核素骨显像诊断颞下颌关节病变的临床价值

目的: 探讨利用放射性核素骨三相显像和SPECT检查颞下颌关节紊乱病患者的价值.材料和方法: 66例颞下颌关节紊乱病患者接受X线片、放射性核素骨三相显像和SPECT检查.通过骨扫描结果进行定性和半定量分析,选择23例患者接受外科手术治疗.结果: 选择保守治疗者43例,血池相和延迟相影像及SPECT两侧关节区影像对称.接受颞下颌关节重建术者23例,血池相和延迟相影像及SPECT影像两侧关节区影像不对称,患侧关节区放射性强度和髁状突放射性计数比值稍高于对侧;术中发现,髁状突表面软骨有破坏,术后患者症状缓解.结论: 骨扫描可以作为颞下颌关节紊乱病的早期器质性病变的检测手段,选择为治疗方法提供参考.     

儿童创伤性强直颞下颌关节的血流变化

目的：探讨创伤性颞下颌关节强直后儿童颞颌关节血流的变化。材料与方法：应用放射性同位素三相骨扫描方法检查７名创伤性颞下颌关节强直患儿,观察其颞颌关节区血流变化。结果：强直侧颞颌关节区三相骨扫描血流相曲线明显低于非强直侧,强直侧颞下颌关节区延迟相和血池相的放射计数比值比健侧大。结论：创伤性颞颌关节强直可使颞颌关节区血流灌注受到明显影响。     

核素三相骨扫描监测小型猪髁突骨折后血流变化及修复过程

目的：观测髁突骨折后的血供变化、骨内代谢活性变化以及由此导致的修复状况。材料和方法：中国实验用小型猪９头，分别造成左侧髁突纵行和横行骨折模型，在不同时间进行核素三相骨扫描检查。结果：两种类型髁突骨折血流相的时间－放射性活度曲线术侧颞下颌关节（ＴｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒＪｏｉｎｔ，ＴＭＪ）血流有较大变化，术侧ＴＭＪ区延迟相和血池相的放射性计数比值各个时间组均比健侧大，其中所有三相术侧的变化纵行骨折区大于横行骨折区。不同类型髁突骨折引起的关节血流变化不同，髁突纵行骨折比横行骨折变化更大。结论：核素三相骨扫描在骨折后修复过程中能为临床提供非常有用的信息，由此可反映出不同类型骨折后在不同时间的骨代谢、血供及修复过程的状况。     

骨放射性损伤血液供应及代谢改变的实验研究

目的 探讨放射线照射后近、远期骨局部血流及代谢的变化。方法 ^60Co(30Gy）一次性照射兔右后肢胫骨，分别于致伤后第1、3、6、12、24和52周行局部血流量（RBF）测定、动脉灌注显像和延迟骨显像。结果 照射后伤侧RBF逐渐增加，3周时为对照侧的2倍，6周时两侧接近，52周时仅为对照侧的27．8％。致伤后3周，受照侧时间－放射性曲线明显高于对照侧，12周开始降低，52周时约为对照侧的25％。照射后3周伤侧延迟骨显像ROI计数明显增加（P＜0．01），6周时两侧差异无显著性（P＞0．05），12周后受照侧明显降低（P＜0．01）。结论 放射性骨损伤早期受照局部骨血液供应增加伴成骨代谢活跃，中晚期局部血循环及成骨代谢明显低下。     

板对颞下颌关节紊乱病治疗作用及对脑血流的影响

颞下颌关节（TMJ）为人体结构复杂的关节之一，参与咀嚼、语言等多项复杂性生理功能，活动很灵活，易受损伤，人群发病率很高，但统计数字差异较大。颞下颌关节紊乱病（TMD）症状复杂，一般有颞下颌关节区及相应的软组织包括肌肉的疼痛；下颌运动异常和伴有功能障碍；关节弹响、破碎声及杂音等三类症状，可伴有头痛、眼及耳部症状，影响咀嚼功能并可引起全身不适。颞下颌关节紊乱病针对不同的病因和致病机制有多种治疗方法，     

下颌骨双向牵张成骨治疗颞下颌关节强直伴小下颌畸形

目的:探讨牵张成骨技术在颞下颌关节强直伴小下颌畸形治疗中的应用效果。方法:对6例颞下颌关节强直伴严重小下颌畸形的患者采用一期下颌骨双向牵张成骨、二期颞下颌关节成形术进行治疗。结果:所有患者术后均顺利完成牵引计划,并在3个月后拆除牵张器,面容获得极大改善,张口度达到25mm以上,睡眠呼吸暂停症状消失,营养状况改善,口内咬合关系基本恢复。结论:牵张成骨技术为临床上治疗颞下颌关节强直伴严重小下颌畸形提供了有效方法。     

