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PubMed2006

Frequency of sternal variations and anomalies evaluated by MDCT.

OBJECTIVE: Our objective was to reveal the frequency and MDCT appearances of sternal variations and anomalies in subjects without sternal deformities. SUBJECTS AND METHODS: One thousand consecutive patients who underwent thoracic MDCT examination were enrolled in the study. All MDCT data, including multiplanar and curved-planar reconstructed images, were evaluated for detection of sternal variations and anomalies. Various kinds of sternal variations and anomalies, such as suprasternal bones and tubercles, manubriosternal and sternoxiphoidal fusions, sternal clefts and foramina, and sternal sclerotic bands were documented. RESULTS: In 1,000 subjects, the frequencies of main sternal variations and anomalies were as follows: suprasternal bone in 4.1%, suprasternal tubercle in 4%, complete manubriosternal fusion in 19.6%, complete sternoxiphoidal fusion in 30.3%, sternal foramen in 4.5%, and sternal sclerotic band in 37.1%. Xiphoidal foramen was seen in 27.4%, and the most common type was single foramen. Xiphoid process mostly ended as a single process (71%). Double-ended xiphoid process was also frequent (27.2%). Pseudocleft and pseudoforamen at the sternoxiphoidal junction were detected in 3.3% and in 3.6% of subjects, respectively. CONCLUSION: MDCT exhibited various sternal variations and anomalies. Sternal foramen is a frequent minor anomaly and generally associated with sternal sclerotic bands. Early manubriosternal and sternoxiphoidal fusions can be seen in early adulthood without osteodegeneration. Double-ended xiphoid process and single xiphoidal foramen are frequent sternal variations. Awareness of MDCT appearances of sternal variations and anomalies provides a better differential diagnosis with pathologic conditions.

Adult↗
PubMed1984

Computed tomography of the sternum and its articulations.

The chest wall present diagnostic difficulties for both the clinician and the radiologist. Because of normal variations in anatomy and ossification, analysis of the sternal region can be particularly confusing. We reviewed the normal computed tomographic (CT) appearance of the sternum in 354 patients. Important normal sternal variants included cortical unsharpness along the posterior aspect of the manubrium , lateral surfaces of the body, and at the sternal fibrocartilaginous articulations; soft tissue prominence at the junction of the sternum and costochondral cartilage; and bony sclerosis at the transitions from manubrium to body and from body to xiphoid. In seven patients with clinically significant sternal abnormality, key CT features were abnormal soft tissue mass (7/7), destruction or irregularity of the cortical contour (7/7), and abnormal increased attenuation of bone (1/7). CT should be the radiologic study of choice in patients with suspected abnormality of the sternum and its articulations.

Adolescent↗
PubMed2006

Age-related normal variants of sternal uptake on bone scintigraphy.

PURPOSE: The purpose of this study was to describe the variable age-related normal appearance of the sternal area on bone scintigraphy. METHODS: We studied 334 patients (158 males and 176 females) aged 15 days to 85 years, mean age 32.5 +/- 19.9 years, who did not have symptoms associated with the sternum and chest wall or a history of malignancy. All patients underwent whole-body bone scan 3 hours after intravenous injection of Tc-99m MDP. RESULTS: In patients younger than 10 years, sternal uptake was equal to nearby ribs with homogeneous uptake and poorly defined outlines. In older patients, the sternum showed markedly greater uptake than nearby ribs and the borders became well defined. Different patterns of sternal uptake were noted: 1) increased uptake in the manubrium; 2) hot spots in the angle of Louis, body and xiphoid; 3) a photopenic area just above the xiphoid process; 4) heterogeneous sternal body uptake; and 5) hyperactivity along the sternal body borders. Of these variants, the angle of Louis hot spot was the most common finding (63.5%). A linear pattern of hot spots in the sternal body was seen most frequently between 10 and 30 years old and corresponded to 3 transverse ridges of bone, representing the sites of union. Increased tracer uptake only at the medial end of the clavicle in the SC joints was seen in 42.13% of patients younger than 30 years. CONCLUSION: This study showed age-related normal variants of sternal uptake on bone scanning in asymptomatic patients. Understanding these variants may be helpful in differentiating normal and abnormal patterns of uptake in the sternum on radionuclide bone imaging.

Adolescent↗
PubMed2005

Sternal uptake on bone scintigraphy: age-related variants.

