核素全身骨显像定量分析对肾性骨病的诊断意义

对45例正常人及16例肾脏病患者进行了全身核素~(99)Tc~m-MDP骨显像定量分析。根据骨骼摄取示踪剂程度的不同,将显像分为高、中、低三个活性等级(以Y,R,G表示),并与X线检查结果比较。16例患者均显示全身骨代谢明显异常,表现Y及R区显著增高(P<0.001),而X线检查仅10例显示有骨病征象。4例经维生素D治疗前后的核素扫描对比,显示Y区有明显下降,但X线检查未见明显变化。表明全身核素骨扫描对肾性骨病的早期诊断、鉴别诊断和疗效评价有较重要意义,为一有价值的诊断方法。     

核素骨显像诊断老年性肺癌骨转移的临床价值

目的 评价核素骨显像在诊断老年性肺癌骨转移中的临床价值。方法 用ＳＰＥＣＴ核素全身骨显像探测及分析骨转移灶。结果 核素骨显像检出骨转移灶为１００．０％,明显高于Ｘ－ＣＴ（３０．０％）及Ｘ线平片（２５．０％）,且发现肺磷癌和肺腺癌发生骨转移率最高。结论 核素骨显像对老年性肺癌骨转移诊断有重要价值。     

放射性核素血管显像诊断柏一查氏综合征的探讨

应用放射性核素法对9例柏—查氏综合征进行了动态腔静脉显像,并与X线及B超检查进行对照,说明核素血管显像对本病具有重要诊断价值。     

SAPHO综合征一例

SAPHO综合征是主要累及皮肤、骨和关节的慢性疾病.骨肥厚、无菌性骨炎及不同形式皮肤损伤是本病特征性改变.目前全球报道的病例数不足500例,大多数病例集中在欧洲、北美、日本和澳大利亚等国家和地区,近十几年来,随着对其的认识,我国SAPHO综合征也偶见报道.现就本院收治的1例典型病例报告如下.     

肿瘤骨转移的核素骨显像结果分析

核素骨显像是目前医界公认诊断骨转移瘤的最有效方法,它不但能一次成像显示全身骨骼情况,还可较X线检查提前3—6个月发现病灶。本文对我院2007年1月～2008年12月462例恶性肿瘤患者的全身骨显像结果进行分析,现报告如下。     

99mTC-MDP骨关节显像在早期类风湿关节炎中的临床价值

目的　探讨核素骨关节显像对早期和活动期类风湿关节炎 (RA)诊断价值。方法　对 31例确诊为RA患者进行99mTC -羟基亚甲基二磷酸 (MDP)全身骨关节显像检查 ,全部RA患者根据关节疼痛部位摄X线平片 ,同时进行血沉 (ESR)、血清C反应蛋白 (CRP)、类风湿因子 (RF)滴度、关节压痛指数 (JTI)、关节肿胀指数 (JSI)测定。结果　 31例RA患者骨显像阳性 2 9例 ,诊断符合率 93 5 %,而非RA关节炎 (AS和OA)组和正常人组核素骨关节显像率分别为 80 0 %和 10 5 %;在 2 2 6个有临床表现的关节中 ,核素显像阳性是 2 0 1个 ,总符合率为88 9%;在 2 0例早期RA(≤ 2年 )中 ,核素骨关节显像率 95 0 %,X线片RA改变符合率 2 0 0 %;病变关节摄取示踪剂程度与JTI、JSI、ESR、CRP呈正相关 (r为 0 4 5～ 0 5 2 ,P <0 0 5 )。结论　99mTC骨关节显像为骨关节无创伤性、功能性、灵敏度高但特异性不强的检查方法 ,结合临床症状、体征及血清免疫学改变 ,对提高早期和活动期RA的诊断及评估有帮助。     

50例肺癌骨转移的诊断及放疗止痛

目的：分析肺癌骨转移诊断方法、骨转移分布部位及放射治疗止痛效果。方法：总结分析广州军区武汉总医院50例肺癌骨转移病例。结果：全部患者采用核素骨显像检查，对骨显像中呈单发者进一步采用MRI、CT及X平片证实。转移灶分布于脊柱（53％），胸部骨（19％），骨盆（13％），四肢骨（9％）及颅骨（6％）。全部患者接受了放射治疗，45例疼痛者放疗后疼痛得到不同程度缓解。结论：肺癌骨转移发生率高，对可疑患者应常规行骨显像检查，放射治疗止痛效果好，对提高患者生活质量有一定作用。     

