放射性核素骨显像在股骨颈骨折治疗中的应用

目的探讨放射性核素骨显像在股骨颈骨折治疗中对治疗方法的选择和预后判断的应用价值. 方法对2003年9月-2005年3月收治的21例股骨颈骨折术前患者和获得随访的10例股骨颈骨折内固定术后患者进行放射性核素骨显像检查.计算患头/健头放射性计数比值、以及头/臼比和头/髂比,与对照组进行比较. 结果 21例术前股骨颈骨折患者中,2例股骨头放射性分布大致正常,4例轻度缺血,15例严重缺血.10例内固定术后患者中,3例术后3个月复查患者处于高代谢,4例1年后复查患者放射性分布接近正常,3例患者术后3年复查出现轻度晚期缺血. 结论应用放射性核素骨显像对股骨颈骨折患者进行术前检查和术后随访,可以早期大致观察股骨头的血运和代谢情况,有助于选择治疗方法和判断患者预后情况.     

核素骨显像诊断颞下颌关节病变的临床价值

目的: 探讨利用放射性核素骨三相显像和SPECT检查颞下颌关节紊乱病患者的价值.材料和方法: 66例颞下颌关节紊乱病患者接受X线片、放射性核素骨三相显像和SPECT检查.通过骨扫描结果进行定性和半定量分析,选择23例患者接受外科手术治疗.结果: 选择保守治疗者43例,血池相和延迟相影像及SPECT两侧关节区影像对称.接受颞下颌关节重建术者23例,血池相和延迟相影像及SPECT影像两侧关节区影像不对称,患侧关节区放射性强度和髁状突放射性计数比值稍高于对侧;术中发现,髁状突表面软骨有破坏,术后患者症状缓解.结论: 骨扫描可以作为颞下颌关节紊乱病的早期器质性病变的检测手段,选择为治疗方法提供参考.     

99Tcm-MDP SPECT/CT融合骨显像评价骨折远期愈合能力的应用价值

目的探讨99Tcm-MDP SPECT/CT融合骨显像技术评价骨折远期愈合能力的应用价值。方法回顾性分析2008年1月至2017年8月在我院治疗至少超过6个月的76例骨折患者的影像资料,其中58例经手术治疗,18例采用非手术方法治疗,所有骨折患者均未达到临床愈合标准。对76例骨折患者行SPECT显像、CT扫描和SPECT/CT融合骨显像,分析骨折端的放射性分布及CT特征,观察骨折端放射性浓聚是否连续性通过骨折线,跨越两侧骨折端,评价骨折远期愈合能力,最终骨折愈合情况经临床随访或手术证实。结果76例骨折患者,58例SPECT/CT融合骨显像显示放射性浓聚连续性通过骨折线并跨越两侧骨折端,诊断为骨折具有远期愈合能力,经对症保守治疗,证实52例骨折远期愈合,6例未愈合,SPECT/CT对骨折远期愈合诊断的准确率达89.66%（52/58）。18例骨折端未见明显连续性通过骨折线的放射性浓聚,诊断为骨折不愈合,且不具备远期愈合能力,均进行了手术治疗并证实为骨折不愈合,SPECT/CT对骨折远期不愈合诊断的准确率达100%（18/18）。结论SPECT/CT融合骨显像可较准确地评价骨折的远期愈合能力,具有重要的临床应用价值。     

放射性核素骨显像对骨肿瘤样病变的影像学研究价值

骨肿瘤样病变是在病理、影像及临床表现上与骨肿瘤相似的一类疾病.放射性核素骨显像能够比较清楚地显示全身骨骼的形态及骨骼的血液供应和代谢情况,可以早期发现骨代谢的异常,灵敏度高于其他检查.目前关于骨肿瘤样病变的影像学资料以X射线、CT及MRI多见,该文拟对放射性核素骨显像对骨肿瘤样病变的诊断价值进行综述,旨在初步形成系统认识,以帮助临床医师提高对此类疾病的诊断水平.     

放射性核素骨显像片质量分析

放射性核素骨显像片质量分析①高信耀肖江高质量的影像片是影像诊断的基础，放射性核素骨显像又是核素显像中常用的项目。为此，本文对我室部分骨显像片的质量进行了回顾性分析，并对如何提高影像的质量进行简单的讨论。１资料及方法从１１８５份骨显像片中随机抽取２１３...     