不是牙病的"张嘴疼"

近日，笔者的一位同学打电话来说，他因从小左侧牙齿不好，常用右侧牙齿咀嚼食物。最近一段时间，他感觉吃东西或开口说话时，右侧颞下颌关节部疼痛，尤其是打哈欠和大声说笑时，疼痛更加明显，并且张大口时颞下颌关节部有弹响。到医院一检查，方知患了颞下颌关节紊乱综合征。颞下颌关节是颌面部惟一可以活动的联动关节，有咀嚼、语言、吞咽与表情等功能。在两侧升颌肌群、降颌肌群的协调作用下，它可以完成开闭口、前伸、侧方等各种生理功能运动。如果咀嚼肌群失衡，颞颌关节各组成部分之间的功能、结构失常，甚至出现器质性破坏，就会引起…     

MRI诊断颞下颌关节损伤的价值

目的:探讨MRI诊断颞下颌关节损伤的应用价值。材料和方法:对30例颞下颌关节损伤患者于外伤后3～20天内行颞下颌关节MRI检查,MRI扫描序列包括闭口斜矢状位T1WI、PDWI、斜冠状位T1WI、T2WI,张口斜矢状位T1WI、PDWI。由两位资深放射科医师分析MRI表现。结果:30例共60个颞下颌关节中发现18个髁状突骨折,9个骨损伤,29个关节盘移位,26个关节囊积液、积血。结论:MRI能很好的显示颞下颌关节的骨折、骨损伤以及关节盘与关节囊损伤情况,是颞下颌关节损伤的重要检查与评价手段,具有很高的临床应用价值。     

夹板治疗髁状突纵形骨折对颞下颌关节血流影响的研究

目的：观察髁状突纵形骨折后及夹板治疗时双侧颞下颌关节区的血流情况。探讨夹板治疗机制。材料和方法：中国实验用小型猪１４头,分为髁状突纵形骨折未治疗组、夹板治疗组及正常对照组。分别于髁状突纵形骨折后２、３、４、１２周做核素三相骨扫描检查。结果：髁状突纵形骨折侧颞下颌关节（Ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒｊｏｉｎｔ,ＴＭＪ）血流相的时间－放射性强度曲线改变大,峰值升高,峰时后延,以２周时最为明显,夹板治疗组各时间点均较未治疗组的ａ／β比值高。骨折侧血池相及延迟相计数比值升高,骨折后２周最高,然后逐渐下降。延迟相计数比值在夹板治疗组较未治疗组高。结论：夹板治疗髁状突纵形骨折有利于骨折后的血供,可能的作用机制是夹板减轻关节内及骨内压力,减轻静脉瘀血。     

颞下颌关节的磁共振成像检查

颞下颌关节疾病是临床常见病,介绍了颞下颌关节的解剖及常用磁共振成像检查方法,主要对颞下颌关节的正常及常见病变的磁共振表现及一些新的成像方法进行了综述,并与其他常用检查方法进行了比较.     

A comparative study of<Superscript>2O1</Superscript>T1 scintigraphy and three-phase bone scintigraphy following therapy in patients with bone and soft-tissue tumors

OBJECTIVE: The purpose of this study was to evaluate the usefulness of 201Tl scintigraphy in comparison with three-phase bone scintigraphy in the differentiation of residual/recurrent tumors from post-therapeutic changes, in patients previously treated for bone and soft-tissue tumors. METHODS: Thirty-five 201Tl and three-phase bone scintigraphy scans were obtained for 30 patients with a history of bone or soft-tissue tumor who had undergone chemotherapy, radiation therapy, tumor resection, or a combination of these treatments. The planar 201Tl images were acquired 10 mins (early) and 2 hrs (delayed) after the intravenous injection of 111 MBq 201Tl-chloride. Three-phase bone scintigraphy was performed using 740 MBq 99mTc-HMDP at the same lesion site as for 201Tl imaging. The blood flow images were obtained every 10 sec for 2 mins and were immediately followed by the blood pool image after 5 mins. Three to 4 hrs later, bone images were obtained. 201Tl and three-phase bone scintigraphies were correlated with the histopathologic findings and/or clinical follow-up of more than 3 months. RESULTS: Of the 35 cases, 15 were free of disease and 20 had residual or recurrent tumors. Of the 20 residual or recurrent cases, all had true-positive 201Tl early and delayed scans, while bone scintigraphy was true-positive on the blood flow, blood pool and bone images in 16, 18 and 12 cases, respectively. 201Tl early and delayed images and 99mTc-HMDP blood flow and blood pool images were false-positive in one patient. The histology of this false-positive case showed the presence of lymph proliferative tissue. CONCLUSIONS: Although 201Tl uptake after treatment does not always indicate recurrence, 201Tl scintigraphy may still be more useful than three-phase bone scintigraphy in the follow-up of patients with bone and soft-tissue tumors following therapy.     