BACKGROUND: When reporting bone scans, it is important to distinguish between normal variants and skeletal pathology involving the sternum. There are only limited reports dealing with age-related normal variants of the sternum on bone scintigraphy. METHODS: We have studied the age-related variants of sternal uptake on bone scintigraphy. In a prospective study, 152 consecutive patients (66 males and 86 females) undergoing whole-body bone scanning, and who had no symptoms associated with the sternum, were evaluated for patterns of normal sternal uptake. Three hours after intravenous injection of (99m)Tc-methylene diphosphonate ((99m)Tc-MDP), whole-body bone scans in the anterior and posterior projections were acquired. Patterns of sternal uptake, including the sites and distribution of increased and decreased uptake, were analysed using age-related groups. RESULTS: Three patterns of tracer uptake in the sternum were recognized: a uniform pattern was most common in children (< or =12 years); a heterogeneous uptake pattern was frequently seen in adolescents, young adult and adult groups; and a segmented pattern was commonly seen in the geriatric group (>60 years). A predominant focal finding was a hot spot at the angle of Louis. In addition, there were focal spots of decreased tracer uptake in the lower sternum, just above the xiphoid process, and spots of increased tracer uptake in the body of the sternum. Such focal spots were not seen in subjects of less than 12 years of age. CONCLUSION: Evolutionary changes of the sternum appear to exist throughout life. There are age-related normal variants of sternal uptake on bone scintigraphy.

Adolescent↗
PubMed1975

Distribution of 99mTc-Sn diphosphonate and free 99mTc-pertechnetate in selected soft and hard tissues.

Because increased uptake of 99mTc-diphosphonate (ethane-hydroxy-1, 1-diphosphonate) occasionally occurs in the anterior neck region, the possible increased affinity of the diphosphonate bone-scanning agent for cartilage was investigated. In vivo scintigraphic studies and organ analyses from rats and rabbits injected with this bone scintigraphic agent were performed. Trachea-to-muscle uptake ratios were a high 45:1 in adult Sprague-Dawley rats and approached the femur-to-muscle ratio of 93:1. Technetium-99m-diphosphonate uptake was also increased, but to a lesser extent, in xiphoid cartilage, tendon, and ear cartilage; this was proportional to the calcium content of the organ. The thyroid showed a high affinity for free pertechnetate but not 99mTc-diphosphonate, providing further evidence that the increased neck uptake of this 99mTc-diphosphonate is due to tracheal, not thyroid activity. In addition, premedication of three patients with 200 mg of potassium-perchlorate did not block this neck uptake. Interpretation of scintigraphs performed with 99mTc-diphosphonate that show lesions in the cervical spine should take into account the potential for false-positive readings caused by this increased tracheal uptake.

Achilles Tendon↗
PubMed1997

Expression of a truncated, kinase-defective TGF-beta type II receptor in mouse skeletal tissue promotes terminal chondrocyte differentiation and osteoarthritis.

Members of the TGF-beta superfamily are important regulators of skeletal development. TGF-betas signal through heteromeric type I and type II receptor serine/threonine kinases. When over-expressed, a cytoplasmically truncated type II receptor can compete with the endogenous receptors for complex formation, thereby acting as a dominant-negative mutant (DNIIR). To determine the role of TGF-betas in the development and maintenance of the skeleton, we have generated transgenic mice (MT-DNIIR-4 and -27) that express the DNIIR in skeletal tissue. DNIIR mRNA expression was localized to the periosteum/perichondrium, syno-vium, and articular cartilage. Lower levels of DNIIR mRNA were detected in growth plate cartilage. Transgenic mice frequently showed bifurcation of the xiphoid process and sternum. They also developed progressive skeletal degeneration, resulting by 4 to 8 mo of age in kyphoscoliosis and stiff and torqued joints. The histology of affected joints strongly resembled human osteo-arthritis. The articular surface was replaced by bone or hypertrophic cartilage as judged by the expression of type X collagen, a marker of hypertrophic cartilage normally absent from articular cartilage. The synovium was hyperplastic, and cartilaginous metaplasia was observed in the joint space. We then tested the hypothesis that TGF-beta is required for normal differentiation of cartilage in vivo. By 4 and 8 wk of age, the level of type X collagen was increased in growth plate cartilage of transgenic mice relative to wild-type controls. Less proteoglycan staining was detected in the growth plate and articular cartilage matrix of transgenic mice. Mice that express DNIIR in skeletal tissue also demonstrated increased Indian hedgehog (IHH) expression. IHH is a secreted protein that is expressed in chondrocytes that are committed to becoming hypertrophic. It is thought to be involved in a feedback loop that signals through the periosteum/ perichondrium to inhibit cartilage differentiation. The data suggest that TGF-beta may be critical for multifaceted maintenance of synovial joints. Loss of responsiveness to TGF-beta promotes chondrocyte terminal differentiation and results in development of degenerative joint disease resembling osteoarthritis in humans.

