多发性骨髓瘤骨显像的临床价值

目的 探讨多发性骨髓瘤的全身骨显像表现及骨髓显像对多发骨髓瘤骨损害的探测价值。方法 46例多发性骨髓瘤患者按常规进行全颓有显像,显像剂^99mTc-MDP,其中22例有详细的X检查结果。结果 ①多发性骨髓瘤骨显像阳性率60．6％（32／46）。②骨显像大多表现为多发性异常浓聚骨病灶,以肋骨最为多见,其余依次为胸椎、颅骨、腰椎、骨盆、四肢近端。③5例（10．9％）骨显像表现为顶骨放射性均匀增高,形似“帽状”;5例（10．9％0表现为双侧肱骨头和／或双侧股骨头放射性对称性异常增高。④X线检查阳性而骨显像阴性18．2％,多见于颅骨;骨显像阳性而线查阴性22．7％,多见于肋骨及肱骨头和股骨头;骨显像与X线检查少的患者。结论 ①多发性骨髓瘤全身显像的阳经为69．6％。②多发性骨髓瘤的骨显像大多表现为全身多发放射性浓聚灶,多见于躯干骨,颅骨及双侧肱骨头和股骨头也较常见。③多发性骨髓瘤的骨显像可能有一定的特征表现：颅顶骨的“帽状”征及双侧肱骨头和／或双侧股骨头放射性对称异常增高。④骨显像与常规X线检查对多发性骨髓瘤的骨损害探测各有所长,二者相互补充,骨显像可以作为探测多发性骨髓瘤骨损害的常规方法。     

骨显像肋骨单发浓聚灶分析

目的 探讨肋骨单发浓聚灶骨显像特点及临床意义.方法 选择84例全身骨显像发现肋骨单发浓聚灶病例,将浓聚灶按位置划分为肋骨与肋软骨交界处、前肋、侧肋和后肋四个部位,按浓聚灶形状分为点状、团块状和条形三种,分别进行分析.结果 骨显像肋骨单发浓聚灶以点状、条形为主.点状浓聚灶分布以肋骨与肋软骨交界处及前肋居多,多为肋骨骨折(42/61,68.85%);绝大部分条形浓聚灶(18/19,94.74%)为肋骨转移瘤.后肋浓聚灶中,大部分(24/29,82.76%)为肋骨转移瘤.结论 良恶性肋骨单发浓聚灶图像具有一定的特征性,有利于鉴别诊断.     

99Tcm-MDP全身骨显像诊断多发性骨髓瘤

目的评价99Tcm-MDP全身骨显像对多发性骨髓瘤的诊断价值.方法对15例经实验室检查、临床骨髓穿刺和手术病理证实的多发性骨髓瘤进行回顾性分析,15例做了SPECT全身骨显像和X线检查,其中7例做了CT扫描.结果多发性骨髓瘤病变部位以肋骨、腰椎、胸椎、头颅骨为最多,其次为肩胛骨、骨盆、四肢骨、胸骨和锁骨等,主要表现为病变部位呈异常放射性浓聚灶和多发性浓聚合并放射性稀疏减淡或缺损区,CT或X线检查主要表现为溶骨性破坏.结论 SPECT全身骨显像结合X线、CT检查不失为诊断骨髓瘤的一种辅助方法.SPECT骨显像对多发性骨髓瘤病人化疗疗效的监测和预后评价具有一定临床价值.     

核素全身骨显像在单纯性肋骨骨折诊断中的应用

目的：探讨99mTc-MDP全身骨显像对单纯性肋骨骨折的诊断价值。方法：26例患者共49处单纯性肋骨骨折,分析99mTc-MDP全身骨显像检查结果,与胸部X线平片及螺旋CT比较。结果：全身骨显像、胸部X线平片及螺旋CT对单纯性肋骨骨折的检出率分别为97.9%（48/49）、55.1%（27/49）和73.5%（36/49）,全身骨显像的检出率明显高于胸部X线平片及螺旋CT（χ2=22.7,10.8,P均〈0.05）。结论：对于单纯性肋骨骨折全身骨显像较X线检查具有更高的灵敏度。     

