| Objective:1.Retrospective analysis of imaging characteristics and distribution of sacroiliac joint/sacral lesions in whole-body bone imaging.2.To explore the diagnostic value of whole body bone imaging in sacroiliac joint/sacral lesions.Methods:A retrospective analysis was conducted of patients who underwent whole-body bone imaging examinations in the Department of Nuclear Medicine of the Third Hospital of Hebei Medical University from January 2015 to September 2022 and showed abnormal radioactivity distribution in the sacroiliac joint/sacrum.Clinical data of patients were recorded,including gender,age,clinical pathology,imaging data,and clinical diagnosis.The unilateral and bilateral distribution,morphology,radiation uptake,and nature of the sacroiliac joint/sacral lesions were statistically analyzed.And imaging analysis of the characteristics of several major sacroiliac joint/sacral diseases.For patients with simultaneous involvement of sacroiliac joint/sacrum lesions and when there are multiple types of lesions and levels of radiation uptake,superposition calculations are performed.Results:1.General characteristics of included casesA total of 1091 patients(571 males and 520 females)with an average age of 59.5±14.8 years,ranging from 3 to 91 years old,were included,including 558 malignant lesions and 543 benign lesions.2.Analysis of benign and malignant sacroiliacjoint/sacral lesionsUnilateral and bilateral classification:A total of 513(malignant 70.6%;benign 29.4%)were distributed unilaterally at the sacroiliac joint,and a total of 543(malignant 34.8%;benign 65.2%)were distributed bilaterally.There is a statistical difference between the two sets of data(χ2=135.176,P<0.001).Morphological classification:The shape of the sacroiliac joint can be divided into five types:punctate,massive,stripe,patchy and annular.562 punctate lesions at the sacroiliac joint(malignant 56.9%;benign 43.1%);314 mass lesions(69.7%malignant;30.3%benign);247 patchy lesions(malignant 62.3%;benign 37.7%);179 striped lesions(8.9%malignant,91.1%benign);There are 25 annular(osteolytic)lesions,all of which are malignant.There are statistical differences in the overall comparison of the five groups of data(χ2=207.945,P<0.001).The morphology of the sacrum can be divided into four types:punctate,massive,patchy,and annular.182 punctate lesions at the sacrum(68.1%malignant;31.9%benign);98 mass lesions(65.3%malignant,34.7%benign);54 striped lesions(malignant 74.1%;benign 25.9%);7 annular(osteolytic)lesions were malignant.Overall comparison of the four groups of data showed no statistical difference(P=0.224).Classification of the degree of radioactive uptake:it is divided into obvious uptake,mild uptake,and sparse(defect)uptake.There were 786 obvious uptake lesions at the sacroiliac joint(58.9%malignant,41.0%benign);386 mild uptake lesions(malignant 12.7%;benign 87.3%);There were 61 sparse(defective)lesions(73.8%malignant;26.2%benign).The overall difference between the three groups of data is statistically significant(χ2=244.396,P<0.001).Significant uptake of 294 at the sacrum(84.4%malignant;15.6%benign);Mild intake of 17(malignant 47.1%;benign 52.9%);16 cases were sparse(defect)(malignant 56.3%;benign 43.7%).The overall difference between the three groups of data is statistically significant(χ2=80.818.P<0.001).3.Comparative analysis of multiple myeloma and bone metastasisMorphological classification of lesions:There was no statistical difference between the four groups of data on the sacroiliac joint in terms of punctate,massive,patchy and annular(χ2=7.286,P=0.063).There was also no statistically significant difference in the overall comparison of the four groups of data at the sacrum:punctate,massive,patchy and annular(χ2=7.185,P=0.066).Radioactive uptake of lesions:There was no statistically significant difference between significant uptake,mild uptake,and sparse(defect)data at the sacroiliac joint(χ2=1.070,P=0.586).There is a statistical difference in the overall comparison between the three groups of data:significant uptake at the sacrum,mild uptake,and sparse(defect)data(χ2=22.227,P<0.001).Gender and age:There is no statistical difference between the male and female groups(χ2=0,P=0.997).There is no statistical difference between the two groups in terms of age(t=0.482,P=0.903).4.Comparative analysis of degenerative changes and inflammatory lesionsMorphological classification of lesions:There are statistical differences among the four groups of data on the sacroiliac joint:punctate,massive,stripe and patchy(χ2=19.813,P<0.001).Radioactive uptake of lesions:There is a statistical difference between significant and mild uptake at the sacroiliac joint between the two groups of data(χ2=8.173,P=0.004).Gender and age:There are statistical differences between the male and female groups(χ2=9.642,P=0.002).There is statistically significant difference between the two groups in age(t=2.327,P<0.001).Conclusion:1.Whole body bone imaging can sensitively display sacroiliac joint/sacral lesions,and has important clinical value in determining the nature of the lesion.2.The whole body bone imaging shows abnormal radioactivity distribution in the sacroiliac joint.If it is unilateral,there is a high possibility of malignant lesions;If it is bilaterally distributed,the possibility of benign lesions is high.3.The radiological distribution of sacroiliac joint/sacral lesions can be characterized by punctate,massive,stripe,patchy and annular.The distribution of radioactivity in sacroiliac joint/sacral lesions is mainly in the form of punctate and massive,but both have no clinical significance in judging benign and malignant lesions;If the distribution is annular,the possibility of malignant lesions is high;If it appears as a stripe like distribution,the possibility of benign lesions is high.4.The degree of radioactivity uptake in sacroiliac joint/sacral lesions has certain clinical value in the diagnosis of benign and malignant lesions.If the manifestation is obvious uptake or sparse(defect),the possibility of malignant lesions is high;If mild ingestion is present,the possibility of benign lesions is high.Among benign sacroiliac joint lesions,degenerative and inflammatory lesions are the most common,and the radionuclide uptake in inflammatory lesions is more obvious than the former;Bone metastases and multiple myeloma are the most common malignant lesions of the sacrum,both of which exhibit radioactive concentration.However,if there is a coexistence of radioactive concentration,sparsity,and defect(annular uptake),the likelihood of multiple myeloma is greater. |
