The particular usefulness of radioisotope methods in some benign bone diseases.

The authors have performed radioisotope examinations in 271 patients with various non-neoplastic bone diseases. According to their opinion, early diagnosis and follow-up of therapeutic results are the main characteristics which allow radioisotopes to play an important and irreplaceable role. They particularly emphasize the usefulness of radioisotope methods in femoral aseptic necrosis and Paget's disease.     

The interchangeability of radioisotope and X-ray based measurements of bone mineral density

Lumbar spine and femoral neck bone mineral density (BMD) were measured with a Novo radioisotope based dual photon densitometer and with a Lunar X-ray densitometer in 94 subjects attending a Metabolic Bone Disease Clinic. There was a strong correlation between results obtained from each machine for the same skeletal site. The correlation coefficients for the spine and femoral neck were 0.97 and 0.88, respectively. The differences between results from each machine were normally distributed with a mean bias of 37.5% for the spine and 27.8% for the femur, which arise principally from differences in machine calibration. In each case the BMD was greater when measured by X-ray absorptiometry. The range for the bias was approximately 25-50% for the spine and 10-45% for the femoral neck. The results from these two machines are not interchangeable. When subjects who are participating in long term studies using a radioisotope densitometer are transferred to an X-ray densitometer, an individual conversion factor must be measured at each site for each subject.     

Scintigraphy of benign bone disease

Bone scintigraphy is ideally suited for the investigation of benign bone disease as it functions at a physiological level. It is freely available and has whole-body capability and high-contrast resolution. When coupled with single-photon emission computed tomography/computed tomography (SPECT/CT), it can be utilized to provide precise anatomical localization, attenuation correction, and therefore better lesion localization. A considerable volume of data has accumulated on the role of bone scintigraphy in trauma and its complications, overuse injuries, vascular disease of bone, metabolic bone diseases, and a variety of other disorders. This article is an overview of the established applications and signposts of potential future applications with the increasing prevalence of SPECT/CT devices and technical advances in attenuation correction, collimator modeling, and resolution recovery software.     

Diagnostic-therapeutic procedure in benign bone tumors

The indications of surgical treatment of benigne bone tumours are strongly related to the clinical behaviour, the patient's complaints and the activity in Tc-bone scan. Some lesions – like the nonossifying fibroma – that can safely be diagnosed by conventional x-rays may not be treated surgically – as long as the patients are free of pain, and there is no risk of pathologic fracture. In case of clinically relevant lesions, activity in Tc-bone scan, or a risk of fracture, biopsy and curettage combined with autologous or homologous bone grafting is indicated. Some aggressive tumors, like the giant cell tumor, have to be treated more aggressively by curettage with adjuvant measures (Phenole) or by marginal excision.     

The usefulness of bone-marrow scintigraphy in the detection of bone metastasis from prostatic cancer

We used a combination of bone and bone-marrow scintigraphy to study 25 patients with prostatic cancer. Of the 18 cases whose ^99mTc-methylene diphosphonate (MDP) bone scans showed hot spots in the lower lumbar region of the spine and/or the pelvic bone, 8 had normal bone-marrow scintigrams. These 8 patients were subsequently shown to have senile, degenerative changes of the spine. On the other hand, in 9 of the 10 patients whose bone-marrow scintigrams showed accumulation defects, follow-up study and characteristic X-ray findings confirmed the presence of metastases. In all 6 cases with extensive bone metastases shown by ^99mTc-MDP bone scintigraphy, ^99mTc-sulphur-colloid bone-marrow scintigraphy showed multiple accumulation defects. In conclusion, bone-marrow scintigraphy was found to be useful in distinguishing metastatic lesions from benign degenerative changes in the cases with suspected bone involvement, as well as in evaluating equivocal lesions in the pelvis.     

The usefulness of bone-marrow scintigraphy in the detection of bone metastasis from prostatic cancer

We used a combination of bone and bone-marrow scintigraphy to study 25 patients with prostatic cancer. Of the 18 cases whose 99mTc-methylene diphosphonate (MDP) bone scans showed hot spots in the lower lumbar region of the spine and/or the pelvic bone, 8 had normal bone-marrow scintigrams. These 8 patients were subsequently shown to have senile, degenerative changes of the spine. On the other hand, in 9 of the 10 patients whose bone-marrow scintigrams showed accumulation defects, follow-up study and characteristic X-ray findings confirmed the presence of metastases. In all 6 cases with extensive bone metastases shown by 99mTc-MDP bone scintigraphy, 99mTc-sulphur-colloid bone-marrow scintigraphy showed multiple accumulation defects. In conclusion, bone-marrow scintigraphy was found to be useful in distinguishing metastatic lesions from benign degenerative changes in the cases with suspected bone involvement, as well as in evaluating equivocal lesions in the pelvis.     