Combined use of bone and bone marrow scintigraphies for the diagnosis of active sacroiliitis: A new approach

Diagnosis of sacroiliitis (SI) with bone scintigraphy may involve difficulties even with a quantitative approach. The aim of this study was to evaluate the combined use of bone and bone marrow scintigraphies for the diagnosis of active sacroiliitis. Thirty-one patients who were clinically suspected to have SI were included in the study. Bone and bone marrow scintigraphies were done after injections of 740 MBq of 99mTc-MDP (MDP) and 370 MBq of 99mTc-sulfur colloid (SC) respectively with a 2-day interval. Both visual and quantitative assessment of MDP uptake and visual assessment of SC uptake in sacroiliac joints were performed. Also sacroiliac joint radiographic findings for each patient were evaluated and graded from 0 to 4 according to the New York grading system. Patients were divided into 2 groups according to their x-ray findings (Group A: grade 0-2, Group B: grade 3-4). A total of 14 patients (10 bilateral, 4 unilateral) had increased MDP uptake with decreased/normal SC uptake. Twelve of 14 patients had grade 0-2 radiographic changes while only 2 patients had grade 3-4 radiographic changes. Increased MDP uptake with decreased/normal SC uptake is the most common scintigraphic pattern seen in acute phase SI in which radiographic findings are generally found to be normal or slightly changed. In at least in 8 patients the decreased bone marrow uptake of SC was demonstrated, supporting the diagnosis. Although our results did not reveal any significant superiority of bone marrow scintigraphy to bone scan for the detection of active sacroiliitis, combined use of bone and bone marrow scintigraphies was presented as an alternative method to characterize patients with active sacroiliitis.     

卒中偏瘫早期复杂性区域性疼痛综合征患者的三相骨扫描半定量研究

目的 探索三相骨扫描早期相和延迟相在判断卒中偏瘫早期复杂性区域性疼痛综合征患者的半定量研究结果方面是否存在差异。方法29例入选的脑卒中偏瘫早期复杂性区域性疼痛综合征患者经静脉注射99Tcm-亚甲基二膦酸盐（MDP）后行三相骨扫描,半定量计数健侧和患侧的腕、掌指、指间和远指关节感兴趣区（ROI）,比较健患侧差异（秩和检验）。同时,计算各扫描相放射性计数总的患／健侧放射性比值,比较其差异（单因素方差分析和Bonferroni检验）。结果在灌注相、血池相和延迟相,患侧腕、掌指、近指、远指关节的ROI放射性计数均大于健侧（秩和检验,Z=-4．73～-2．10,P均〈0．05）。各相的患／健侧放射性比值之间差异无统计学意义（单因素方差分析,F=0．807,P〉0．05）。各相之间两两比较差异也无统计学意义（Bonferroni检验,si值均为0．29,x=-0．31,-0．33,-0．03,P均〉0．05）。结论卒中偏瘫早期复杂性区域性疼痛综合征患者三相骨扫描均存在偏瘫侧腕及手部各关节的放射性浓聚,早期相和延迟相没有明显不同,三相均可用于该病的辅助诊断。     

Magnetic resonance imaging versus bone scintigraphy in suspected scaphoid fracture

