Imaging of Anterior Chest Wall Inflammatory Disease: Expert Recommendations

Inflammatory conditions of the anterior chest wall are clinically relevant but remain underrecognized and inconsistently assessed in imaging protocols. The anterior chest wall may be affected by systemic and localized diseases, such as spondyloarthritis, chronic nonbacterial osteitis, rheumatoid arthritis, crystal arthropathies, and osteoarthritis. In spondyloarthritis, anterior chest wall involvement is common yet frequently subclinical. Magnetic resonance imaging enables early detection of enthesitis, synovitis, and osteitis, as well as structural lesions, such as erosions, fatty metaplasia, sclerosis, ankylosis, and hyperostosis. Rheumatoid arthritis typically presents with synovitis, inflammatory cysts, and erosions. Pediatric chronic nonbacterial osteitis manifests as multifocal bone inflammation, often involving the clavicle, requiring whole-body imaging. Adult chronic nonbacterial osteitis includes variants such as sternocostoclavicular hyperostosis and Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis syndrome. Members of the Arthritis Subcommittee of the European Society of Musculoskeletal Radiology prepared this article. It presents updated information on imaging the anterior chest wall in rheumatic conditions with emphasis on systematic assessment. Guidance is provided on optimal imaging sequences, reporting terminology, and differential diagnoses. Ultrasound is the first-line examination. Magnetic resonance imaging is the modality of choice for detecting active inflammation in bone and soft tissue; computed tomography remains preferred for detailed bone and crystal disease evaluation. Recognizing anterior chest wall inflammation can improve diagnostic accuracy and guide early treatment.