# Feasible CT features to distinguish incidental rib enhancement from sclerotic metastasis in patients with malignancies

## TL;DR

This study identifies CT scan features that can help distinguish harmless rib enhancement from cancer-related rib changes in patients with malignancies.

## Contribution

The study introduces specific CT characteristics to differentiate incidental rib enhancement from sclerotic metastasis in cancer patients.

## Key findings

- Incidental rib enhancement shows nodular/patchy enhancement in the arterial phase and decreased density in the venous phase.
- Rib enhancement is closely connected to the intercostal venous plexus and disappears on unenhanced scans, unlike sclerotic metastasis.
- Most rib enhancements shrink or disappear during the venous phase, aiding in differentiation from metastasis.

## Abstract

To investigate the CT features of incidental rib enhancement (RE) and to summarize the CT characteristics for distinguishing the RE from sclerotic metastasis (SM) in patients with malignancies.

This retrospective observational study enrolled 79 patients with RE (involved 133 ribs) during October 2014 and December 2021. Another 53 patients with SM (160 SM) in the same period were selected randomly for comparison. The location, enhancement patterns of RE were reviewed. The CT values of RE regions and SM were measured and statistically analyzed.

Most REs (70 patients, 88.6%) were in the 1st to 6th ribs. 50 patients had solitary RE and 29 with multiple REs in a regional distribution. All the REs were closely connected to the intercostal venous plexus (ICVP) ipsilateral to the injection site. No visible abnormalities on unenhanced scans were detected in all REs. One hundred and twenty REs (90.2%) had nodular/patchy enhancement. The CT value of RE regions in the venous phase was lower than that in the arterial phase (589.8 ± 344.2 HU versus 1188.5 ± 325.3 HU, p < 0.001). During the venous phase, most REs (125, 94.0%) shrank or disappeared. SM appeared similar on both contrast-enhanced and unenhanced scans in terms of shape and CT values.

The RE demonstrated characteristic CT features. The manifestations of nodular/patchy enhancement in the arterial phase, decreased density and shrinkage or disappearance during the venous phase, and no abnormality on unenhanced scans, as well as a close connection with the ICVP, may help differentiate RE from SM.

The online version contains supplementary material available at 10.1007/s00256-024-04609-3.