Magnetic resonance imaging (MRI) has become increasingly useful in the evaluation of musculoskeletal problems, including those of the wrist. In patients with a wrist injury, MRI is used mainly to assess vascularity of scaphoid non-union. However, the use of MRI in patients in the acute phase following carpal injury is not common. Three-phase bone scintigraphy is routinely performed from at least 72 h after injury in patients with suspected scaphoid fracture and negative initial radiographs. We evaluated MRI in this patient group. The bone scan was used as the reference method. Nineteen patients were included. Bone scintigraphy was performed in all 19 patients, but MRI could be obtained in only 16 (in three patients, MRI was stopped owing to claustrophobia). In five patients, MRI confirmed a scintigraphically suspected scaphoid fracture. In one patient, a perilunar luxation, without a fracture, was seen on MRI, while bone scintigraphy showed a hot spot in the region of the lunate bone, suspected for fracture. This was confirmed by surgery. In two patients, a hot spot in the scaphoid region was suspected for scaphoid fracture, and immobilization and employed for a period of 12 weeks. MRI was negative in both cases; in one of them a scaphoid fracture was retrospectively proven on the initial X-ray series. In another two patients, a hot spot in the region of MCP I was found with a negative MRI. In both, the therapy was adjusted. In the remaining six patients, both modalities were negative. We conclude that in the diagnostic management of patients with suspected scaphoid fracture and negative initial radiographs, the use of MRI may be promising, but is not superior to three-phase bone scintigraphy.     

Whole-body and pinhole bone scintigraphic manifestations of Reiter’s syndrome: distribution patterns and early and characteristic signs

The characteristic whole-body and pinhole scintigraphic manifestations of osteo-enthesopathy and arthropathy in Reiter’s syndrome (RS) are described, with an emphasis on early diagnosis. We analysed 59 sets of whole-body and pinhole bone scintigrams of 59 patients with RS. The population comprised 47 men and 12 women with an age range from 15 to 53 years (mean=29.4). Bone scintigraphy was carried out 2–2.5 h after intravenous injection of technetium-99m hydroxydiphosphonate using a single-head gamma camera (Siemens Orbiter Model 6601) with a low-energy high-resolution and a 4-mm pinhole collimator for whole-body and pinhole scintigraphy, respectively. In total 262 lesions of osteo-enthesopathy and arthritis were detected on 59 whole-body scintigrams, an incidence of 4.4 lesions per patient. As anticipated, the lesional distribution was asymmetrical: 68% were in the lower limb skeleton and 32% in the axial and upper limb skeleton. Pinhole bone scintigraphy, applied selectively to one region of interest in each case, enabled us to accurately diagnose arthritis and osteo-enthesopathy. It was noteworthy that osteo-enthesopathy, alone or in combination with arthritis, occurred in 78.9%, and had a strong predilection for the foot bones, especially the calcaneus (25.6%). Pinhole scintigraphy detected enthesopathy in the absence of radiographic alteration in 14.1% of cases and portrayed characteristic signs of RS in 6.9%. Whole-body bone scintigraphy augmented with pinhole scintigraphy was found to be useful in order to panoramically display the systemic involvement pattern, to assess the characteristic bone and articular alterations and to detect early signs of RS. Received 1 August and in revised form 17 October 1998     

Implications of Three-Phase Bone Scintigraphy for the Diagnosis of Bisphosphonate-Related Osteonecrosis of the Jaw

Purpose

Bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ) is a well-known serious complication of BP treatment. This study was undertaken to evaluate the diagnostic usefulness of three-phase bone scintigraphy in patients with BRONJ.

Methods

Forty-one patients (48 lesions) with clinically proven BRONJ (2 males, 39 females, age 74.3 ± 6.7 years) underwent Tc-99 m HDP bone scintigraphy. Visual interpretation and semiquantitative analysis of uptakes using lesion-to-contralateral uptake ratios during the blood pool phase (BUR) and during the osseous phase (OUR) were performed, and relations were sought between these and various clinical parameters.

Results

Three-phase bone scintigraphy showed increased perfusion and blood pooling in 21 (63.6 %) and 27 (81.8 %) of 33 lesions, respectively. The osseous phase was positive for 45 (93.8 %) of the 48 lesions. Of the four inflammatory clinical parameters of BRONJ [pus discharge, pain, swelling, and erythrocyte sedimentation rate (ESR)], patients with three or more parameters had more positive findings in vascular and blood pool phase images (p = 0.033, p = 0.027). By semiquantitative analysis, patients with a positive ESR had statistically higher BUR and OUR (both p < 0.001). Higher stage BRONJ lesions had higher OUR than lower stage lesions (p = 0.003). In addition, bone scintigraphy revealed three clinically covert BRONJ lesions without bone exposure, and four patients were up-staged based on bone scintigraphy.