CT引导下经皮椎体成形术治疗椎体良恶性病变的技术探讨

目的：探讨CT引导下经皮穿刺椎体成形术治疗脊柱病变时技术的优化和并发症的防治.方法：对45例共62个椎体行经皮穿刺椎体成形术,其中血管瘤4例4个椎体、骨质疏松7例12个椎体、椎体恶性肿瘤34例46个椎体.经CT扫描定位,将不透X线骨水泥（主要成分为粉剂甲基丙烯酸树脂多聚体和液态甲基丙烯酸树脂单体）按粉剂与液体为4∶1比例混合调制成糊状,用1ml注射器匀速缓慢注入病变椎体.结果：本组完全缓解率（CR）77.78%,部分缓解率（PR）17.78%,有效率为95.56%.止痛作用2周至18个月持续有效.CT和平片随访观察骨水泥密度、形态与术后所见无变化,未见椎体进一步压缩.术后即刻CT证实有7例10椎骨水泥向椎体周边组织渗漏,只有1例硬膜外渗漏者导致暂时性神经根性痛.结论：经皮穿刺椎体成形术适用于椎体血管瘤、骨质疏松、转移瘤等溶骨性病变,只要我们操作得当,可以避免多数并发症的发生.     

Fusion in the hyoid bone: usefulness and implications

Increasing age induces fusion in the hyoid bone. The present study was conducted to assess the usefulness of fusion in the hyoid bone in age estimation. A total of 130 excised hyoid bones from dead bodies belonging to the age group of 4-70 years were studied. The mean age of unilateral and bilateral fusion in males was 39.39 and 41.77 years, respectively. The mean age of unilateral and bilateral fusion in females was 37.5 and 45 years, respectively. Fusion was not seen in ages below 20 years. Non-fusion has been found even after the age of 60 years. Although there was significant association between fusion in the hyoid bone and advancing age, it cannot be considered a good indicator for estimating age. With a high degree of variation in the age of fusion, the hyoid bone needs to be studied along with other determinants for estimating age. Fusion in the hyoid bone is not related to the sex of the victim and there is no tendency towards early fusion on the left side compared with the right side. If the victim of pressure on the neck is aged over 38 years, the clinicians and forensic experts should expect fractured hyoids. If a fractured hyoid bone is not found even in the elderly, pressure on the neck cannot be ruled out.     

CT在诊断乳房良性疾病中的应用

评价ＣＴ诊断乳房良性疾病的价值。方法４４例患者接受乳房ＣＴ扫描和钼靶摄片检查。对比分析这两种检查方法对乳房良性疾病的定位和定性准确性。所有病例经病理证实均为良性疾病。结果ＣＴ对乳房纤维瘤和乳房囊肿有明确诊断作用,对乳房深部病灶、乳房多发性多样良性病变的诊断优于钼靶摄片检查。     

The current status of bone scintigraphy in malignant diseases

For the past few decades, planar bone scintigraphy has been the most frequently performed imaging study in the evaluation of metastatic bone disease. Although scintigraphic findings alone are often nonspecific for skeletal pathologies, this technique reportedly has an exquisite sensitivity. However, recently accumulated data on the efficacy of positron emission tomography with fluorine-18 fluorodeoxyglucose and fluorine-18 sodium fluoride as well as magnetic resonance imaging for evaluating skeletal metastatic disease now indicate that conventional planar bone scintigraphy is not very sensitive in the detection of metastatic bone lesions in selected malignancies. Nevertheless, bone scintigraphy still remains the primary imaging modality for evaluation of metastatic bone disease owing mainly to its cost effectiveness and wide availability. In addition, recently introduced hybrid imaging systems combining single-photon emission computed tomography and spiral computed tomography, although not widely available yet, increase considerably both the sensitivity and specificity of bone scintigraphy. This article focuses primarily on the current role of bone scintigraphy and its strengths and weaknesses in assessing different types of malignant diseases relative to other imaging modalities in selected malignancies.