反流性食管炎几种诊断方法的研究

本文对41例有典型反流性食管炎症状者,进行了内镜检查、粘膜活检、食管X线检查和核素闪烁显像综合检查.23例无反流症状者作对照.41例有反流症状组的内镜检查.均见食管粘膜有轻或中度炎症改变.病理活检的阳性率为76%,其中87%为中期食管炎.内镜检查用于观察有无食管炎症及其程度.41例均行核素闪烁显像检测,显示有反流者81%.本组病例中有31例行X线钡餐检查,显示有反流者53%.核素显像和X线钡餐用于确定有无胃食管反流,前者较后者敏感.     

骨斑点症合并眼眶骨异常一例报告

分析1例骨斑点症合并左侧眼眶骨异常摄取患者的临床特点。患者,男性,22岁,因腹部CT发现骨盆及双侧股骨近端异常就诊。完善实验室生化检查、全身同位素骨显像及LEMD3基因突变检测,确诊为骨盆及双侧股骨骨斑点症。同时骨显像发现左侧眼眶骨存在不同于骨斑点症性质的病灶,表现为核素点状浓聚,完善眼眶CT后发现病灶处磨玻璃样改变,拟诊为左侧眼眶骨纤维异常增生症。本文在进行文献复习的基础上对该两种疾病的发病机制、临床表现及影像学表现进行综述。展开讨论,旨在提高临床医生的认识。     

胃肠道肿瘤核素诊断

0 引言与常规的医学影像诊断技术(超声、X线CT、及MRI等)不同,核医学显像(或核素显像)需要特定放射性核素标记的显像剂即放射性药物,显像时先将放射性药物引入(通过注射或口服等途径)人体内,再通过显像仪器γ相机、单光子计算机断层显像仪(SPECT)或正电子计算机断层显像仪(PET)进行体外平面、全身或断层扫描。核医学显像的实质是显示特定的放射性药物在体内尤     

SAPHO-Syndrom

The SAPHO syndrome, an acronym for synovitis, acne, pustulosis, hyperostosis and osteitis, is a rare disease which affects bones, joints and the skin. The main osteoarticular features are hyperostosis and osteitis. Osteoarticular symptoms predominantly occur on the anterior chest wall but the spine and the peripheral skeleton can also be involved. The most important skin affections are palmoplantar pustulosis and severe acne. The etiology of this syndrome remains unclear but infectious, immunological and genetic factors are involved. The diagnostic features of SAPHO syndrome are clinical and radiological. The most important diagnostic procedure is Tc-99 m bone scintigraphy but conventional x-rays as well as computed tomography (CT) and magnetic resonance imaging (MRI) can also contribute to the final diagnosis. Bone histology and positron emission tomography CT (PET-CT) may help to differentiate SAPHO syndrome from malignancies and infectious osteomyelitis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of treatment. The results obtained using antibiotics and disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine and methotrexate are inconsistent. Bisphosphonates and anti-tumor necrosis factor (anti-TNF) drugs have shown promising results in small studies but further research is still necessary.     

Radiological features of long bones in synovitis, acne, pustulosis, hyperostosis, osteitis syndrome and their correlation with pathological findings

The purpose of this study was to demonstrate the radiological features of long bones in synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome and to correlate these with the clinical findings. Eleven long bone lesions in seven cases of SAPHO syndrome were examined. The patients ranged in age from 6 to 63 years, with a mean of 47 years. In all seven cases, radiography, ^99mtechnetium bone scintigraphy, CT scan, and magnetic resonance imaging (MRI) were performed. In six of the cases, bone biopsy and bone culture were carried out for 7 long bones. Seven of the involved lesions were from the shaft of the femur, one each was from the neck and the shaft of the humerus, and one was from the proximal tibia. These lesions showed radiologically hyperostosis, osteolysis, and bone infarction-like lesion. Osteolysis was occasionally accompanied by sclerotic change. Hyperostosis usually showed diaphyseal involvement, presenting low signal intensity on T₁- and T₂-weighted MR images. Histologically, these findings corresponded to massive bone necrosis, new bone formation, fibrosis, or a mixture of these associated with mild inflammatory cell infiltration. Osteolysis involved dyaphysis, metaphysis, or epiphysis associated with arthritis, and presented low signal intensity on T₁-weighted images, nonhomogeneous signal intensity lower than fat on T₂-weighted images, and high signal intensity on fat suppression images. These findings corresponded to fibrosis, granulation, and inflammatory cell infiltration with lymphocyte aggregation. Bone infarction-like lesion was observed in the shaft or neck of the femur and the humerus and accompanied by calcification and cystic change. Bone cultures were negative in all cases in which bone biopsy was performed. Although hyperostosis is thought to be a characteristic bone lesion in SAPHO syndrome, the long bone lesion can occasionally show not only hyperostosis but also osteolytsis and bone infarction-like lesions. Received: April 17, 2001 / Accepted: August 2, 2001     

