Neck

Pinhole scanning can be used to visualize the small parts of the individual cervical vertebrae, the hyoid bone, and the mineralized anterior neck cartilages. The spinous processes, laminae, and apophyseal joints are portrayed on the posterior view (Fig. 4.8) and the vertebral bodies with the endplates, pedicles, and apophyseal joints are visualized on the lateral view (Fig. 4.9). For the topographic study of the up per cervical spine and skull base a close-up pinhole scintigraphy is taken. Thus, the close-up posterior pinhole scan shows characteristic uptake in the dens in the midline sided bilaterally by photopenic median atlantoaxial articular spaces (Fig. 4.10). The lateral masses of the atlas, atlantooccipital joint, and paired lateral atlantoaxial joints are also visualized on this view. On the close-up lateral view, the disk spaces are presented as photopenic slits between "hot" vertebral bodies, whereas higher tracer uptake may be seen in the atlantooccipi-

Apophyseal Joints Cervical Spine

Fig. 4.8A, B Posterior view of the cervical spine. A Posterior pinhole scintigraph of the cervical spine shows increased tracer uptake in the spinous processes (sp) and apophyseal joints (aj). The intervertebral foramina (if) are demonstrated as photopenic areas lying between the spinous processes and apophyseal joints. B Anteroposterior radiograph identifies the spinous processes (sp), apophyseal joints (aj), and intervertebral foramina (if)

Fig. 4.8A, B Posterior view of the cervical spine. A Posterior pinhole scintigraph of the cervical spine shows increased tracer uptake in the spinous processes (sp) and apophyseal joints (aj). The intervertebral foramina (if) are demonstrated as photopenic areas lying between the spinous processes and apophyseal joints. B Anteroposterior radiograph identifies the spinous processes (sp), apophyseal joints (aj), and intervertebral foramina (if)

Cervical Spine Pedicles Lateral

Fig. 4.9A, B Lateral view of the cervical spine. A Lateral pinhole scintigraph of the lower cervical spine shows minimally increased tracer uptake in the vertebral endplates (ep) and bodies, pedicles (p), and apophyseal joints (aj). The disk spaces and the intervertebral foramina are photopenic. B Lateral radiograph identifies the individual vertebrae with endplates (arrows) and disk spaces (ds), apophyseal joints (aj), and pedicles. The dens (d) and spinous process (sp) are also visualized

Fig. 4.9A, B Lateral view of the cervical spine. A Lateral pinhole scintigraph of the lower cervical spine shows minimally increased tracer uptake in the vertebral endplates (ep) and bodies, pedicles (p), and apophyseal joints (aj). The disk spaces and the intervertebral foramina are photopenic. B Lateral radiograph identifies the individual vertebrae with endplates (arrows) and disk spaces (ds), apophyseal joints (aj), and pedicles. The dens (d) and spinous process (sp) are also visualized

Apophyseal Cervical

Fig. 4.10A, B Posterior view of the uppermost cervical 4.3 Thoracic Cage spine and skull base. A Posterior pinhole scintigraph of the uppermost cervical spine and skull base reveals increased tracer uptake in the atlantooccipital joints (ao), lateral masses of the atlas (lm), the dens (d), and the apophyseal joints (aj). The atlantoaxial (aa) joints are relatively photopenic because they are larger than the other joints. B Open-mouth anteroposterior radiograph identifies the atlantooccipital joints (ao), lateral masses of the atlas (lm), the dens or odontoid process (d), and the atlantoaxial joints (aa)

Apophyseal Joints Cervical Spine

Fig. 4.11 Lateral view of the uppermost cervical spine. Lateral pinhole scintigraph of the upper cervical spine reveals increased tracer uptake in the atlanto occipital joint (ao), dens (d), apophyseal joints (aj), and spinous processes (sp) (open arrow faint tracer uptake in an os nuchae). The upper portion of Fig. 4.9B identifies the dens (d), apophyseal joints (aj) and spinous processes (sp)

Fig. 4.11 Lateral view of the uppermost cervical spine. Lateral pinhole scintigraph of the upper cervical spine reveals increased tracer uptake in the atlanto occipital joint (ao), dens (d), apophyseal joints (aj), and spinous processes (sp) (open arrow faint tracer uptake in an os nuchae). The upper portion of Fig. 4.9B identifies the dens (d), apophyseal joints (aj) and spinous processes (sp)

