核素骨显像在应力性骨折、隐性骨折早期诊断中的价值

目的 研究核素显像在应力性骨折、隐性骨折早期诊断中的价值.方法 收集22例临床怀疑存在应力性骨折或隐性骨折患者的X线片、SPECT核素骨三相检查的资料,分析二者(X线、核素显像)的影像学表现及与病变好发部位的相关性.结果 (1)所有患者均在X线片阴性结果的情况下再进行了核素骨三相扫描,最后诊断应力性骨折12例,隐性骨折8例,正常2例;(2)SPECT核素骨三相扫描血流相、血池相显示骨折部位血供增加,延迟相表现为骨折处异常放射性聚集;(3)应力性骨折或隐性骨折好发部位均具有一定的特征性,均好发于骨骼生物力学上的薄弱区.结论 应力性骨折多为不完全性骨折 ,有些仅仅涉及到皮质,故在疾病的初期,X光片多为正常影像;隐性骨折多由于部位隐蔽,或太小骨折而导致X射线检查难于发现异常.核素显像主要显示的是功能性的异常,尤其骨三相扫描还可显示病变的血供改变情况,对于发现病灶非常敏感,故要早期诊断应力性骨折或隐性骨折核素骨显像是一很有必要的检查手段,尤其是在X光片为阴性结果的情况下.

Value of bone scintigraphy in early diagnosis of stress and occult bone fracture

Objective To assess the value of bone scintigraphy in the early diagnosis of stress or occult born fracture.Methods The study included 22 patients with clinical suspicion of stress or occult born fracture.The characteristics of X-ray and SPECT sicintigraphy of three-period bone were analyzed,and fracture location and pathological alternations were evaluated.Results(1) All 22 patients had negative X-ray for bone fracture.However,the three-period bone sicintigraphy demonstrated 12 patients with stress fracture,8 patients with occult fracture and 2 patients with no fracture.(2) Three-period bone sicintigraphy of vascular and tissue periods showed an increase in blood supply,and a focally increased uptake in the fracture areas was noted on late bone-period sicintigraphy.(3)The stress or occult born fracture often occurred in the biomechanical weak area of the bone with unique characteristics.Conclusion The stress fracture is often incomplete.It may only involve in the cortex.The locations of the occult fracture are often covered,and born fracture is small,therefore,it is difficult to detect stress or occult born fracture by X-ray.In the early period of stress or occult bone fracture,X-ray often appears to be normal.SPECT sicintigraphy is able to detect function abnormality,particularly changes in vascular structure,blood supply and pathology with high sensitivity.Therefore,a bone sicintigraphy should be considered as an important method for early diagnosis of stress and occult bone fracture,especially when X-ray is normal.