血清PSA与前列腺癌骨转移的关系

目的:探讨血清前列腺特异抗原(PSA)预测前列腺癌骨转移的价值.方法:以全身核素骨显像为金标准,回顾性分析放免法测定的58例前列腺癌骨转移和63例非骨转移患者血清PSA水平与骨转移的关系.结果:血清PSA≤10/μg/L者骨转移的发生率极低,发生率为0.PSA≥20 μg/L者有骨转移的可能,骨转移的发生率为50%.PSA≥40/μg/L者骨转移的可能性极大,骨转移的发生率为68%.结论:对于新诊断而未治疗的前列腺癌的患者,PSA<10μg/L者无骨痛或病理性骨折时不必行全身核素骨显像检查.PSA≥20μg/L者应常规行全身核素骨显像检查,以早期确诊前列腺癌骨转移.     

PSA和SPECT骨显像在前列腺癌诊断治疗中的意义

目的：研究PSA、SPECT骨显像在前列腺癌诊断及治疗中的临床意义。方法：对100例经临床确诊的前列腺癌患者全部行血清PSA测定及全身骨显像。结果：发生骨转移的患者为81％,PSA≥20tμg／I．的患者发生骨转移的为60％。结论：血清PSA与骨显像联检对前列腺癌临床诊断、疗效观察及预后判定具有重要的指导意义。     

SPECT骨显像评价骨质疏松的临床价值

目的探讨SPECT骨显像诊断骨质疏松及其相关病变的临床价值。方法42例经确诊的骨质疏松及其相关病变患 者,其中男14例,女28例。所有患者行SPECT全身骨显像检查,显像后对所有患者及正常人进行对比分析。结果放射性 分布增高者颅骨32例(76. 2% ),腰椎28例(66. 7% ),同时出现颅骨、胸骨及腰椎放射性分布增高者和股骨放射性分布稀疏 者15例(35. 7% )。颅骨放射性分布增高者中有18例(56. 3% )顶部呈“帽样”改变,其余14例(43. 7%)不均匀放射性分布增 高。SPECT骨显像能发现在骨质疏松背景下发生的骨髓瘤、多发性骨折、骨关节炎等相关病变。结论SPECT核素骨显像可 作为骨质疏松患者的辅助检查项目。     

恶性肿瘤患者全身骨显像与骨密度检查的临床研究分析

目的 研究恶性肿瘤患者骨转移和非骨转移的全身骨显像与骨密度检查的变化.方法 采用双探头SPECT仪器对288例恶性肿瘤患者进行全身骨显像,同时采用定量超声骨密度仪进行骨密度检查,并与1292例正常人作对照.结果 骨转移瘤患者的骨密度(BMD)水平较正常健康人群显著下降(P＜0.05),非转移瘤患者的BMD水平较正常健康人群无显著意义(P＞0.05).结论 恶性肿瘤患者在骨转移同时伴有骨质疏松.     

18F-脱氧葡萄糖正电子发射计算机断层显像CT检查在前列腺癌诊断和分期中的应用价值

目的 评价18F-脱氧葡萄糖(18F-FDG)正电子发射计算机断层显像CT检查(PET/CT)在前列腺癌诊断和分期中的应用价值.方法 经手术或穿刺活检病理证实为前列腺癌患者40例,年龄52 ～ 78岁,平均67岁.其中T24例,T316例,T420例.行18F-FDG PET/CT及99Tcm-MDPECT骨显像检查,统计PET/CT显像对前列腺癌原发灶、淋巴结转移及骨转移诊断的敏感性,对比分析PET/CT显像及99Tcm-MDPECT骨显像对骨转移的诊断效果.结果 40例患者中,18F-FDG PET/CT检查显示前列腺局部结节状放射性浓聚17例,对原发灶诊断敏感性为43％.17例淋巴结转移患者中CT检查发现8例,18F-FDG PET/CT检查发现15例,诊断敏感性为88％,其中5例患者因PET/CT检查改变了临床分期以及治疗方案.18F-FDG PET/CT对骨转移诊断的敏感性与99Tcm-MDP骨显像相近,但特异性(95％)和准确率(96％)均明显高于99Tcm-MDP骨显像,其中6例患者因PET/CT检查改变了临床分期,2例改变了治疗方案.结论 18F-FDG PET/CT对前列腺癌淋巴结转移和骨转移有较高诊断价值,对前列腺的分期具有特殊优势,可为临床医生制定治疗方案提供可靠依据.     