骨显像和血HLA-B_(27)检测早期诊断强直性脊椎炎

目的　探讨放射性核素骨显像及人类白细胞抗原 (HLA B2 7)检查对强直性脊椎炎 (AS)早期诊断价值。方法　对首次发病且X线检查未见异常的 35例后臀部疼痛患者作了骨显像及HLA B2 7测定 ,并制订了对AS的早期诊断标准 ,对患者临床随访 0 5～ 2 5a ,用纽约会议标准再次进行诊断 ,以评价早期诊断标准的准确性。结果　根据早期诊断标准有 30例患者被诊断为AS ,随访后再次诊断 ,其中 2 9例被诊断为AS ,前后 2次诊断符合率为 96 7%。结论　放射性核素骨显像与HLA B2 7检查相结合对AS的早期诊断和治疗可提供可靠依据。     

三相骨显像对创伤后感染性骨折愈合不良的诊断价值

目的评价99Tcm-MDP三相骨显像对创伤后感染性骨折愈合不良的诊断价值。资料与方法 92例骨折内固定术后愈合不良患者行99Tcm-MDP三相骨显像。根据术后临床诊断将患者分为感染组(48例)和对照组(44例)。比较两组间半定量分析指标A/N血流和A/N血池的差异。所有患者同时行血常规、血沉和C-反应蛋白等实验室检查,并评价各指标的诊断效能。结果 99Tcm-MDP三相骨显像中,血流相的灵敏度为91.7%,特异度为72.7%,阳性预测值为78.6%,阴性预测值为88.9%;血池相的灵敏度为93.8%,特异度为61.4%,阳性预测值为72.6%,阴性预测值为90.0%。A/N血流和A/N血池在感染组与对照组间差异均有统计学意义(P<0.01),且A/N血流与A/N血池对感染的诊断效能优于其他实验室检查指标(P<0.05)。结论三相骨显像是无创且相对准确的诊断方法,具有较好的阴性预测意义,可作为特异性炎症显像剂难以获得时的替代方法。在诊断时综合临床及相关实验室检查,必要时行SPECT/CT融合显像可提高诊断准确性。     

病理证实的130例脊柱疾病核素骨显像研究

目的:比较核素全身骨平面显像和MRI、CT及X线诊断脊柱转移瘤及其他脊柱疾病的价值.材料和方法:130例经病理证实的脊柱疾病患者行99mTc-MDP全身骨显像,其中104例同期行MRI、61例行CT、107例行X线片检查.结果:骨显像的诊断灵敏度为:转移瘤91.7%,原发骨恶性肿瘤73.3%,良性肿瘤54.2%,瘤样病损81.8%,炎性病变100%,压缩性骨折100%.61.1%的转移瘤患者伴有其他部位骨骼的异常浓聚或稀疏灶.结论:核素骨显像诊断骨转移瘤最有效;其他脊柱疾病,几种影像技术各有其优势,骨显像对判断病灶范围及伴发其他骨病变有较大价值.     

99Tcm-MDP SPECT/CT融合显像在钙化防御诊断中的增益价值

目的探讨99Tcm-MDP SPECT/CT融合显像较常规平面骨显像在钙化防御诊断中的增益价值.资料与方法回顾性分析2019年3月—2020年9月东南大学附属中大医院核医学科42例临床疑诊钙化防御患者,均行全身骨显像和SPECT/CT融合显像,并经皮肤活检确诊.观察全身骨显像和SPECT/CT融合显像(均42例)诊断的...     

核素肺灌注显像对急性肺栓塞诊断的临床价值

目的评价放射性核素肺灌注显像在诊断急性肺动脉栓塞中的价值。方法对临床怀疑有急性肺动脉栓塞的25例患者进行了放射性核素肺灌注显像,同时行双下肢深静脉显像。结果25例患者中有23例出现不同程度的多发肺段血流灌注异常,其中41个肺段出现放射性缺损区,84个肺段出现放射性稀疏区。25例患者6例双下肢深静脉血栓形成。结论放射性核素肺灌注显像是诊断急性肺动脉栓塞的一种无创伤性的有效的检查方法。     

Tarsal navicular stress fractures: radiographic evaluation

Tarsal navicular stress fractures are a potential source of disabling foot pain in physically active individuals. The diagnosis of tarsal navicular stress fracture requires a high index of clinical and radiographic suspicion because the fracture is only rarely evident on routine radiographs or standard tomograms. The radiographic diagnosis of a tarsal navicular stress fracture may require anatomic anteroposterior tomograms or a radionuclide bone scan with plantar views. Radiographic examinations of 23 fractures in 21 patients are evaluated.     

