| Objectives:1.The imaging characteristics and distribution of sternoclavicular joint /clavicle lesions in whole-body bone imaging were analyzed retrospectively.2.To explore the diagnostic value of whole-body bone imaging in sternoclavicular joint / clavicle lesionsMethods:Retrospective analysis of patients who completed whole-body bone imaging and showed abnormal radioactive distribution of sternoclavicular joint / clavicle in the Department of Nuclear Medicine,Third Hospital of Hebei Medical University from January 2015 to September 2022.Inclusion criteria:(1)The patient’s age and gender are not limited;(2)The diagnosis is clear;(3)The quality of whole-body bone imaging was good,and abnormal radioactive distribution was observed in sternoclavicular joint / clavicle.Exclusion criteria:(1)Invasive examination or radiotherapy and chemotherapy before sternoclavicular joint / clavicle examination;(2)The patient’s sternoclavicular joint / clavicle has a clear history of trauma,or there is a long-term movement,marching and other continuous,repeated excessive stress;(3)Patients who were lost to follow-up or had no results after 6-12 months of follow-up.Diagnostic criteria: satisfy one of the following conditions(1)Confirmed by biopsy or surgical pathology;(2)Combined with imaging examination and clinical diagnosis and treatment results for clinical diagnosis,and followed up for more than 6 months,after 6 months of telephone follow-up,it was diagnosed as a malignant lesion;after 6 months of hospitalization,it was diagnosed as containing a malignant lesion;after 6months,new lesions appeared on bone imaging,the disease progressed,or fusion imaging diagnosed malignant lesions,but treatment Later,the symptoms further aggravated,regardless of whether there were new lesions,they were all diagnosed as malignant lesions.After 6 months of telephone follow-up,no malignant lesions were diagnosed;after 6 months of hospitalization,no malignant lesions were diagnosed after discharge;or bone imaging was performed again after 6 months without any relevant treatment,and the images of the lesions faded or disappeared,and there was no bone during the period Pain and other related clinical symptoms were all diagnosed as benign lesions.The classification and statistics of unilateral and bilateral distribution,morphology,degree of radioactive uptake,single and multiple aspects of sternoclavicular joint / clavicle lesions were performed,and the correlation between the above factors and the benign and malignant lesions was analyzed.In addition,the main diseases of sternoclavicular joint / clavicle lesions were analyzed in terms of unilateral and bilateral distribution,morphology,radioactive uptake,lesion site,gender and age.For lesions involving the sternoclavicular joint / clavicle at the same time and when the lesions have multiple morphological types and radioactive uptake levels,superimposed calculations are performed.Results:1.General situation: a total of 258 patients were included,including 142 males and 116 females,with an average age of 57.2±16.6 years.There were105 cases of sternoclavicular joint lesions,including 102 cases ofbenign and 3cases of malignant,and 170 cases of clavicular lesions,including 43 cases of benign and 127 cases ofmalignant.The above included 17 cases of sternoclavicular joint / clavicle involvement,including 15 cases ofbenign and 2 cases ofmalignant.2.Benign and malignant analysis of sternoclavicular joint / clavicle lesionsUnilateral and bilateral distribution: the unilateral distribution of sternoclavicular joint lesions was 57 cases(benign 98.2%,malignant 1.8%),and the bilateral distribution was 48 cases(benign 95.8%,malignant 4.2%).The difference was not statistically significant,r=0.880.There were 130 cases of unilateral distribution of clavicle lesions(benign 26.2%,malignant 73.8%),and 40 cases of bilateral distribution(benign 22.5%,malignant 77.5%),the difference was not statistically significant,r=0.642.Morphological type: it can be divided into five types: punctate,masslike,stripe,patchy and annular.The sternoclavicular joint lesions were punctate in2 cases(benign 100.0%),patchy in 102 cases(benign 97.1%,malignant 2.9%),and annular in 1 case(benign 100.0%),no other morphology,the difference was not statistically significant,r=1.000.Clavicle lesions were punctate in 76cases(benign 13.2%,malignant 86.8%),masslike in 20 cases(benign 15.0%,malignant 85.0%),stripe in 67 cases(25.4% for benign and 74.6% for malignant),patchy in 15 cases(benign 80.0%,malignant 20.0%),and annular in 5 cases(benign 40.0%,malignant 60.0%).The difference was statistically significant,r<0.001.Degree of radioactive uptake: it can be divided into obvious uptake and mild uptake.There were 78 cases of obvious uptake(benign 98.7%,malignant1.3%)and 41 cases of mild uptake(benign 95.1%,malignant 4.9%)in sternoclavicular joint lesions,the difference was not statistically significant,r=0.566.There