正常人和偏侧咀嚼者颞下颌关节核素骨显像的比较

目的:比较放射性同位素骨三相显像技术对正常人及偏侧咀嚼者颞下颌关节影像检查的差异.材料和方法:正常男性志愿者15名和偏侧咀嚼者20名,接受放射性核素骨三相显像检查,以分析、比较不同咀嚼方式对颞下颌关节及骨的血流和骨代谢的影响.结果:正常人及偏侧咀嚼者两侧颞下颌关节形态对称,偏侧咀嚼者两侧髁状突运动不一致.正常人下颌骨不同部位的骨血流和骨代谢有特定差异.偏侧咀嚼者骨扫描示上述部位差异改变,非咀嚼侧关节区放射性强度稍高于咀嚼侧.结论:放射性同位素骨三相显像可以准确显示颞下颌关节的功能变化.     

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。     

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。     

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。     

He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Ｈｅ夹板治疗时双侧颞下颌关节区的血流情况。探讨Ｈｅ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、Ｈｅ夹板治疗组及正常对照组。分别于髁状窦纵形骨折后２、３、４、１２周做核素三相骨扫描检查。结果 髁状穿纵形骨折侧颞下颌关节（Ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒ ｊｏｕｎｔ,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     

~(99m)Tc骨闪烁显像诊断下颌?状突增生

对14例有下颌髁状突增生的临床与X线特征的面部不对称者作了骨闪烁显像:静脉注入~(99m)Tc-H-MDP三小时后,用聚焦准直器及500000计数对下颌髁状突区作放大的正侧位显像.如双侧髁区呈对称性摄取则为阴性扫描,如单侧摄取增加则为阳性扫描.每例患者术后定期随访最少二年半.结果:14例中10例为阴性扫描,双侧髁区呈对     

99Tcm-MDP SPECT颞颌关节显像对髁突肥大的诊断价值

目的 探讨99Tcm-MDP SPECT颞颌关节显像对髁突肥大的诊断价值.方法 回顾性分析2009年至2010年行99Tcm-MDP SPECT颞颌关节显像的髁突肥大(临床确诊)患者56例(男22例,女34例,平均年龄21.5岁),其中31例接受了髁突高位切除术并有组织病理学结果.另收集10例因恶性肿瘤等其他疾病行骨显像的对照者,男女各5例,平均年龄22.6岁,加做颞颌关节显像.对所有研究对象进行SPECT图像分析及半定量分析,采用独立样本t检验比较髁突肥大组与对照组间患侧髁突/顶骨及患侧髁突/双侧髁突的摄取比差异,髁突肥大组患侧与健侧的摄取差异行配对t检验.对手术治疗患者的SPECT结果与其病理结果进行Pearson相关分析.结果 髁突肥大组患侧髁突/顶骨摄取比(1.66 ±0.63)及患侧髁突/双侧髁突摄取比(0.59±0.44)均明显高于对侧(1.34±0.34、0.41±0.04,t=3.687和6.590,均P＜0.01),并且明显高于对照组左侧髁突相应数据(1.12 ±0.07和0.50±0.01,t =6.459和4.750,均P＜0.001).SPECT检查诊断髁突生长活跃的灵敏度为95.2％(20/21),特异性为60.0％(6/10),阳性预测值为83.3％ (20/24),阴性预测值为6/7.患侧髁突/双侧髁突摄取比与软骨组织增生的厚度无明显相关[软骨膜、增殖层、肥大层的平均厚度分别为(150.5±94.9)、(185.2±113.6)、(167.7 ±76.9)μm,r=0.46、0.47、-0.12,均P＞0.05].结论 99Tcm-MDP SPECT颞颌关节显像能够有效评估髁突肥大患者的骨质生长活性,为手术方式的选择提供重要依据.     