Fig. 4.10A, B Posterior view of the uppermost cervical 4.3 Thoracic Cage spine and skull base. A Posterior pinhole scintigraph of the uppermost cervical spine and skull base reveals increased tracer uptake in the atlantooccipital joints (ao), lateral masses of the atlas (lm), the dens (d), and the apophyseal joints (aj). The atlantoaxial (aa) joints are relatively photopenic because they are larger than the other joints. B Open-mouth anteroposterior radiograph identifies the atlantooccipital joints (ao), lateral masses of the atlas (lm), the dens or odontoid process (d), and the atlantoaxial joints (aa)

tal joint, the median atlantoaxial joint, and the base of the dens. Generally, tracer uptake in the apophyseal joints and spinous processes tends to be moderate (Fig. 4.11). The os nuchae (calcification of the ligamentum nuchae), when not too small, can be visualized.

Various parts of the sternum including the sternoclavicular joints, the manubriosternal joints, and the first costosternal joints and the jugular notch can be distinctly imaged by pinhole scin-tigraphy (Fig. 4.12A). Normally, tracer uptake stands out in the sternoclavicular joints and the jugular notch where the sternocleidomastoid muscles are attached. The tracer uptake in the sternoclavicular joints is more often than not asymmetrical, and it is presumably related to handedness. The costosternal and xyphoid cartilages may concentrate tracer when mineralized (Fig. 4.12B). As a rare variant, the first two segments of the sternal body may form incomplete articulation and show prominent uptake, simulating a pathological process (Fig. 4.12C). It is to be interpreted with caution since the site also coincides with a persisting sternebra.

Costochondral Joint Pictures

Fig. 4.12A-C Normal sternum in adults and children. A Anterior pinhole scintigraph of the manubrium sterni in a 42-year-old man shows tracer uptake in the sternoclavicular joints (sc), sternal notch, and manubriosternal junction (ms). Note increased tracer uptake in the right sternoclavicular joint due to right-handedness. B Lateral scintigraph in a woman shows physiological uptake in the costochondral junction (ccj) and retroverted xyphoid process (x). C Anterior scintigraph of the upper sternum in a child demonstrates prominent tracer uptake in the growing manubriosternal junction (ms) and proximal sternebra (ss)

Fig. 4.12A-C Normal sternum in adults and children. A Anterior pinhole scintigraph of the manubrium sterni in a 42-year-old man shows tracer uptake in the sternoclavicular joints (sc), sternal notch, and manubriosternal junction (ms). Note increased tracer uptake in the right sternoclavicular joint due to right-handedness. B Lateral scintigraph in a woman shows physiological uptake in the costochondral junction (ccj) and retroverted xyphoid process (x). C Anterior scintigraph of the upper sternum in a child demonstrates prominent tracer uptake in the growing manubriosternal junction (ms) and proximal sternebra (ss)

An incompletely ossified sternum or sternal ossification center in children is typically discoid in appearance. At this stage, the medial clavicular ends and jugular notch avidly accumulate tracer due to brisk bone formation and the stress of the fortified ligaments (Fig. 4.13). Pinhole scintigraphically, the ribs and clavicles are shown as simple, bar-like structures with uniform tracer uptake of relatively low inten-

Manubrial Sternal Junction

Fig. 4.13 Anterior view of the manubrium sterni in a child. Anterior pinhole scintigraph of the manubrium in an 11-year-old boy demonstrates a rounded, modest tracer uptake in the ossification center (arrow). The intense tracer uptake in the medial clavicular ends indicates active bone growth. The manubriosternal junction (msj) appears widened due to the relative abundance of cartilage at this age

Fig. 4.13 Anterior view of the manubrium sterni in a child. Anterior pinhole scintigraph of the manubrium in an 11-year-old boy demonstrates a rounded, modest tracer uptake in the ossification center (arrow). The intense tracer uptake in the medial clavicular ends indicates active bone growth. The manubriosternal junction (msj) appears widened due to the relative abundance of cartilage at this age sity. Understandably, however, the actively growing parts always accumulate tracer rather intensely.

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