Animals↗
PubMed2002

Validation of a bone analog model for studies of sternal closure.

BACKGROUND: The incidence of serious sternal wound complications may be reduced with improvements in closure methods. Biomechanical testing of median sternotomy closures in cadavers has proven useful but is limited by availability, high cost, and wide variations in the material properties of the sterna. This study tests whether artificial sterna can be used to replace whole cadavers in sternal closure testing. METHODS: Two common wire closure techniques were tested using both whole cadavers and artificial sternal models formed from bone analogue material. Sternal models were molded from polyurethane foam (20 lbs/ft3) to simulate the mechanical properties observed in human cadaveric sterna. The force vector previously identified as the most detrimental to sternal cohesion (lateral traction) was used to stress the closures. Separation of the incision site was measured at the manubrium, midsternum, and xiphoid and data were compared between cadaver and bench test groups. RESULTS: Sternal separations recorded in cadavers were found to be similar to bench test results for both closure types. Data variability within test groups was found to be consistently lower using artificial sterna, where peak standard deviations for sternal motion averaged less than half that measured in cadavers. CONCLUSIONS: Results suggest that anatomic sternal models formed from solid polyurethane foam can be used to approximate the biomechanical properties of cadaveric sterna and that reliable information regarding sternal closure stability can be secured through this means. Moreover, bench test data were shown to be less variable than cadaveric results, thus enhancing the power to detect small differences in sternal fixation stability.

Biomechanical Phenomena↗
PubMed2002

Musculoskeletal problems of the chest wall in athletes.

Chest pain in the athlete has a wide differential diagnosis. Pain may originate from structures within the thorax, such as the heart, lungs or oesophagus. However, musculoskeletal causes of chest pain must be considered. The aim of this review is to help the clinician to diagnose chest wall pain in athletes by identifying the possible causes, as reported in the literature. Musculoskeletal problems of the chest wall can occur in the ribs, sternum, articulations or myofascial structures. The cause is usually evident in the case of direct trauma. Additionally, athletes' bodies may be subjected to sudden large indirect forces or overuse, and stress fractures of the ribs caused by sporting activity have been extensively reported. These have been associated with golf, rowing and baseball pitching in particular. Stress fractures of the sternum reported in wrestlers cause pain and tenderness of the sternum, as expected. Diagnosis is by bone scan and limitation of activity usually allows healing to occur. The slipping rib syndrome causes intermittent costal margin pain related to posture or movement, and may be diagnosed by the 'hooking manoeuvre', which reproduces pain and sometimes a click. If reassurance and postural advice fail, good results are possible with resection of the mobile rib. The painful xiphoid syndrome is a rare condition that causes pain and tenderness of the xiphoid and is self-limiting. Costochondritis is a self-limiting condition of unknown aetiology that typically presents with pain around the second to fifth costochondral joints. It can be differentiated from Tietze's syndrome in which there is swelling and pain of the articulation. Both conditions eventually settle spontaneously although a corticosteroid injection may be useful in particularly troublesome cases. The intercostal muscles may be injured causing tenderness between the ribs. Other conditions that should be considered include epidemic myalgia, precordial catch syndrome and referred pain from the thoracic spine.

Adolescent↗
PubMed1993

Contribution to the study of the development and ossification of human sternum.

We have studied the development of sternum in man. Complete microscopic series of sections through thorax of human embryos and fetuses from the second and third months of gestation served as the research material. Preparations were stained by Alcian blue and Mayer's haematoxyline, counterstained by eosine. We also had a set of macroscopic preparations of sterna and adjacent parts of ribs from fetuses of the fifth and sixth months of gestation. These specimens were stained by Alcian blue and by Alizarine and subsequently cleared by glycerine method. We have found that sternum develops by a fusion of sternal bars. Sternal bars develop from anterior bent parts of ribs, lying one over another like tiles. The newly formed sternum has different proportions in comparison to its definitive state. In all the cases its manubrium is wider and bigger, its xiphoid process is longer, in almost all the cases doubled or at least bifurcated. The sternocostal junctions are provided with interzones with the exception of the first rib. Its primordium continues into sternum without any border. Clavicle is connected with sternal anlage without any visible border and this interzone quickly develops as the primordia of the sternoclavicular articulation and the disc. In the medial part, there is a cartilaginous model which ossifies very early--as the first bone of the body. In young embryos from the end of the second month of gestation the clavicle and sternum show very different structures. Ossification of the sternum begins in the fifth month by developing a large number of very small centers of ossification which are not yet detectable by X-ray or CT.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1984

[Sternum-splitting approach for ossification of the posterior longitudinal ligament in the cervico-thoracic junction].