99mTc骨闪烁显像诊断下颌髁状突增生

对14例有下颌髁状突增生的临床与X线特征的面部不对称者作了骨闪烁显像:静脉注入99mTc-H-MDP三小时后,用聚焦准直器及500 000计数对下颌髁状突区作放大的正侧位显像。如双侧髁区呈对称性摄取则为阴性扫描,如单侧摄取增加则为阳性扫描。     

Ⅵ型髁突骨折致颞下颌关节损伤的MRI表现

目的 探讨MRI在Ⅵ型髁突骨折致颞下颌关节损伤中的应用价值. 方法 对18例Ⅵ型髁突骨折患者于伤后3～14 d内行颞下颌关节MRI检查,分析MRI表现. 结果 在18例19侧Ⅵ型髁突骨折中有15侧发生关节盘移位,9侧关节囊撕裂,16侧关节盘后区组织撕裂(双板区),19侧关节腔内关节液改变. 结论 MRI能很好地显示Ⅵ型髁突骨折引起的颞下颌关节损伤情况,是颞下颌关节损伤的重要检查与评价手段,有利于指导临床上对治疗方案的选择.     

256例下颌骨髁状突骨折的流行病学分析

髁状突是下颌骨结构比较薄弱的部位,其骨折发生率约占下颌骨骨折的1/3[1].髁状突是颞下颌关节的重要组成部分,骨折后处理不当,可出现咬合关系异常、颞下颌关节功能紊乱,甚至关节强直等.笔者回顾性分析本院1991-2006年收治的256例髁状突骨折患者的资料,了解髁状突骨折的临床特点和流行病学情况.     

SPECT in the study of pathology of the temporomandibular joint. The authors' personal experience]

Symptomatic temporomandibular joint dysfunctions may affect about 25% of the adult population, with a smaller though significant percentage of patients experiencing severe impairment. From 1986 through 1991, 107 patients with severe temporomandibular joint symptoms and with various temporomandibular joint disorders were evaluated with conventional radiology and with closed/open-mouth temporomandibular joint tomograms. Single-photon emission-computed tomography (SPECT) and planar imaging were performed on 32 patients using a rotating gamma camera equipped with a general purpose collimator. Transaxial, coronal and sagittal tomoscintigrams were reconstructed. Increased radiotracer uptake in the temporomandibular joint was regarded as a positive finding, and the intensity of temporomandibular joint activity was compared with that of adjacent calvarium using regions of interest. In the 32 patients submitted to scintigraphy, conventional radiology showed no pathologic patterns, while SPECT showed pathologic findings in 31 patients (97% of cases). The patient with normal temporomandibular joint findings on SPECT exhibited abnormal maxillary isotope uptake, ipsilateral to the symptoms. Our results indicate that SPECT is a simple, noninvasive, inexpensive and very sensitive screening test relative to the internal derangement of the temporomandibular joint. Moreover, it provides information which is not available by means of routine bone scans or X-ray studies. Thus, SPECT appears to be the modality of choice for patients whose clinical findings are equivocal or whose symptoms are unclear, and it can guide treatment strategies and be useful in the follow-up.     

胸肋锁骨肥厚综合征临床影像学诊断

目的探讨胸肋锁骨肥厚综合征的影像学诊断与鉴别诊断。资料与方法回顾性分析6例患者的X线平片和CT平扫资料。6例中,3例行工作站图像后处理,3例行单光子计算机体层(SPECT)扫描。结果6例均为双侧性胸-肋-锁骨区受累骨增粗,骨、骨髓腔及肋软骨密度增高。相邻关节间隙消失,呈骨性融合。CT见右侧第1肋软骨处假骨折线。SPECT扫描示胸锁关节区双侧较对称的放射性核素浓聚。结论胸肋锁骨肥厚综合征具有较典型的影像学特征,结合临床可做出正确诊断。CT成像在显示受累骨骨皮质、髓腔、韧带骨化、关节骨性强直等方面的改变优于X线平片和SPECT。     

