核素全身骨显像鉴别诊断肋脊关节骨转移瘤

目的观察核素全身骨显像中肋脊关节放射性浓集灶的影像学特点及其对骨转移瘤的鉴别诊断价值。方法回顾性分析60例确诊为恶性肿瘤、骨显像示肋脊关节受累者的临床、影像及病理资料。以同期高分辨率CT、临床随访及病理结果为标准,分析核素全身骨显像中肋脊关节骨异常放射性浓集的特点,探讨其诊断灵敏度和特异度。结果 60例中,54例(54/60,90.00%)存在骨转移瘤。骨显像示肋脊关节处放射性异常浓集灶呈中心靠肋骨侧和中心靠椎体侧,呈现为横向和纵向条形。将中心靠肋骨侧浓集定义为骨转移瘤阳性,骨显像的灵敏度与特异度分别为59.26%(32/54)和83.33%(5/6);将横向条形浓集定义为骨转移瘤阳性,灵敏度与特异度分别为29.63%(16/54)和100%(6/6);将中心靠肋骨侧浓集或横向条形浓集均定义为骨转移瘤阳性,灵敏度与特异度分别为88.89%(48/54)和83.33%(5/6)。结论核素全身骨显像显示肋脊关节处放射性异常浓集,尤其当病灶中心靠肋骨侧和呈横向条形浓聚时,应高度警惕骨转移瘤。

Radionuclide whole body bone imaging in differential diagnosis of costovertebral joint metastases

Objective To evaluate image features and diagnostic value of radionuclide bone imaging for differentiating malignant and benign costovertebral joint lesions. Methods Data of 60 patients with various cancers and costovertebral joints lesions in radionuclide bone imaging were retrospectively analyzed. Taken high resolution CT (HRCT), clinical follow-up and pathologic results as diagnostic standards, the image features of radionuclide bone imaging for differentiating malignant and benign costovertebral joint lesions were explored, and the sensitivity and specificity were evaluated. Results Among 60 patients with radioactive anomaly concentration rib ridge joint lesions, 54 (54/60, 90.00%) were proved bone metastases by HRCT.Rib bone imaging in spinal joints radioactive anomaly concentration center located at frame side or vertebral lateral, present as vertical and horizontal strips. When concentration with center on lateral ribs was defined as bone metastase, the sensitivity and specificity of radionuclide bone imaging was 59.26% (32/54) and 83.33% (5/6), respectively. When horizontal bar concentration was defined as positive, the sensitivity and specificity was 29.63% (16/54) and 100% (6/6), respectively. Furthermore, when center on lateral ribs concentration or horizontal bar concentration were defined as positive, the sensitivity and specificity was 88.89% (48/54) and 83.33% (5/6), respectively. Conclusion For radionuclide whole body bone imaging, radioactive anomaly consistence lesions on costovertebral joint, especially punctiform lesions with centre approaching to rib and transverse lesions are probably bone metastases.