In this paper the author reported an operative approach for ossification of the posterior longitudinal ligament (OPLL) of the lower cervical and upper thoracic vertebrae. There are two types of surgery for OPLL, namely, posterior and anterior approaches. As a rule, we utilize an anterior approach for OPLL. Recently we performed a modified sternum-splitting approach in surgery for OPLL in the cervico-thoracic junction. In the original trans-sternal approach introduced by Cauchoix, the sternum is split from the suprasternal notch to the xiphoid process. We cut the manubrium only. However, a satisfactory exposure of the cervico-thoracic vertebrae down to the third thoracic level was obtained. After reaching the anterior surface of the cervico-thoracic vertebrae, the central portion of the vertebral body and the ossified lesion between the lower one third of the C7 vertebral body and the upper one third of the Th3 vertebral body were removed with an air-drill under an operating microscope. The longitudinal bone defect of the vertebral bodies was filled with a bone graft obtained from the iliac bone. Removal of the ossified lesion in the cervico-thoracic junction can be performed safely by utilizing the modified sternum-splitting approach. This approach can be applied also to endarterectomies at the origins of the vertebral arteries and the right subclavian artery.

Cervical Vertebrae↗
PubMed1986

Postnatal development of dependence on thyroid hormones for growth and differentiation of rat skeletal structures.

We have studied the development of thyroid hormone dependence for growth and differentiation of rat skeletal tissues. The radius, tail tip or xiphoid process from 1-day-old rats was transplanted in its entirety under the kidney capsule of euthyroid or hypothyroid (TX) adult syngeneic virgin rats and grown there for 3, 6, 9, 12 or 15 days. Pieces of the sternum or calvarium were treated similarly. Growth of transplanted radius and sternum in TX hosts showed significant retardation by day 3, and that of transplanted calvarium, tail tip and xiphoid showed significant inhibition by day 6 post transplantation. Tissue differentiation of all of the transplants was inhibited in TX hosts and the appearance of epiphyseal ossification centers was significantly delayed. Injection of Propylthiouracil (PTU) in solvent into the neonatal rats from day 1 to day 15 post partum inhibited tail length increase by day 7, and body weight gain by day 9, as compared to the growth of solvent injected littermate pups. Our results indicate that the growth and differentiation of endochondral bones are more dependent on TH levels than are those of membranous bones and cartilage. Endochondral bones develop TH dependence for growth and differentiation before day 4 post partum, while the membranous bones and cartilage develop this dependence at the end of the first week.

Aging↗
PubMed1977

Regional blood flow redistribution during early burn shock in the guinea pig.

The distribution of blood flow was determined with radioactive microspheres following scald injury in guinea pigs. Burn was induced in halothane-anesthetized guinea pigs by a 3-sec immersion to the xiphoid process in 100 degree C water. Cardiac output and fractional blood flow measurements were made at preburn, 15-min postburn, and 75-min post-burn. In the scalded animals cardiac output decreased 58% by 75 min postburn. Three different blood flow responses to burn were noted: a) Brain, heart, hepatic artery, and adrenals received an increased fraction of the cardiac output; b) the fractional distribution of the diaphragm, liver (portal), spleen, gastrointestinal tract, muscle (from burned portion of the body), and bone remained constant; while c) the pancreas, burned skin, nonburned skin, and adipose tissue received a reduced fraction of the cardiac output. Although some regions of the body (i.e., brain and heart) received a greater percentage of the total cardiac output after burn injury, the cardiac output decrease was sufficient to cause a depression in absolute blood flow to all but two sites (adrenals and hepatic artery).

Animals↗
PubMedDate not supplied

Rib counting on CT using the sternal approach.

To devise a new method for counting ribs on CT scan, we evaluated the CT anatomy of the costal cartilages and the proximal xiphoid in 20 control patients without rib pathology. The sternal end of costal cartilages seen on the same image as the proximal xiphoid was always the seventh (n = 20). These costal cartilages were located anterolateral (n = 13) or lateral (n = 7) to the proximal xiphoid. In fifteen patients with rib pathology, 23 abnormal ribs were localized by our method. All of these ribs correlated with those seen on chest radiographs and rib cage views or with resected ribs on postoperative films.