腰椎SPECT显像对关节突关节源性下腰痛的诊断价值

目的 探讨腰椎SPECT显像对关节突关节源性下腰痛的诊断价值.方法 2006年7月至2007年3月共35例下腰痛患者被纳入该研究,根据腰椎SPECT显像结果分为腰椎关节突关节阳性组和阴性组.阳性组行关节突关节注射治疗,阴性组行保守治疗或手术治疗.记录治疗前腰痛情况和显像阳性组随访治疗后1,3及6个月的腰痛情况,并比较分析,阴性组记录相关治疗和治疗后6个月的腰痛情况.采用SPSS 10.0软件,2组患者治疗前相应参数比较用完全随机设计的成组比较t检验,显像阳性组患者治疗前后视觉模拟比例尺(VAS)评分比较采用配对t检验.结果 腰椎SPECT显像检出关节突关节病变15例,随访行关节突关节注射治疗的14例患者(另1例因治疗后在外院又行手术治疗,排除在外),治疗后1,3和6个月疼痛缓解人数比例分别为12/14(85.7%),11/14(78.6%)和7/14(50.0%).治疗后1,3和6个月疼痛评分[VAS分别为(31.33±7.69),(38.21±10.67),(44.64±12.63)mm]与治疗前[VAS为(69.67±5.81)mm]相比差异有统计学意义(t值分别为12.55,8.36,5.54,P均<0.01).显像阴性20例,其中手术治疗3例,保守治疗17例,随访6个月14例(70.0%)患者治疗有效.结论 腰椎SPECT显像有助于检出关节突关节源性下腰痛,筛选适合行关节突关节治疗的患者,以减轻疾病症状,提高患者生活质量.     

Bone SPECT of the back after lumbar surgery.

PURPOSE: It may be difficult to evaluate back pain in patients who have undergone spinal surgery, because symptoms may be secondary to all the possible abnormalities in patients who have not had surgery plus postoperative complications, including infection, unstable fusion sites, or transfer of biomechanical stresses to other regions. MATERIALS AND METHODS: Sixty-three patients with back pain and a history of lumbar spinal surgery had bone SPECT examinations. Twenty-eight patients had laminectomies, 10 had laminectomies with fusion, 10 had laminectomies with fusion and metallic stabilization devices (3 of which were removed), 7 had fusion without laminectomy, 7 had discectomies, and 1 had a fusion with metallic stabilization but no laminectomy. Eighty-seven percent of the fusions were posterior. The results of SPECT scanning were correlated with surgery, clinical information, and diagnostic radiologic studies. RESULTS: Patients with fusions tended to be scanned further out from the time of surgery than were patients with laminectomy alone or especially discectomy. Bone SPECT excluded bony abnormalities in the operative site in 7 of 63 patients. One hundred thirty-two lesions were uncovered, with facet abnormalities (n = 51) the most common followed by disc space-centered conditions (n = 29), pseudarthrosis (n = 20), sacroiliac joint (n = 18), vertebral body lesions (n = 9), and miscellaneous sites (n = 5). Sixty percent of the abnormalities located in the facets, disc spaces, and vertebral bodies were located in the operative field, whereas 29% were above and 11% were below it. CONCLUSION: Bone SPECT was useful in evaluating these patients to exclude bony lesions or to identify pseudarthrosis, abnormal facets, disc space-centered lesions, and sacroilitis.     

New quantitative method for bone tracer uptake of temporomandibular joint using Tc-99m MDP skull SPECT

Objectives  

Quantitative bone SPECT studies have several advantages over qualitative studies for evaluating a temporomandibular joint (TMJ), yet in certain cases additional images are still needed. Accordingly, the current study developed a new easy SPECT quantification method for the bone tracer uptake in a TMJ and evaluated its usefulness and inter-observer variability in patients with TMJ pain.     

色素沉着绒毛结节性滑膜炎的MRI表现

目的 探讨色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis，PVNS)的MRI表现。方法 23例PVNS中膝关节9例，髋关节9例，踝关节3例，肘关节1例，腕关节1例，均经手术和病理证实。23例PVNS均行X线和MR检查，其中4例行CT检查。分析PVNS的影像学表现，着重总结PVNS的MR影像学特点。结果 X线表现：23例均可见关节及软组织肿胀，7例关节内外可出现较致密结节状或分叶状软组织肿块影，19例可见邻近关节骨质侵蚀性小缺损。CT表现：4例中3例可见关节内外结节状或分叶状软组织肿块，增强扫描可见结节样强化，1例CT仅显示关节囊增厚，关节内积液。MRI表现：23例病变部位增生肥厚的滑膜在T1WI上呈中等或中等稍低信号，在T2WI上呈中等稍高信号，其内可见多发散在结节，呈T1WI、T2WI低信号灶；增生肥厚的滑膜在快速梯度回波(FFE)T2WI序列上呈明显结节样低信号。23例病变关节均可见不同程度的关节积液。19例有骨质破坏，表现为凹陷性类圆形骨质缺损，骨缺损区T1、T2WI呈中等信号灶，周围有硬化边，呈T1WI、T2WI低信号。相邻骨髓腔内可见弥漫性反应性水肿灶，呈片状高T2信号。结论 MRI能准确显示PVNS的病变范围和程度，对PVNS有定性诊断价值。     