PET/CT显像中SUVmax对骨转移瘤与骨髓瘤鉴别诊断的价值

目的 回顾性分析未知原发灶的多发性骨破坏患者PET/CT显像中骨髓瘤与骨转移瘤病变SUVmax的特征,为临床鉴别诊断提供依据.方法 CT或MRI发现的多发骨破坏患者119例,其中71例PET/CT检查后行病理检查,男40例,女31例;年龄37～87岁,平均61-3岁.病理确诊骨髓瘤21例,骨转移瘤41例.测量骨髓瘤和骨转移瘤每个骨病变的SUVmax并进行比较,采用ROC曲线获得鉴别诊断的分界点.采用单因素方差分析比较不同形态学特征(溶骨性和成骨性)骨转移瘤与骨髓瘤SUVmax的差异.结果 PET/CT在骨髓瘤病例中共检出315个病灶,在骨转移瘤病例中共检出684个病灶.骨髓瘤病灶SUVmax(3.42±1.96)值明显低于转移瘤病灶(7.03±4.15).SUVmax值为4.45时,鉴别骨髓瘤和骨转移瘤的敏感性和特异性分别为80.4%和72.4%.溶骨性骨转移瘤病灶SUVmax值(8.02±4.85)明显高于成骨性骨转移瘤(4.79±2.61)和骨髓瘤(3.37±1.92),而成骨性骨转移瘤与骨髓瘤病灶的SUVmax值差异无统计学意义(P>0.05).结论 PET/CT对未知原发灶的多发性骨破坏患者骨髓瘤与骨转移瘤的鉴别诊断具有潜在的价值,多发性骨破坏病灶SUVmax值较低和溶骨性破坏可提示骨髓瘤.     

骨显像评价^89Sr治疗前列腺癌骨转移的效应

目的了解骨显像评价^89Sr对前列腺癌骨转移的治疗效果。方法通过骨显像确认骨转移的53例前列腺癌患者，静脉给药^89Sr治疗，剂量1．48-2．22MBq（40～60μC）／kg，3-6个月后复查骨显像，与治疗前对比。结果（1）治疗后39（73．6％）例骨转移灶数目较治疗前明显减少或消失，10（18．9％）例稳定，4（7．5％）例恶化；（2）骨转移灶代谢活性即ROI比值（T/NT），由治疗前的（4．8&#177;3．3）下降到（3．2&#177;2．7）；（3）部分病例可发现新生转移灶，范围扩大，核素浓集程度加深，临床改善和预后不佳。结论骨显像评价^89Sr治疗前列腺癌骨转移，客观、全面，对预后评价也有较高的临床价值。     

肾癌患者核素骨显像必要性分析

目的 探讨肾癌患者核素骨显像检查的必要性.方法 行核素骨显像的肾癌患者152例.男106例,女46例.年龄11～86岁,平均56岁.肿瘤直径1.5～20.0 cm,平均6 cm.TNM和AJCC分期:I期88例,其中T1a47例、T1b41例;Ⅱ期38例;Ⅲ期16例,其中T3a10例、T3b6例;Ⅳ期10例.组织学分级高分化90例,中分化43例,低分化19例.应用Logistic回归对10项可能影响肾癌骨转移的临床病理学因素进行分析.结果 152例患者中核素骨显像异常33例,其中骨转移22例(14.5%).126例局限性肾癌中发生骨转移11例(8.7%);16例局部进展性肾癌中发生骨转移5例(31.2%);10例转移性肾癌中发生骨转移6例(60%).Logistic回归分析结果表明肾癌骨转移与临床分期相关,肾癌中有骨痛症状者骨转移率为40.9%(9/22).结论局限性肾癌(Ⅰ、Ⅱ期)患者不必常规行骨显像检查,有骨痛症状情况下可考虑使用;临床分期≥Ⅲ期者,不管有无骨痛症状均应考虑核素骨显像检查. 能影响肾癌骨转移的临床病理学因素进行分析.结果 152例患者中核素骨显像异常33例,其中骨转移22例(14.5%).126 局限性肾癌中发生骨转移11例(8.7%);16例局部进展性肾癌中发生骨转移5例(31.2%);10例转移性肾癌中发生骨转移6例(60%).Logistic回归分析结果表明肾癌骨转移与临床分期相关,肾癌中有骨痛症状者骨转移率为40.9%(9/22).结论局限性肾癌(Ⅰ、Ⅱ期)患者不必常规行骨显像检查,有骨痛症状情况下可考虑使用;临床分期≥Ⅲ期者,不管有无骨痛症状均应考虑核素骨显像检查. 能影响肾癌骨转移的临床病理学因素进行     

SPECT/CT同机图像融合诊断股骨头缺血性坏死

目的 评价SPECT/CT同机图像融合技术诊断股骨头缺血性坏死的临床应用价值.方法 53例临床可疑股骨头缺血性坏死患者行全身骨显像及骨盆局部SPECT/CT断层显像并对SPECT和CT同机图像进行重建与融合.结果 ①融合图像诊断阳性率高于断层图像及平面图像,差异具有显著性;②融合图像对早期病变诊断阳性率高于断层显像及平面显像,差异具有显著性.结论 SPECT/CT同机图像融合技术对于股骨头缺血性坏死的早期诊断、鉴别诊断及疾病分期均有一定的临床价值.     