Long-delayed onset of chest wall pain defining a patient with SAPHO syndrome.

A 57-year-old woman presented with 2 months history of right chest pain with direct tenderness and swelling over the right sternoclavicular joint. She had a 20-year history of skin rash over both soles and palms suggestive of pustulosis palmaris and plantaris without musculoskeletal symptoms. CT scan of the right sternoclavicular joint showed osteolysis of the joint and adjacent sclerosis. 99mTechnetium bone scan was abnormal with increased uptake over the joint and manubrium. She was diagnosed with SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis). This case report emphasizes the long duration that can lapse between onset of initial skin manifestations and musculoskeletal symptoms to define SAPHO syndrome.     

Pulmonary adenocarcinoma associated with SAPHO syndrome difficult to differentiate from multiple bone metastasis

The patient was a 57-year-old man with a chief complaint of anterior chest pain who was diagnosed with clinical stage IV (c-T2N2M1) non-small-cell lung cancer (adenocarcinoma). Tenderness in the sternoclavicular joint, acne, periodontitis, and palmoplantar pustulosis were evident, and SAPHO syndrome was diagnosed. SAPHO syndrome is a rare disorder that results in synovitis, acne, pustulosis, hyperostosis, and osteomyelitis. Bone scintigraphy showed tracer accumulation in the costal cartilage, sternoclavicular joint, and cervical vertebrae 6-7. Although the bone lesions of SAPHO syndrome were difficult to differentiate from bone metastasis of pulmonary adenocarcinoma, metastatic bone tumors were ruled out by magnetic resonance imaging, computed tomography, and fluorodeoxyglucose positron emission tomography. There have been no previously reported cases of lung cancer with comorbid SAPHO syndrome. We report such a case and discuss the relevant literature, particularly that concerned with the evaluation of bone lesions.     

Synovitis,acne, pustulosis,hyperostosis, and osteitis syndrome with cranial bone involvement: Case report and literature review

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoimmune inflammatory disease characterized by osteoarticular and dermatological manifestations. The most common osteoarticular manifestations involve the anterior chest wall, axial skeleton, and long bones. Cranial bone involvement is less reported in SAPHO syndrome. We herein present three cases of SAPHO syndrome with cranial bone involvement, and review the previous literature on similar manifestations. It was revealed that SAPHO syndrome could lead to cranial bone involvement, which could involve the dura mater, leading to hypertrophic pachymeningitis, but the outcome is usually good. Janus kinase inhibitors may be a potential treatment option.     

C1–C2 spondylodiscitis in an adult with SAPHO syndrome: an unusual presentation

The main advantage of recognition and diagnosis of SAPHO syndrome is the avoidance of unnecessary prolonged antibiotic treatment and repeated invasive procedures. The combination of synovitis, acne, pustulosis, hyperostosis and aseptic osteitis is known as SAPHO syndrome. The most common site of the disease is the upper anterior chest wall, characterized by predominantly osteosclerotic lesions, hyperostosis, and arthritis of the adjacent joints. Osteosclerosis of the vertebral bodies, hyperostosis, and erosions of the vertebral plates are rarely encountered. We present a case of SAPHO syndrome with C1–C2 spondylodiscitis. Diagnosis of SAPHO syndrome was established using Khan et al. criteria (Schilling, SAPHO syndrome, Encyclopedie Orphanet, 2004). CT showed osteosclerotic lesions of dens axis. MRI sequences reveal inflammatory bone marrow oedema. Radiologists should be aware of this unusual syndrome to avoid misdiagnosis (tumour/infection), unnecessary surgery, and antibiotic therapy.     