were 134 cases of obvious uptake of clavicle lesions(benign17.9%,malignant 82.1%),and 41 cases of mild uptake(benign 26.8%,malignant 73.2%).The difference was not statistically significant,r=0.212.Single and multiple: 12 cases of single sternoclavicular joint lesions(benign 100.0%),93 cases of multiple(benign 96.8%,malignant 3.2 %),the difference was not statistically significant,r=1.000.There were 22 cases of single clavicle lesions(benign 68.2%,malignant 31.8%)and 148 cases of multiple(benign 18.9%,malignant 81.1%).The difference was statistically significant,r<0.001.3.Comparative analysis of sternoclavicular inflammatory lesions and degenerative changesUnilateral and bilateral distribution: the inflammatory lesions were unilateral in 30 cases and bilateral in 29 cases,and the degenerative lesions were unilateral in 25 cases and bilateral in 15 cases.The difference was not statistically significant,r=0.252.Morphological type: the inflammatory lesions were punctate in 1 case,patchy in 57 cases and annular in 1 case,and the degenerative lesions were punctate in 1 case and patchy in 39 cases.The difference was not statistically significant,r= 1.000.Degree of radioactive uptake: the inflammatory lesions showed obvious uptake in 58 cases and mild uptake in 8 cases,and degenerative changes showed obvious uptake in 17 cases and mild uptake in 30 cases.The difference was statistically significant,r<0.001.Gender: there were 25 males and 43 females in inflammatory lesions,26 males and 15 females in degenerative changes,and the difference was statistically significant,r=0.022.Age: the average age of inflammatory lesions was 48.3±14.1 years old,and the age of degenerative changes was 68.4±7.4 years old.The difference was statistically significant,r<0.001.4.Comparative analysis of clavicle metastases and plasma cell tumorsUnilateral and bilateral distribution: there were 80 cases of unilateral distribution of bone metastases and 26 cases of bilateral distribution.There were 15 cases of unilateral distribution and 4 cases of bilateral distribution of plasma cell tumors.The difference was not statistically significant,r=0.972.Morphological type: bone metastases were punctate in 56 cases,masslike in 13 cases,stripe in 43 cases,and patchy in 3 cases.Plasma cell tumors were punctate in 10 cases,masslike in 3 cases,stripe in 6 cases,and annular in 3cases.The difference was statistically significant,r=0.019.Degree of radioactive uptake: bone metastases showed obvious uptake in90 cases and mild uptake in 20 cases.Plasma cell tumors showed obvious uptake in 9 cases and mild uptake in 10 cases.The difference was statistically significant,r=0.003.The lesion site: among the bone metastases,64 cases were located in the inner half ofthe clavicle,40 cases were located in the outer half ofthe clavicle,and 12 cases were larger than the half of the clavicle.Of the plasma cell tumors,13 were located in the inner half of the clavicle and 8 were located in the outer half of the clavicle.The difference was not statistically significant,r=0.369.Gender: there were 69 males and 37 females in bone metastases,9 males and 10 females in plasma cell tumors,and the difference was not statistically significant,r=0.142.Age: the average age of bone metastases was 63.1±12.5 years old,plasma cell tumors was 62.0±7.4 years old,the difference was not statistically significant,r=0.704.Conclusions:1.In the whole-body bone imaging,when abnormal radioactive distribution occurs in the sternoclavicular joint,the lesion is often benign.The nature of the lesion is not related to the single and bilateral distribution,morphological type,radioactive uptake degree,single and multiple factors.The benign lesions of sternoclavicular joint are mainly inflammatory lesions and degenerative changes.Inflammatory lesions were more common in middle-aged women,and degenerative changes were more common in elderly men.Both of them showed increased radioactive uptake,but the degree of uptake of inflammatory lesions was more obvious than that of degenerative changes.2.In the whole-body bone imaging,when the clavicle has abnormal radioactive distribution,the lesions are often malignant.The nature of the lesions is not related to the unilateral or bilateral distribution and the degree of radioactive uptake.When the morphology is mainly punctate,masslike and stripe,it is more likely to be malignant lesions.The presence of patchy shape indicates a high probability of benign lesions.If the clavicle lesion is multiple,it indicates that the possibility of malignant disease is high;if it is single,it indicates that the possibility ofbenign disease is high.The malignant lesions of clavicle are mainly bone metastases and plasma cell tumors.Both of them showed increased radioactive uptake,but bone metastases were more obvious than plasma cell tumors.If the shape of radioactive uptake is annular,it indicates that the possibility of plasma cell tumor is high. |