磁共振成像与核素骨显像对骨质疏松性椎体骨折诊断的比较

目的:比较分析磁共振成像(MRI)与核素骨显像对胸腰椎椎体骨质疏松性骨折诊断的敏感性及特异性。方法:24例(66个节段)胸腰椎骨质疏松性椎体骨折患者,分别行全身核素骨显像和脊柱MRI检查,比较两种方法对椎体发生骨折的显示情况。结果:以受累椎体个数为统计单位,在胸腰椎范围内,共66个椎体确定为责任节段,行椎体后凸成形术;MRI诊断60个节段,核素骨显像诊断58个节段,将两者的诊断个数进行Kappa检验,两者一致性较高,有统计学意义(Kappa=0.72,P=0.000)。结论:在显示骨质疏松性椎体压缩骨折方面,核素骨显像与MRI具有较高的一致性,可作为诊断骨质疏松性椎体骨折责任节段的有效辅助检查方式。     

高频超声在踝关节扭伤的诊断中的价值

目的 分析踝关节侧副韧带损伤及微小骨折的超声图像特征并评价其诊断价值.方法 采用7-13MHz线阵探头探查100例踝关节扭伤患者,观察侧副韧带损伤情况及是否存在微小骨折.其中51例超声诊断侧副韧带撕裂伤与手术比较,35例超声诊断微小骨折与X线检查、CT或MRI检查比较.结果 44例侧副韧带完全及部分撕裂伤的超声诊断与手术结果符合.35例超声诊断微小骨折中5例X线首次检查阳性,再行针对性X线检查检出28例阳性.结论 高频超声对踝关节侧副韧带损伤的诊断无创、快速、较准确,且诊断微小骨折可作为X线检查的补充.     

Usefulness of single photon emission computed tomography imaging in the detection of lumbar vertebral metastases from prostate cancer

Objective:   To determine whether single photon emission computed tomography (SPECT) is useful in the detection of prostate cancer bone metastases in the lumbar vertebrae.
Methods:   Thirty-nine patients (12 with benign prostatic hyperplasia, 27 with prostate cancer) were considered and submitted to bone SPECT. All of them had increased uptake in lumbar vertebrae on bone scintigraphy. In those with prostate cancer, definitive diagnosis of bone metastases was established by magnetic resonance imaging (MRI). SPECT axial images were classified into five accumulation patterns: mosaic, large hot, diffuse, peripheral, and articular (or pediculate). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bone SPECT were calculated.
Results:   Overall, 116 vertebral lesions (49 metastatic, 67 degenerative) were studied. Mosaic, large hot and diffuse patterns were more frequently associated with metastatic lesions (84.2%, 70.3%, and 63.1% of the cases, respectively). On the other hand, peripheral and articular (or pediculate) patterns were mostly ascribed to degenerative lesions (100% and 87.5% of the cases, respectively). Sensitivity, specificity, PPV and NPV of bone SPECT were 95.9% (47/49), 73.1% (49/67), 72.3% (47/65), and 96.1% (49/51), respectively.
Conclusions:   Bone SPECT provides better accuracy than bone scintigraphy in differential diagnosis of lumbar vertebral lesions from prostate cancer.     

Differential diagnosis between metastatic and osteoporotic vertebral fractures using sagittal T1-weighted magnetic resonance imaging