放射性核素骨显像对乳腺癌的诊断价值

目的：探讨放射性核素骨显像（SPECT）对乳腺癌的诊断价值。方法：116例未经手术、放疗及化疗的乳腺癌Ⅳ期初诊患者，均分别行SPECT核素骨显像、骨X线平片及骨CT检查。所有患者静脉注射^99mTc—MDP3～4h后行放射性核素骨显像检查。结果：116乳腺癌Ⅳ期初诊患者中，SPECT显像阳性：有骨转移的22例，无骨转移的16例。SPECT、X线及CT对病灶诊断的灵敏度分别为84．6％、61．5％和69．2％，SPECT灵敏度明显高于X线平片和CT（P〈0．05）。结论：SPECT对Ⅳ期乳腺癌有无骨转移有重要的诊断价值，在病例筛选中可作为首选检查项目。     

64层螺旋CT在无错位性肋骨骨折诊断中的应用价值

目的探讨64层螺旋CT的扫描技术和后处理功能在无错位性肋骨骨折诊断中的应用价值。方法对外伤怀疑肋骨骨折或X线平片诊断肋骨骨折的患者进行64层螺旋CT扫描,所有图像均进行多平面重建(MPR)、容积再现技术(VR)、曲面重组技术(CPR)及轴位图像结合分析。结果 829例患者中肋骨骨折数为1820根,其中无错位性肋骨骨折601根,占骨折总数的33.0%。601根中,前肋141根,腋中线处238根,后肋185根,多发骨折37根。发生于肋软骨交界处89根,胸肋关节处103根。结论无错位性肋骨骨折X线平片准确诊断困难,应用MPR、VR、CPR及轴位图像结合分析更能准确诊断无错位性肋骨骨折,可清晰、直观、完整地显示肋骨结构、骨折位置、形态及程度。     

MSCT薄层图像在隐匿性肋骨骨折中的诊断价值

目的探讨MSCT薄层图像及冠状位重建在隐匿性肋骨骨折的诊断价值。方法回顾性分析45例钝性外伤患者肋骨骨折X线阴性的CT薄层图像及冠状位重建,记录肋骨骨折的部位、形态、数目;所有患者均于2⁴周复查,并以患者的随访图像为诊断肋骨骨折的标准,比较MSCT薄层图像、薄层联合冠状位重建在隐匿性肋骨骨折中的诊断准确性。结果 CT随访图像确诊肋骨骨折63根,其中薄层图像检出57根,薄层图像联合冠状位重建检出63根,两者对比有统计学意义(χ2=2.04,P=0.031)。骨折位于前弓31根,腋部17根,后肋15根。肋骨完全骨折25根;肋骨不完全骨折38根(骨密度增高6根,骨皮质皱褶19根,骨皮质翘起13根)。X线阴性肋骨骨折主要发生在前弓,最主要的类型是骨皮质皱褶。结论 MSCT薄层图像能很好地显示隐匿性骨折的类型、部位及数目,联合冠状位重建能提高肋骨骨折的诊断准确性。     

高频超声与X线诊断肋骨及肋软骨骨折对比分析

目的探讨肋骨、肋软骨骨折的超声诊断价值。方法对62例肋骨、14例肋软骨骨折患者的超声检查结果与X线检查结果进行回顾性对比分析。结果 X线诊断肋骨骨折52例,阳性率83.87%,肋软骨未显像:超声诊断肋骨骨折62例,肋软骨骨折14例,阳性率100%。结论超声对肋骨、肋软骨骨折,特别是线性骨折的诊断明显优于X线,两者结合分析可提高诊断率。     

胸部CT联合骨扫描对单发肋骨浓聚灶鉴别诊断的临床价值

目的 探讨胸部CT联合骨扫描对单发肋骨浓聚灶鉴别诊断的临床价值.方法 回顾分析104例单发肋骨浓聚病例的浓聚形态及骨质改变.分析两者之间及与随访结果之间的关系.结果 69.3%单发肋骨浓聚灶胸部CT联合骨扫描可明确诊断.74.3%骨折表现为点状、结节状浓聚.转移灶的浓聚形态取决于骨质改变,57.7%条形浓聚为转移.27例患者不能确诊需随访.结论 骨显像单发肋骨浓聚灶联合观察胸部CT有助于鉴别诊断,可避免不必要的随访.     

