骨质疏松性骨折与骨转移瘤的骨显像鉴别诊断

目的分析骨质疏松性骨折的骨显像特征,评价其用于与转移性骨肿瘤鉴别诊断的价值。方法回顾性研究53例骨质疏松性骨折患者的临床及骨显像资料,提出骨质疏松性骨折的特征性影像表现,并通过对53例骨质疏松性骨折患者和随机抽取的100例骨转移瘤患者的阅片试验,评价骨显像用于骨质疏松性骨折与肿瘤骨转移鉴别诊断的可行性及其临床诊断效能。结果骨质疏松性骨折在骨显像上常表现为多发病灶,其特征性影像表现为与骨骼走形相垂直的点状或短条状浓聚,横行于椎体的线样浓聚,或位于骶骨的“H”形浓聚,这些病灶无膨胀性生长或沿骨骼走形分布特点。依据上述影像特征与肿瘤骨转移进行鉴别,其诊断灵敏度、特异性、准确性分别为96.2%、97.0%和96.7%;且阅片者之间(kappa值:0.80~0.89)及阅片者自身(kappa值:0.82~0.86)的判断结果一致性较好。结论在骨显像中,骨质疏松性骨折具有特征性影像表现,不仅可用于骨质疏松性骨折的诊断,也可用于骨质疏松性骨折与骨转移瘤的鉴别诊断。

Bone scintigraphy used in differential diagnosis of osteoporotic fractures and bone metastases

Objective To analyze the bone imaging characteristics of osteoporotic fractures and evaluate its value in the differential diagnosis of metastatic bone tumors.Methods The clinical and bone imaging data of 53 patients with osteoporotic fractures were retrospectively studied,and the characteristic imaging manifestations of osteoporotic fractures were proposed.Through a reading test,the feasibility and clinical efficacy of bone imaging in the differential diagnosis of osteoporotic fractures and tumor bone metastases were evaluated in 53 patients with osteoporotic fractures and 100 randomly selected patients with bone metastases.ResultsOsteoporotic fractures were commonly appear as multiple lesions on skeletal scintigraphy.Lesions usually showed high uptakes shipped as“linear”in vertebra,“H”type in sacrum,and“spot”or short line vertical to skeleton courser in rib and other sites,and no dilatational growth or distribution along the bone was found.When the above imaging features were used to identify the bone metastases,the diagnostic sensitivity,specificity and accuracy were 96.2%,97.0%and 96.7%,respectively.Moreover,both the judgment result between the readers(Kappa value:0.80-0.89)and the reader himself(Kappa value:0.82-0.86)have a better consistency.Conclusion In bone scintigraphy,osteoporotic fracture has its characteristic imaging manifestations,which can be used not only in the diagnosis of osteoporotic fractures,but also in the differential diagnosis between the osteoporotic fractures and bone metastases.