代谢性骨病骨显像特点探讨

为提高骨显像对临床上各种骨疾患的鉴别诊断能力,本文回顾分析了代谢性骨病在骨显像上的特征表现.临床确诊的142例共6种代谢性骨病:其中甲状旁腺功能亢进症117例;肾性骨病4例;畸形性骨炎16例;成人骨软骨病2例;石骨症2例,脆骨病1例.142例代谢性骨病的骨显像结果可分为四种类型:全身骨摄取显像剂增加(I型);局部骨摄取显像剂增加(Ⅱ型);全身+局部骨摄取显像剂增加(Ⅲ型)和正常骨显像图(Ⅳ型).部分甲旁亢、石骨症、脆骨病和肾性骨病骨显像表现为I型;畸形性骨炎、成人低血磷软骨病和部分甲旁亢骨显像表现为Ⅱ型;表现为I型的代谢骨病患者发生病理性骨折或继发局部骨病变时骨显像表现为Ⅲ型.Ⅳ型骨显像仅发现在早期甲旁亢的患者.各种类型在异常显像骨的部位、骨显像病灶的形状、摄取显像剂的程度等方面均有自身特点,根据这些特点再结合病史及X线结果可有助与骨肿瘤加以区别.

Clinical research of bone scan characteristics for metabolic bone diseases

Characteristic images of ~(99m)Tc-MDP bone scintigraphy in patients with metabolic bone diseases (MBD) were analyzed and compared, in an attempt to improve the capability of differential diagnosis in this aspect. A total of 142 cases, clinically confirmed as (MBD), were categorized into six groups: hyperparathyroidism (117), renal osteodystrophy (4), Paget's disease (16), hypophosphatemic osteomalacia (2), Albers-Schonberg disease (2), and Brittle bone disease (1). They were diagnosed clinically or pathologically, and scanned with ~(99m)Tc-MDP bone scintegraphy, from which the 142 MBD cases were classified into 4 types. The cases of Type I had increased amount of ~(99m)Tc-MDP uptake in whole body bones, including hyperparathyroidism, Albers-Schonberg disease, brittle bone disease and renal osteodystrophy. The cases of Type Ⅱ had high uptake of ~(99m)Tc-MDP in local region of bones, including paget's disease, hypophosphatemic osteomalacia and hyperparathyroidism. A Type I case with pathological fracture or secondary osteopathy was classified as Type Ⅲ. Type Ⅳ cases were in early stage of hyperparathyroidism, with normal bone scan image. Analysis of the characteristics of ~(99m)Tc-MDP bone scintigraphic findings (locations, morphology and intensities) in patients with MBD may be helpful in the differential diagnosis of MBD, in association with the patient's history and X-ray data altogether.