrow). The value of SUVmax was not significantly high (Left SUV max value, 2.1; Right SUV max value, 1.9).

Fig. 5.

Ultrasound images show enlargement of the costal cartilage and the end of rib in the (b) left 3rd costochondral joint (arrow) and (c) right 4th costochondral joint (open arrow) compared with the (a) right 3rd and (d) left 4th costochondral joints.

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