核医学显像对不明性质颈痛患者的诊断价值

目的 探讨核医学显像在诊断不明性质颈痛中的价值.方法 70例不明性质颈痛患者,X线、CT或MRI结果提示骨质破坏或占位性病变,无法确定病变性质,拟手术治疗入院.为明确诊断,行99m Tc-亚甲基二磷酸盐(99mTc-MDP)全身骨显像.显像后1周内行手术或病灶穿刺活检,获得病理学结果.10例骨显像多发骨转移瘤的患者进行了符合线路18F-脱氧葡萄糖(FDG)肿瘤代谢显像.结果 骨显像阳性62例.33例颈部单发病灶,其中原发恶性肿瘤4例,转移瘤6例,良性病变23例.29例为多发病灶,其中转移瘤24例.25例患者骨显像后改变了治疗方案.10例转移瘤患者中的7例18F-FDG肿瘤代谢显像找到了原发病灶.结论 全身骨显像应作为诊断不明性质颈痛的重要辅助手段.18F-FDG肿瘤代谢显像与全身骨显像联合应用对于不明性质颈痛的明确诊断,分期,指导临床治疗有着重要的意义.

The role of nuclear imaging in the diagnosis of patients with cervical pain of uncertain diagnosis

Objectives Neck pain with bone destruction can be caused by various disorders of the cervical vertebra. This study was undertaken to discuss the role of nuclear imaging in evaluating such lesions. Methods Seventy patients suffered from neck pain of uncertain diagnosis were initially considered undergoing surgery. Radiographs or MRI showed bone destruction or occupying diseases in cervical vertebra and could not settle on the diagnosis. All patients had bone scans performed using99mTc-methylene diphosphonate(MDP) before surgery. Biopsy or surgery were carried out to all patients after bone scan in one week. 10 of patients with metastasis showed by bone scan underwent whole body 18F-FDG coincidence imaging in the same week to find primary tumors. Results Altogether,62 patients had scintigraphic abnormalities. Bone scan results showed 33 cervical solitary lesions,including primary malignant tumors 4,metastatic disease 6,benign diseases 23. Bone scan results showed more extensive diseases than had been suspected clinically in 29 patients,including metastatic disease24. Clinical management was changed by bone scan results in 25 patients for whom surgery was initially considered. Whole body 18F-FDG imaging successfully demonstrated 7 primary sites in the 10 patients with metastatic diseases. Conclusion Bone scan should be a regular choice for screening patients of cervical pain of uncertain diagnosis and presence of bone destruction. Combined with bone scan,whole body 18F-FDG imaging assists in both finding primary tumors and selecting the appropriate treatment protocols for metastatic patients.