The role of radionuclide bone scintigraphy in fibrous dysplasia of bone

PURPOSE: The purpose of this study was to study the characteristics of fibrous dysplasia (FD) of bone on bone scans and to evaluate the diagnostic value of radionuclide bone scans in FD. METHODS: Radionuclide bone scans were performed in 42 cases of histopathologically proven FD and the results were compared with other imaging modalities. A retrospective study method was used to analyze the imaging results. RESULTS: Although FD showed nonspecific increased 99m-Tc MDP uptake, its appearance is different than bone metastates and other bone diseases. Combining scans with x-rays and other imaging modalities can improve the diagnostic accuracy of this disease. CONCLUSIONS: Radionuclide bone scans are of certain value in the diagnosis of FD. The diagnostic specificity of FD with radionuclide bone scanning can be improved in association with other imaging modalities such as x-rays.     

SPECT/CT骨显像在多发性骨髓瘤诊断中的临床应用

目的:研究多发性骨髓瘤(MM)SPECT/CT骨显像的影像学特征,探讨SPECT/CT在多发性骨髓瘤中诊断中的临床应用价值。方法:回顾性分析31例确诊多发性骨髓瘤患者SPECT/CT骨显像的表现特征,分析融合显像对多发性骨髓瘤的诊断意义,并对部分患者进行动态观察,评价其在疗效监测中的作用。结果:①31例患者骨显像阳性率80.6%,共发现病灶130个,以脊柱、肋骨最常累及,绝大多数表现为放射性核素浓聚(128个),仅2个病灶表现为放射性分布减低;②SPECT/CT融合断层显像23例次,对于平面显像难以诊断的59处,明确鉴别了良恶性53处;对于6例单发病灶患者给出了明确诊断;③11例患者共行23次动态显像,结果提示4例病情好转,7例病情加重。结论:SPECT/CT骨显像对于多发性骨髓瘤骨病的诊断及疗效监测具有较高的临床应用价值。     

Imaging of stress fractures in the athlete

Osseous stress fractures and stress reactions represent the effect of abnormal repetitive stress on normal bone. An accurate and thorough clinical history and sequential radiographs often suffice 40 make the diagnosis especially when the fracture occurs in one of the common locations, such as the tibia, metatarsals, or calcaneus. In cases that are atypical in location or clinical presentation the authors rely more on MR imaging, radionuclide bone scanning, and occasionally CT. MR imaging detects early changes of osseous stress injury and allows precise definition of anatomy and extent of injury, and is the preferred modality for evaluating the continuum of osseous manifestations of stress injury. MR imaging is useful in evaluating shin splints, early osseous stress injuries, and overt stress fracture. In the elite athlete prompt diagnosis and early rehabilitation are the goals.     

Radiographically occult femoral and pelvic fractures are not mutually exclusive: a review of fractures detected by MRI following low-energy trauma

Objectives

The purpose of this study was to review the MRI examinations of a large group of low-energy trauma patients in whom pelvic MRI had detected radiographically occult fractures, in order to characterize prevailing fracture patterns and determine how often co-existing proximal femoral and pelvic fractures were observed.

Methods

All patients having pelvic MRI over 5?years were identified. Word-search software selected 269 MRI reports containing the term ‘fracture’. Further scrutiny identified 168 with diagnosis of fracture. MRI request and imaging record review identified 102 low-energy trauma cases that had MRI for clinical suspicion of fracture despite normal radiographs. Sixty-six cases were excluded for the following reasons: no expressed clinical suspicion of occult fracture; history suggesting high-energy trauma; skeletal co-morbidity hindering acute fracture identification; interval more than 2?weeks between radiographs and MRI. The 102 study MRI examinations, which employed a limited two-sequence protocol, were reviewed. Any fracture that had not been appreciated on radiographs was recorded and characterized as femoral, pelvic, or co-existing femoral and pelvic fractures.

Results

The 102 study cases had a median age of 82?years. The median interval between pelvic radiographs and MRI was 3?days. MRI showed undiagnosed femoral fracture in 48/102 cases (47.1%), sacral fracture in 41/102 (40.2%), and pubic fracture in 55/102 (53.9%). In 11/102 cases (10.8%), MRI showed undiagnosed fractures of both proximal femur and pelvic ring (seven sacral, six pubic bone, two other site fractures). In 10/11 cases with co-existing femoral and pelvic fractures, the femoral fracture was incomplete.