BackgroundMagnetic resonance imaging (MRI) is the most helpful for determining the differential diagnosis between metastatic and osteoporotic vertebral fractures; especially whole spine MRI is effective if patients have multiple spinal metastases. However, it is time-consuming to obtain all planes for all metastatic vertebrae. If we can differentiate these metastatic and osteoporotic vertebral fractures based on only one section and signal intensity, it would save time and be effective for patients with pain. This study investigated the usefulness of sagittal T1-weighted MRI findings in differentiating metastatic and osteoporotic vertebral fractures.MethodsWe retrospectively reviewed patients diagnosed with metastatic or osteoporotic vertebral fractures. Findings characteristic of metastatic fractures were considered: (a) pedicle or posterior element involvement; (b) convex posterior border of the vertebral body; (c) epidural infiltration; and (d) diffuse homogeneous low signal intensity; findings characteristic of osteoporotic compression fractures were also considered: (e) low-signal-intensity band and (f) posterior retropulsion. Chi-square test or Fisher's exact probability test was used to investigate the usefulness of each MRI finding. Intra- and inter-observer reliability analysis was performed.ResultsThis study comprised 43 patients with metastases (45 vertebrae) and 118 patients with osteoporotic fractures (156 vertebrae). All findings showed significant difference with each fracture (p-value: <0.01 to 0.03). Although each MRI finding exhibited high intra- and inter-observer reliability (κ: 0.66 to 1.00), finding (c) exhibited low reliability. Finding (a) showed high sensitivity (88.9%) and usefulness for screening, and findings (b), (d), (e), and (f) showed high specificity (90.4%–100%) and usefulness for definitive diagnosis.ConclusionsCharacteristic findings with sagittal T1-weighted MRI were useful in the differential diagnosis of metastatic and osteoporotic vertebral fractures. To prevent overlooking metastatic fractures with sagittal T1-weighted MRI, findings of the pedicle or posterior element involvement should be focused on because of its reliability and sensitivity.     

Bone density in osteopenic women: A modified distal radius density measurement procedure to develop an “at risk” value for use in screening women

This study measured radial and lumbar spine bone density in postmenopausal white female patients with nontraumatic fractures and their agematched controls. Bone density measurements were made with a single-beam densitometer. Distal radial bone density measurements were made at the site at which the radius and ulna are separated by 5 mm, which is ～5 mm from the distal radioulnar joint. Lumbar spine density was obtained using a dualbeam densitometer. Density at the commonly used “2/3” site near the midradius was also measured. Forty-six crush fracture osteoporotic patients, 35 hip fracture patients, and 20 osteopenic patients referred to the clinic for back pain or excessive bone loss but with no history of nontraumatic fracture were studied. Bone density values at all sites in the patient populations were statistically reduced from control values (p < 0.01). At a mean age of 62 years, density of the midradius was 12% below the control value. However, both vertebral and distal radial densities (“5 mm” site) were 25% below control values. The spine/distal radius ratio remained constant. It was demonstrated that bone density at the modified distal radial site could be used to predict vertebral density in osteopenic patients. An “at risk” value useful in screening procedures was determined as that distal radius density value ?95% of all values from fracture patients—325 mg/cm². It is concluded that distal radial density at the new “5 mm” site can be used in conjunction with midradius density as a preliminary test for both generalized and trabecular bone mass loss in women.     

Bone microarchitecture assessed by TBS predicts osteoporotic fractures independent of bone density: the Manitoba study

The measurement of BMD by dual‐energy X‐ray absorptiometry (DXA) is the “gold standard” for diagnosing osteoporosis but does not directly reflect deterioration in bone microarchitecture. The trabecular bone score (TBS), a novel gray‐level texture measurement that can be extracted from DXA images, correlates with 3D parameters of bone microarchitecture. Our aim was to evaluate the ability of lumbar spine TBS to predict future clinical osteoporotic fractures. A total of 29,407 women 50 years of age or older at the time of baseline hip and spine DXA were identified from a database containing all clinical results for the Province of Manitoba, Canada. Health service records were assessed for the incidence of nontraumatic osteoporotic fracture codes subsequent to BMD testing (mean follow‐up 4.7 years). Lumbar spine TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Osteoporotic fractures were identified in 1668 (5.7%) women, including 439 (1.5%) spine and 293 (1.0%) hip fractures. Significantly lower spine TBS and BMD were identified in women with major osteoporotic, spine, and hip fractures (all p < 0.0001). Spine TBS and BMD predicted fractures equally well, and the combination was superior to either measurement alone (p < 0.001). Spine TBS predicts osteoporotic fractures and provides information that is independent of spine and hip BMD. Combining the TBS trabecular texture index with BMD incrementally improves fracture prediction in postmenopausal women. © 2011 American Society for Bone and Mineral Research     

9例骨软化症临床误诊分析

目的 通过骨软化症的误诊原因分析,提高临床对该病的诊治水平,使其能够被早期诊断与治疗.方法 采用病例回顾的方法,分析9例骨软化症的临床资料,包括一般资料、临床表现、实验室检查、影像检查、误诊情况及治疗转归等.结果 9例患者均被误诊为严重骨质疏松症,其中3例被误诊为强直性脊柱炎,2例被误诊为腰椎间盘突出症,3例被误诊为无菌性股骨头坏死,1例误诊为肿瘤骨转移.在明确诊断为骨软化症之前,治疗效果不佳.确诊后,按骨软化症采取相应治疗,病情显著改善.结论 骨软化症在临床上非常容易与以骨痛、身体活动受限、脆性骨折等为主要临床表现的骨质疏松症相混淆而误诊为骨质疏松症及其他疾病.临床对于以骨痛、脆性骨折、骨骼畸形、活动受限和肌无力为主要表现的就诊患者,应进行全面检查,可以鉴别诊断,减少误诊的发生.     

