Spiral CT with multiplanar reconstruction in the diagnosis of sternoclavicular osteomyelitis

The purpose of this study was to determine whether contrast-enhanced spiral ct scanning supplemented by multiplanar reconstruction is of value in the evaluation of suspected infection of the sternoclavicular joints.

Seven patients with suspected infection of the sternoclavicular joints were evaluated with spiral CT using narrow collimation (4 mm) and close interscan reconstruction (2-4 mm). All patients were scanned immediately following the injection of 120 ml Omnipaque-300 at a rate of 3 ml/s. Spiral CT scans were of 24 or 32 s duration and done as single-breath-hold studies. All images were then filmed at soft tissue and bone settings (window width 2300, window center 270). In selected cases, coronal, sagittal, and/or oblique reconstruction of data was done for review.

All studies were successfully completed without any interscan or intrascan motion. In six cases, infections of the sternoclavicular joint was found, including five cases of osteomyelitis of the clavicular head. The scans obtained during the phase of high contrast enhancement allowed definition of the extension into the soft tissue and muscle. Bone windows demonstrated subtle cortical and periosteal abnormalities.

Imaging of the sternoclavicular joints with standard CT can be difficult due to interscan motion and the inability to get good data sets for reconstruction. Spiral CT with 24- to 32-s acquisition allows high quality images enabling detection of disease and definition of extent of disease, thus helping to guide patient management.