Conclusions

Limited pelvic MRI found a high prevalence of radiographically occult femoral and pelvic fractures in low-energy trauma patients, with clinical suspicion of fracture despite normal radiographs. Co-existing occult femoral and pelvic ring fractures were commonly observed, and in such cases, the femoral fracture was likely to be incomplete and multiple pelvic fractures were typically present.     

322例骨转移瘤X线诊断和80例核素骨显像对照分析

本文就322例骨转移瘤作了临床X线分析,其中80例作核素骨显像并与X线对照。核素骨显像灵敏度(98.3％)高于X线(57.9％);其精确度(90％)亦高于X线(70％);假阴性率比X线低的多;揭示能更早地发现病灶,是检查骨转移瘤好的筛选方法。X线检查的特异性(95.7％)比核素骨显像(68.2％)强,假阳性率也低。因此两种方法具有互补作用。     

87例肺癌患者核素骨显像结果分析

目的：通过对87例肺癌患者放射性核素全身骨显像结果进行分析，探讨肺癌骨转移的特点和规律。方法：回顾性分析了经临床病理证实的87例肺癌患者的全身骨显像表现。结果：肺癌骨转移率为63．2％，发生骨转移最常见的部位为肋骨，其次为脊椎骨、盆骨、四肢骨、肩胛骨、颅骨和胸锁骨。在不同病理类型的肺癌中，腺癌和鳞癌较其它类型更易发生骨转移。结论：肺癌骨转移比较常见，所以肺癌患者应常规作全身核素骨扫描，以帮助临床制订正确的治疗方案。     

The reliability of the 3-phase bone scan in suspected scaphoid fracture: an inter- and intraobserver variability analysis.

In the diagnosis of scaphoid fracture, the dynamic phase of the radionuclide bone scan alone has been recommended as an early test. To evaluate the independent reliability of the dynamic and static phases of the 3-phase bone scan in this diagnosis, 3 examiners reviewed the 3-phase bone scans of a series of 60 patients with clinical signs of fracture of the carpal scaphoid and with negative or non-diagnostic initial radiographs. The interpretation was performed independently and without the benefit of additional data. The bone scans were reviewed after 1 year by the same observers. The results were analyzed using kappa statistics. The bone scan was suspicious of fracture of the scaphoid in 15 patients. Irrespective of training and experience, the kappa values of the dynamic bone scan between any 2 observers did not exceed 0.57. The kappa values increased significantly when the static phase of the bone scan was examined (> 0.81). The intraobserver variability showed a similar pattern. We conclude that in suspected scaphoid fracture, the dynamic phase of the radionuclide bone scan alone cannot be used as a reliable diagnostic approach because of the low inter- and intraobserver agreement in the interpretation, irrespective of the experience and training of the observer.     

数字化断层融合对骨折诊断的应用价值

目的 探讨数字化断层融合(DTS)对骨折诊断的应用价值.方法 对DR片可疑骨折、或临床体征明显但DR片未显示骨折线的80例外伤患者,进行DTS检查,对比评价DR与DTS图像质量,分析DTS对骨折诊断的价值.结果 80例患者中,DTS图像良好75例,良好率为93.8％;一般5例,差为0例;DR图像良好55例,良好率68.8％,一般17例,差8例.56例可疑骨折的患者,DTS图像明确显示骨折线51例,排除骨折5例;16例DR检查阴性但临床体征明显的患者,DTS均发现骨折.结论 DTS技术可显示深在部位与结构t复杂部位的解剖结构,清晰显示骨折线,能显著提高骨折的检出率.     

原发性甲状旁腺功能亢进症误诊临床与影像分析(附8例报道)

目的:分析原发性甲状旁腺功能亢进症的误诊原因,以提高本病临床诊断率。方法:搜集了8例经手术病理证实的原发性甲状旁腺功能亢进症,分析其临床及影像学资料。结果:本组病例病史最长10年,最短3个月,曾误诊为多发性骨髓瘤1例,多发性骨转移瘤2例,骨折、骨质疏松5例,误诊为消化系肿瘤1例。结论:结合临床表现、实验室检查及影像学特征可以减少甲状旁腺亢进症的误诊率,提高临床检出率及有助于定性、定位诊断。