Conclusions

Bone scintigraphy provides a relatively sensitive means of detecting BRONJ, so it was helpful for accurate BRONJ staging. Furthermore, increased uptakes in vascular and blood pool phases of three-phase bone scintigraphy were related to the inflammatory activity of BRONJ.     

Value of bone scintigraphy in patients with carpal trauma

OBJECTIVE: We planned this study to evaluate the role of bone scintigraphy in patients with suspected carpal fracture and normal or suspicious radiographs following carpal injury. METHODS: Three-phase bone scintigraphy using Tc-99m-MDP was performed on 32 patients with negative radiographs but clinically suspected fracture at two weeks after the trauma. Focally increased radiopharmaceutical uptake was interpreted as a fracture. The final diagnosis was established with clinical follow-up. RESULTS: Twelve (38%) patients had a normal scan excluding fracture. Twelve patients had a single fracture. Multifocal fracture was present in 8 (25%) patients. Eight patients showed scaphoid fractures; of these three showed single scaphoid fracture, and the other five patients revealed accompanying fractures. Distal radius fractures and carpal bone fractures other than scaphoid were both observed in 12 patients. These were eleven fractures of distal radius; three fractures of pisiform; two fractures of hamate; and single fractures of lunate, trapezium and triquetrum. In one patient there was fracture of a first metacarpal bone. CONCLUSION: In patients with suspected carpal bone fracture and normal or suspicious radiographs, bone scintigraphy can be used as a reliable method to confirm or exclude the presence of a scaphoid fracture and to detect clinically unsuspected fractures of distal radius and other carpal bones.     

Reversible findings of methylene diphosphonate bone scintigraphy in Raynaud's phenomenon: case report and review of the literature

A 53-year-old woman with carcinoma of the right breast, spinal metastases and right arm lymphoedema was referred for bone scintigraphy prior to commencement of chemotherapy. The patient arrived in the department complaining of pain in the left hand, which appeared red and slightly swollen. Bone scintigraphy revealed increased tracer uptake in the first four metacarpal and all the carpal bones of the left hand. A repeat three-phase bone scintigram, performed 1 week later when the patient was asymptomatic, showed equal blood flow to both hands with normal blood pool and uptake in bone images. The case demonstrates a state of reversibly increased bone uptake in a patient injected at the time of an episode of Raynaud's phenomenon and the possible implications for scan interpretation. Correspondence to: A.M. AL-Nahhas     

Demonstration of achilles tendon rupture by three phase bone scintigraphy and MRI

A man with complaint of soreness in the right medial ankle underwent three-phase bone scintigraphy; the results of the study suggested chronic active osteomyelitis or cellulitis, he was on antibiotics and was not experiencing any improvement. MR imaging confirmed Achilles tendon rupture. This case illustrates that a positive three-phase study is non-specific disease entity.     

Usefulness of 18F-FDG PET-directed skeletal biopsy for metastatic neoplasm

RATIONALE AND OBJECTIVES: Technium-99m methylene diphosphonate (99mTc-MDP) bone scintigraphy and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) are useful imaging modalities to detect skeletal metastases. Several other conditions such as infection, fractures, and arthritis can cause false-positive results with either modality. However, PET is felt to be more specific than bone scintigraphy for malignancy. Our objective was to investigate the value of PET scan compared with bone scintigraphy for directing biopsies in patients with suspected metastatic bone lesions. MATERIALS AND METHODS: Retrospective case series of subjects with undergoing skeletal biopsy of suspected metastases detected by 99mTc-MDP scintigraphy or 18F-FDG PET scan. Reference standards were pathologic reports and follow-up for 6 months. The diagnostic test performance measures of true positive (TP), false positive (FP), and positive predictive value (PPV) were calculated for each group. The PPV with 95% confidence intervals (CI) was compared using the Fisher exact test. RESULTS: There were a total of 68 subjects. PET-directed skeletal biopsies (n = 39) showed 35 TP, 4 FP, and an 89.7% PPV (95% CI: 75.7-97.1%). Bone scintigraphy directed biopsies (n = 29) had 21 TP, 8 FP, and 72.4 % PPV (95% CI: 52.7-82.7%). The PPV was not significantly different between the groups (P = .10). CONCLUSION: This study supports that PET can be used to effectively direct bone biopsies to confirm metastatic neoplasm and suggests that PET may provide incremental improvement to diagnostic yield over bone scintigraphy. The role of PET compared with bone scintigraphy for directing skeletal biopsies warrants further verification.