肺癌患者肋骨病变的SPECT/CT影像分析

目的 分析217例肺癌患者全身骨显像肋骨病灶的SPECT/CT结果。方法 对全身骨显像发现肋骨病变的217例肺癌患者加行肋骨病变SPECT/CT显像,并进行分类分析。结果 共发现154个肋骨放射性浓聚灶,其中良性病灶71个,包括肋骨骨折灶55个,肋软骨钙化灶11个,骨质增生灶5个;恶性病灶51个,包括破骨性转移37个,成骨性转移14个;性质待定病灶32个,CT无异常发现或表现为肋骨髓腔局部稍高密度影,多位于肋骨与肋软骨交界处。结论 肺癌患者肋骨病灶性质多样,肋骨骨折、肋软骨钙化等良性病变占较大比例,诊断时要注意鉴别,避免误诊。     

Positive findings on bone scan in multiple myeloma

We report a case of multiple myeloma in which the bone lesions showed high uptake of technetium Tc 99m methylene diphosphonate on a bone scan. A review of the literature comparing the usefulness of conventional skeletal radiography and bone scans in diagnosing the osteolytic lesions of myeloma shows that bone scintigraphy, considered by many to have no role in the detection of osteolytic lesions of myeloma, is in fact more sensitive than radiography in detecting lesions in the ribs, scapula, and spine.     

Value of preoperative radionuclide bone scan in suspected primary breast carcinoma

The value of radionuclide bone scanning performed before "curative" surgery in 100 female patients with suspected (91 patients) or known (9 patients) carcinoma of the breast was assessed. Limitations of the bone scan in this patient population were (1) a weak relationship between scan abnormalities and pathologic stage of the primary breast cancer, (2) a high incidence of equivocal scans, and (3) a low incidence of definite scan abnormalities which could not be accounted for by benign osseous disorders. The limited value of preoperative bone scanning in this study may be a result of the high proportion of patients with favorable breast lesions, who would be expected to have a low incidence of bone metastases at the time of primary surgical therapy. Guidelines for the use of bone scanning in the management of primary carcinoma of the breast are discussed.     

The Super-scan and Flare Phenomena in a Nasopharyngeal Cancer Patient: A Case Report

A 26-year-old man with a history of nasopharyngeal carcinoma (NPC) presented with bone metastasis. Bone scan revealed diffuse skeletal metastases with superscan appearance. Afterward, radiotherapy for bone lesions was arranged and the effects were evaluated. The bone scan flare phenomenon appeared within a short time after radiotherapy. Diffuse bone metastasis, which is common in NPC, were indeterminate on images showing superscan pattern or flare.     

An Incidental Finding of Extraosseous Uptake in Technetium 99m Methylene Diphosphonate Bone Scintigraphy: Uterine Leiomyoma

We present the case of a 58-year-old, postsurgical breast cancer patient who was examined for routine controls at the Oncology Department of Namik Kemal University, Tekirdag, Turkey. She was referred to the nuclear medicine department for possible metastatic spread to the skeleton; 740 MBq of methylene diphosphonate tecnetium 99m ([Tc-99m] MDP) was injected intravenously, and 3 hours later a whole-body bone scan was performed. The whole-body bone scan showed no abnormal uptake associated with bone metastases, but in the anterior projection images, an area of mildly increased technetium 99m methylene diphosphonate uptake was seen in the right pelvic region. This appearance did not seem related to bone structures. When a more detailed history of this region was obtained, we learned of the patient's uterine leiomyoma. As a result of ultrasound and magnetic resonance imaging findings, the mildly increased tracer uptake in the right pelvic area on bone scintigraphy was consistent with a calcified uterine myoma. We concluded that a soft tissue concentration of labeled phosphates should always be kept in mind when interpreting whole-body bone scans.     

骨显像中肾脏不显影或淡影的研究

目的：探讨肾脏不显影或淡影在骨显像中的意义。方法：复习骨显像病例,选出肾脏不显影或肾影较正常肋骨影淡的所有病例,了解这些病例在疾病中的分布。结果：复习4709例患的骨显像病历,发现153例出现肾脏不显影或淡影,除外45例为肾功能不全,剩下的108例中,102例出于有恶性肿瘤的病例,4例为原发性甲状旁腺机能亢进;2例为良性骨疾病,在有恶性肿瘤的102例患中,82例有骨转移,同时侵犯2个区域以上的72例,同时侵犯3个区域以上的62例,同时侵犯4个区域以上的48例,全身侵犯的36例,且有16例呈“超级影像！表现,82例有骨转移的病例主要出于前列腺癌,胃癌,乳腺癌和肺癌,在153例有骨转移的前列腺癌中出现23例（15．0％）,在38例有骨转移的胃癌中出现4例（10．5％）,在206例有骨转移的乳腺癌出现9例（4．4％）,在983例有骨转移的肺癌中出现29例（4．0％）,结论：除外肾功能不全,骨显像时出现肾脏不显影或淡影,提示有广泛的代谢旺盛性骨疾患存在可能,且最多见于前列腺癌和胃癌的广泛骨转移及原发性甲状旁腺机能亢进。     

