核素骨显像不典型表现临床分析

目的 :提高对核素骨显像不典型病灶的诊断准确性。方法 :对 1 2 4例核素骨显像呈不典型病灶的骨病患者 ,分别进行病理活检 (手术或穿刺 ) ,定期复查核素骨显像或 X线、CT、MRI检查。结果 :1确诊为骨转移瘤 61例 ( 4 9.2 % ) ,原发性骨肿瘤 1 7例 ( 1 3.7% ) ,骨关节病 2 9例 ( 2 3.4% ) ,骨创伤 9例 ( 7.3% ) ,骨结核 5例 ( 4 .0 % ) ,骨炎症 3例 ( 2 .4% )。2就不典型病灶分布 :骨转移瘤中脊椎 5 2 .7% ,骨盆 2 3.1 % ,胸部 1 4.3% ,四肢 7.7% ,颅骨 2 .2 % ,各组之间差异有显著性 ;原发性骨肿瘤中四肢 71 .4% ,脊椎 1 4.3% ,骨盆 9.5 % ,胸部 4.8% ,各组之间差异有显著性 ;骨关节病中脊椎 5 1 .4% ,四肢 2 7.0 % ,胸部 1 6.2 % ,骨盆 5 .4% ,各组之间差异有显著性。结论 :核素骨显像表现为不典型病灶时首先考虑骨肿瘤 ;发生在颈、腰椎和膝关节处的老年患者以骨关节病为多 ;有骨创伤史者要考虑骨创伤可能 ,骨结核和炎症虽为少数也需与肿瘤鉴别。

Clinical analysis of bone scanning of untypical lesions

Objective : To raise the accuracy o f diagnosis of untypical lesions in whole body bone imaging.Methods: it was unde rwent pathologicbiopsy or reviews of bone imaging or X-ray, CT, MRI 124 cases of untypical lesions.Result : ①In 124 cases of untypical lesions of bone scanning, 61 cases were diagnosed as bon e metastases tumor (49.2%),17 cases as primary bone tumor(13.7%), 29 cases as o steoarthropathy (23.4%), 9 cases as trauma of bone (7.3%), 5 cases as tuberculos is of bone (4.0%), 2 cases as inflammation of bone (2.4%).②As for sites of unty p ical tesions, in bone metastases tumor , sites of untypical lesions w ere as follows :52.7% in spine;23.1% in pelvis;14.3% in thoracic;7.7% in upper a nd lower limbs ;2.2% in skull.There were significant differences among the group s. In primary bone tumor ,71.4% in upper and lower limbs;14.3% in spine;9.5% in pelvis;4.8% in thoracic.There were significant difference s among the groups. In osteoarthropathy,51.4% in spine;27.0% in upper and lower limbs ;16.2% in thoracic;5.4% in pelvis; There were significant differences amon g the groups. Conclusion :When we see one or two focuses that do not manifest t ypical lesion in Radionuclide bone imaging, the synthetic analysis should be un der gone with disease history and laboratory tests and other auxiliary examinations;bo ne tumor should be the first consideration. Focuses in the cervical verte bra or lumbar vertebra are mostly regarded as osteoarthropathy, focuses in the p atient with a history of injury are regarded as trauma. Tuberculous and inflamm ation of bone should also be taken into account, although they are not common.