Internal derangement of the temporomandibular joint: detection by single-photon emission computed tomography. Work in progress

The diagnostic accuracy of both planar and single-photon emission computed tomography (SPECT) bone scintigraphy, radionuclide angiography, arthrography, and conventional radiography was evaluated in 36 patients with temporomandibular joint (TMJ) dysfunction undergoing preoperative testing. The sensitivity of SPECT bone scintigraphy (0.94) was comparable with arthrography (0.96) and significantly better than planar bone scintigraphy (0.76), radionuclide angiography (0.35), and transcranial lateral radiographs (0.04). While data for a larger asymptomatic control population are needed, preliminary results give SPECT a diagnostic specificity of 0.70 for internal derangements of the TMJ requiring surgical correction. It is concluded that SPECT bone scintigraphy is a useful noninvasive imaging test to screen for internal derangement of the TMJ.     

Advanced imaging findings and computer-assisted surgery of suspected synovial chondromatosis in the temporomandibular joint

Synovial chondromatosis of the joint occurs mainly in teenagers and young adults. Only 3% of these neoplasms are located in the head and neck region. Synovial chondromatosis of the temporomandibular joint is therefore a very rare disorder. Therefore, developing a working, histological confirmation is required for differential diagnosis. In this case series, the outcome of histological investigation and imaging techniques are compared. Based on clinical symptoms, five cases of suspected synovial chondromatosis of the temporomandibular joint are presented. In each of the subjects, the diagnosis was confirmed by histology. Specific imaging features for each case are described. The tomography images were compared with the histological findings. All patients demonstrated preauricular swelling, dental midline deviation, and limited mouth opening. Computer-assisted surgery was performed. Histology disclosed synovial chondromatosis of the temporomandibular joint in four cases. The other case was found to be a developmental disorder of the tympanic bone. The diagnosis of synovial chondromatosis of the temporomandibular joint can only be based on histology. Clinical symptoms are too general and the available imaging techniques only show nonspecific tumorous destruction, infiltration, and/or residual calcified bodies, they are only for advanced cases. A rare developmental disorder of the tympanic bone--persistence of foramen of Huschke--has to be differentiated.     

The CT scanner and the temporomandibular joint. Anatomo-radiologic comparisons. Apropos of 14 cases of algodysfunctional of the manducator system

Among 500 CT scan of temporomandibular joint (TMJ), examined since 1982 by bilateral direct sagittal method (Department of Radiology, Pr. A. TREHEUX, CHU Nancy-Brabois), the authors have retained 14 cases of patients with symptoms related to TMJ's dysfunction cured by surgery (Department of Maxillo Facial Surgery, Pr STRICKER, CHU Nancy). These cases were chosen among hundred patients annually examined by CT scan, for various diseases (TMJ's dysfunctions, traumatisms, infections, inflammatory diseases...). These correlations between radiology and surgery about 26 TMJ (2 patients underwent surgery only on one side) were: an accuracy with surgical findings for 19 cases (76%); in 6 cases (23%), a meniscus anteriorly displaced, non detected by CT scan was found by surgery; 2 cases of meniscus perforations (one in the frontal plane, the other sagittal) were surgical findings; in 1 case, a displacement was under-valued by CT scan; in 3 cases, arthrosic changes (1 case of Reiter syndrome), were characterized by CT scan. The authors emphasize the value and the limits of evaluation of the internal derangements of the TMJ with direct sagittal CT.