乳腺肿块或结节的CT诊断

目的 分析乳腺肿块或结节的CT征象，探讨其鉴别诊断价值。方法 52例（58个病灶）乳房肿块病人均行CT扫描，其中病理诊断乳腺癌39例，肉瘤2例，纤维腺瘤7个，囊肿8个，乳腺炎2例。结果 根据病灶形态、边缘、密度，尤其以增强扫描观察病灶强化的幅值和方式 ，常能作出良、恶性诊断，并有助于隐性癌和非肿块型乳腺癌的检出。结论 CT检查，尤其以增强扫描地乳腺肿或结节的鉴别诊断有很大价值。     

99mTc-亚甲基二膦酸盐骨显像评价乳腺癌骨转移的特征

目的 探讨乳腺癌骨转移99mTc-亚甲基二膦酸盐（MDP）全身骨显像及SPECT/CT融合显像的特征。 方法 收集我院2016年1月~2017年5月经病理组织学及免疫组化确诊的乳腺癌资料。初诊时即发现骨转移的患者46例,所有患者均在治疗前行99mTc-MDP全身骨显像,疑骨转移或不明原因骨痛部位行SPECT/CT融合显像。分析三阴乳腺癌（TNB）与非TNBC骨转移病灶分布情况,总结乳腺癌骨转移99mTc-MDP全身骨显像及SPECT/CT融合显像的特点。 结果 共检出46例患者204处病变,脊柱62处（30.39%）,是转移最常见部位,其次肋骨57处（27.94%）、胸部骨31处（15.20%）、骨盆骨28处（13.73%）、颅面骨15处（7.35%）、四肢骨11处（5.39%）。三阴乳腺癌与非三阴乳腺癌、TNBC与非TNBC骨转移在脊柱、肋骨、胸部骨、骨盆骨、颅面骨及四肢骨的病灶分布比例差异无统计学意义（χ2=0.591,P=0.988）。三阴乳腺癌骨转移占整个乳腺癌骨转移的28.26%（13/46）。13例TNBC骨转移共51处病灶,放射性浓聚占90.20%（46/51）, 混合型病灶占7.84%（4/51）,放射性稀疏病变1.96%（1/51）, 且主要为多发骨转移病变, 占84.62%（11/13）。 结论 99mTc-MDP全身骨显像及SPECT/CT融合显像对乳腺癌的早期诊断有重要价值,TNBC骨转移好发与脊柱、肋骨、胸骨,以多发性、放射性浓聚病变为主。       

The computed tomographic findings in intracranial metastases due to breast carcinoma

Seventeen patients with breast cancer had CT evidence of intracranial metastatic lesions. Sixteen patients showed neurological abnormalities on examination; one patient had no abnormalities on clinical examination. CT showed evidence of basal parasellar lesions (3 cases), orbital lesions (2 cases), or cerebral hemispheric (intracerebral or subdural) lesions (11 cases). In one case, diffuse meningeal and cortical nodular enhancement was consistent with diagnosis of carcinomatous meningitis. Ten had solitary and seven had multiple lesions. CT showed evidence of bone lesions in 8 cases and there were accompanying parasellar (3 cases), orbital (2 cases), and subdural lesions (3 cases). The intracerebral lesions(s) had an iso- or hypodense appearance on plain scan; there was peripheral rim or nodular enhancement on post-contrast scan.     

楔型体架在乳腺癌放射治疗中的临床应用

目的：探讨楔型体架在乳腺癌患者放疗期间应用的意义。方法：将108例患者随机分为两组，实验组58例采用楔形体架摆位，对照组50例采用小布枕摆位，并进行临床观察。结果：实验组摆位时间及摆位误差低于对照组（P〈0．05）。结论：应用楔形体架摆位可保持体位的一致性，满足不同个体需求，提高护理人员摆位的精度及速度，减轻劳动强度。