Prognostic Value of Raised Prostatic Acid Phosphatase and Negative Skeletal Scintigraphy in Prostatic Cancer

Summary— Of 438 consecutive cases of newly diagnosed prostate cancer, 178 (41%) had skeletal metastases (TO-4 M1) at the time of diagnosis according to skeletal scintigraphy; 139 men had serum prostatic acid phosphatase (PAP) greater than twice the upper limit of normal on 2 separate occasions at the time of diagnosis and 65% of them had metastases on bone scan. However, 49 men with normal bone scans were found to have similarly raised serum PAP. (Such patients are defined as having skeletal metastases in the current Medical Research Council immediate versus deferred orchiectomy study and stratified accordingly). The actuarial survival of this group was calculated by life table methods and was compared with that of 2 other subgroups: those patients having metastases demonstrated on bone scan, and those patients having both normal bone scans and normal serum PAP. The survival of the “metastatic by acid phosphatase” group was significantly better than that of the “metastatic by bone scan” group but did not differ from that of patients having both normal scans and PAP. For patients with no scintigraphic evidence of skeletal metastases at diagnosis, those with a raised PAP were at a significantly greater risk of scan conversion, although this was more powerfully predicted by high histological grade.     

脊柱骨巨细胞瘤的CT与MRI诊断

目的探讨脊柱骨巨细胞瘤的CT、MRI表现及其诊断价值。方法本组17例为经手术病理证实的脊柱巨细胞瘤患者,男13例,女4例,平均年龄49岁;临床与影像学资料齐全。分析病灶的影像学特征及其对诊断与鉴别诊断意义。结果17例脊柱巨细胞肿瘤患者中颈椎5例,胸椎7例,腰椎2例,骶椎3例;14例仅累及1个椎体,3,例累及2个椎体。本组患者X线片示：11例表现为椎体溶骨性破坏并具一定的膨胀性,6例表现为椎体不同程度的压缩。CT示：椎体破坏区无骨性成分存留。MRI示：T1 WI为较均匀中至低信号,T2 WI为较均匀高信号,病灶部分呈良性的硬化骨边缘,部分终板破坏形成软组织肿块。结论脊柱巨细胞瘤影像学表现不同于四肢巨细胞瘤,瘤内无孵确骨性成分存留;可分为膨胀型和压缩型,兼有良、恶性肿瘤的影像学特征,主要应与脊柱动脉瘤样骨囊肿及转移瘤相鉴别。     

胸椎骨肿瘤的临床特点及诊断

目的 探讨胸椎骨肿瘤患者的临床特点及诊断方法。方法 分析13例胸椎骨肿瘤患者的临床表现、影像学资料、生化学检查及手术病理结果等，并进行归纳、总结。结果 13例中胸椎原发性骨肿瘤有6例，均为良性肿瘤，分别为骨巨细胞瘤3例，嗜酸性肉芽肿2例及海绵状血管瘤1例。胸椎转移性骨肿瘤有7例，其中已知原发肿瘤部位的4例为胃角溃疡型腺癌、肝癌、右下肺细支气管肺泡癌及左乳腺癌各1例，未知原发肿瘤部位的3例。结论 胸椎骨肿瘤患者的发病常无明显的诱因；最常见首发临床症状为持续性或间歇性胸、腰背部局部疼痛，常伴有躯干及双下肢麻木、疼痛、无力，随病情的加重可出现行走困难及下肢活动障碍；最常见的临床体征为病变节段和(或)相邻节段胸椎棘突、棘突旁压痛、叩击痛，另可出现躯干和(或)双下肢痛觉、触觉减退或消失，下肢肌力减退，膝反射及跟腱反射亢进，踝阵挛阳性等体征。应提高对胸椎骨肿瘤的认识和诊断水平，以争取早期手术治疗，提高患者的生活质量及生存率。诊断主要应根据病史、临床表现及胸椎ECT、CT、MRI检查，ECT具有早期诊断价值。治疗以手术治疗为首选。