Adult↗
PubMed1976

[On the metabolic heterogenity of the cartilage tissue (author's transl)].

Autoradiografic studies with 3H-thymidine, 3H-proline and 35S-sulfate in different cartilage tissues from rabbits and rats (articular and epiphyseal cartilage of the knee; costal, xiphoid and tracheal cartilage) were performed. The following results were obtained: The proliferative zone of the epiphyseal plate of young and adult animals is limited to the superior part of the columnar cartilage. The articular cartilage shows no proliferative zones but single S-phase-nuclei in all layers seldom were found. In the adult animals a decrease of DNA-synthetising chondrocytes in all investigated cartilage tissues and a narrowing of the proliferative zone could be detected. 3H-proline and 35S-sulfate in proliferating chondrocytes of the bone cartilage border line and in chondrocytes of the subperichondrial area increasingly were incorporated. Possible causes of the regional differences in the uptake of the used precursors were discussed and the significance of the metabolic heterogenity of the cartilage tissue for aging and pathological processes was pointed to.

Aging↗
PubMedDate not supplied

Postnatal development of the human sternum.

Postnatal development and maturation of the human sternum are highly variable. Endochondral ossification centers (sternebrae) form within each cartilaginous segment of the sternum, with each center enveloped by a spherical growth plate. Within a cartilaginous center there may be either one or two ossification centers, those with two centers retaining and reflecting features of their bilateral embryonic origin. Malaligned bifid centers are clearly associated with rib articulation asymmetry as well. Expansion of individual ossification centers progresses within the peripheral cartilaginous domains of the sternum. With respect to the rostrocaudal axis, sternebrae form between the costosternal articulations. Consistent with the biology of endochondral transition, cartilage canals are evident throughout unossified regions of the hyaline matrix. Expanding ossification of adjacent sternebrae results in depletion of the common area of cartilage between the two sternebrae, and eventually in physiologic epiphysiodesis. Fusion of the mesosternebrae reciprocates the initial pattern of sternebral ossification site appearance, proceeding in a caudal-to-cranial direction. Union of adjacent sternebrae, initiated through a central osseous bridge, progresses through anterior, lateral, cephalocaudal, and posterior domains to achieve synostosis. Accessory and bifid centers of ossification within the same intercostal space coalesce prior to adjoining adjacent sternebrae. Manubriosternal fusion is rare due to the presence of a fibrocartilaginous joint restricting ossification. The xiphoid process remains connected to the most caudal mesosternum via a common zone of hyaline cartilage that ossifies by middle to late adulthood. A single pattern of development does not appear fundamental to successful growth of the sternum, as morphological variants were common.

Adolescent↗
PubMedDate not supplied

Segmental inertial parameters of the human trunk as determined from computed tomography.

This study used computed tomography (CT) imaging to determine in vivo mass, center of mass (CM), and moments of inertia (Icm) about the CM of discrete segments of the human torso. Four subjects, two males and two females, underwent serial transverse CT scans that were collected at 1-cm intervals for the full length of the trunk. The pixel intensity values of transverse images were correlated to tissue densities, thereby allowing trunk section mass properties to be calculated. The percentage of body mass observed by vertebral levels ranged from 1.1% at T1 to 2.6% at L5. The masses of the upper, middle, and lower trunk segments as percentages of body mass were estimated to be 18.5, 12.2, and 10.7%, respectively. The whole trunk mass was estimated to comprise 41.6% of the total body mass. Transverse vertebral CM values were found to lie anterior to their respective vertebral centroids by up to 5.0 cm in the lower thoracic region. For the upper, middle, and lower trunk segments, the average CM positions were found to be 25.9, 62.5, and 86.9% of the distance from the superior to inferior ends of the trunk. The upper and middle trunk CMs corresponded to approximately 4.0 cm anterior to T7/T8 vertebral centroid levels and 1.0 cm anterior to L3/L4 vertebral centroid levels, respectively. For the whole trunk, the CM was 52.7% of the distance from the xiphoid process and approximately 2.0 cm anterior to L1/L2 vertebral centroid levels. Variations in CM and Icm values were observed between subject, but these were within the range of previous reports of body segment parameters. Differences from previous studies were attributable to variations in boundary definitions, measurement techniques, population groups, and body states (live versus cadaver) examined. The disparity between previous findings and findings of this study emphasizes the need to better define the segmental properties of the trunk so that improved biomechanical representation of the body can be achieved.

Abdomen↗