不同骨病患者99Tcm-MDP骨显像与其病理结果对照研究

目的通过对81例骨病患者的核素骨显像与其病理结果进行回顾性分析,以期找出骨良、恶性病变,特别是结核与恶性病变影像学的规律及鉴别要点。方法对81例仅有骨痛或肢体功能障碍症状的骨病患者行99TcmMDP全身骨显像,并与手术及穿刺病理结果进行对照。结果对各病种自身来说,结核多发病灶比单发病灶多82%,其他良性骨病单发病灶比多发病灶多20%,骨转移瘤与原发恶性肿瘤多发病灶比单发病灶分别多36%和18%。恶性病变的病灶在中轴骨及外周骨同时出现(占18%),而良性病变则未见到。良性骨病病灶比邻分布明显多于无规律分布,占90%,而骨转移瘤无规律分布占84%。骨转移瘤及原发恶性肿瘤绝大多数病灶形态不规则(分别占82%及94%)、摄取放射性不均匀(分别占71%及76%)。骨结核病灶累及关节最多,占73%。结论99TcmMDP全身骨显像中除结核外的其他良性骨病以单发分布多见。恶性病变以多发分布多见,并可同时无规律地出现于中轴和外周骨上,绝大多数病灶形态不规则、摄取放射性不均匀。骨结核以多发及易累及中轴骨多见,病灶多形态规则、摄取放射性较均匀,极易累及关节是其显著特征。

99Tcm-MDP bone scan findings compared with osteopathology in different bone diseases

Objective To analyze the different points and rules of imaging between benign and malignant disease of the bones in eighty one patients with 99Tcm-MDP whole body bone scan and pathological results, especially between bone tuberculosis and malignant tumors. Methods We compared the results of 99Tcm-MDP whole body bone scan and osteopathology of surgery or biopsy for eighty-one patients with osteodynia or adjacent dysfunction. Results Multiple lesions were more than solitary lesions by 82% in tuberculosis. Solitary lesions were more than multiple lesions by 20% in other benign bone diseases. Multiple lesions were more than solitary lesions by 36% and 18% in bone metastasis and primary malignant bone tumors, respectively. The focuses were found in axial skeleton and long bones of the extremities simultaneously in 18% malignant diseases, but not for the benign disease. Neighbour distribution was found in 90% benign bone diseases, while in 84% metastatic bone tumor lesions were distributed diversely. The shape of focuses was irregular in 82% metastatic bone tumor and 94% primary malignant bone tumors, and radioactivity uptake was uneven by 71% and 76%. The focuses of 73% bone tuberculosis involved with joints. Conclusion Solitary lesions were major in benign bone diseases excluding tuberculosis by 99Tcm-MDP whole body bone scan. In malignant bone diseases multiple lesions were major and could be seen diversely in axial bones and extremities simultaneously. Shape of focus was irregular and radioactivity uptake was uneven in the most of malignant bone diseases. The most focuses of bone tuberculosis were multiple and distributed in axial bones, and they were regular and uniform as well as involved with joints easily.