原发性甲状旁腺功能亢进症的术前定位诊断

对18例原发性甲状旁腺功能亢进症(PHPT)术前影像学检查结果进行回顾性分析,结果表明B超、CT、MRI及99mTcMIBI核素显像等无创性影像学检查在PHPT的术前定位诊断中具有重要的价值,99mTcMIBI核素显像为首选的术前定位检查方法。     

Spinal and sacroiliac involvement in SAPHO syndrome: A single center study of a cohort of 354 patients

ObjectiveSAPHO syndrome is a highly heterogeneous disease with distinct treatment response. We report the largest cohort of SAPHO syndrome and explore its clinical classification with special interest in spinal and sacroiliac involvement.MethodsA total of 354 patients with SAPHO syndrome were recruited in Peking Union Medical College Hospital. The demographic, clinical and imaging data were collected at baseline. Spinal and sacroiliac involvement was determined by the co-existence of related symptoms and imaging evidence of lesions in the spine or sacroiliac joints on either bone scintigraphy, CT or MRI.ResultsA total of 197 (55.6%) patients were identified to have spinal or sacroiliac involvement. Compared to those without spinal or sacroiliac lesions, these patients were significantly older at onset (38 ± 12 vs 35 ± 10 years old, p = 0.019) but had comparable duration of disease. Therapeutically, patients with spinal or sacroiliac involvement had been treated more aggressively with more frequently prescribed NSAIDs, glucocorticoids, DMARDs, TNF-α inhibitors, and bisphosphonates (all p ≤ 0.001). Nonetheless, greater disease activity was observed for these patients at baseline, supported by both inflammatory markers (ESR and hs-CRP) and visual analog scale (VAS) for pain (all p < 0.001).ConclusionsSAPHO patients with spinal or sacroiliac involvement are older at onset and have greater disease activity despite of more aggressive treatments compared to those without. Stratified management is in urgent need for this rare disease.     

099mTc—MIBI硝酸异山梨酯介入显像对冠脉支架置入术后心肌血流灌注的评估

目的：探讨99mTc锝-甲氧基异丁基异腈（99mTc—methoxyisobutyl isonitrile,Tc—MIBI）评估冠状动脉支架置入术（支架置入术）后损伤区心肌细胞血流灌注状况的价值。方法：40例行支架置入术患者,分别在置入术前、后进行99mTc—MIBI心肌静态显像及其硝酸异山梨酯（ISDN）介入显像,对比分析损伤区心肌细胞血流灌注改善程度。结果：40例患者冠状动脉共有360个节段。术前Tc—MIBIISDN介入显像异常10g个节段（29．2％）,显著少于Tc—MIBI静态显像异常的178个节段（49．4％,P〈0．01）。支架置入术后ISDN介入显像异常91个（25．3％）节段也显著少于静态显像异常的112个节段（31．1％,P〈0．05）。结论：99mTc—MIBI—ISDN介入显像较99mTc—MIBI心肌静态显像更能反映支架置入术后心肌血流灌注情况。     

Diagnosing the SAPHO syndrome: a report of three cases and review of literature

SAPHO, an acronym for synovitis, acne, pustulosis, hyperostosis and osteitis, is a heterogeneous entity with myriad presentations and features overlapping with other entities. It is a differential in patients presenting with skin and bone symptoms, either singly or in combination. Often misdiagnosed radiologically as a malignancy or infection, the diagnosis is seldom thought of. We present three cases referred to us for evaluation of findings unrelated to the presenting symptoms. After evaluation, a ⁹⁹Tc bone scan was ordered, which showed the ‘bull’s head sign’ in all the three cases, confirming the diagnosis. We review the literature for SAPHO. It has a few features which point to its diagnosis and can help us to distinguish it from other seronegative arthritis. The clinician should be aware of this entity and should not hesitate to order a ⁹⁹Tc bone scan. We conclude that SAPHO is not rare, but rather, it is underdiagnosed. High index of suspicion is necessary for diagnosis. A ⁹⁹Tc bone scan is diagnostic and should be ordered in patients having any of the presenting features of the syndrome. We put forward the suggestion of using ⁹⁹Tc bone scintigraphy to define a ‘pre-MRI’ stage of ankylosing spondylitis.