以病理结果为对照观察骨结核与骨肿瘤的骨显像鉴别点  

Differential diagnosis of skeletal tuberculosis and malignant skeletal disease with bone scintigraphy based on pathology

作　　者：张燕燕[1] 张卫方[1] 马婧[1] 

机构地区：[1]北京大学第三医院核医学科,北京100083

出　　处：《中国临床医学影像杂志》2009年第4期267-270,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:经手术、病理证实的骨结核、骨恶性病变患者56例,将其核素骨显像与病理结果进行比较分析,以探索骨结核与骨恶性病变的影像学特征及鉴别要点。方法:对行99Tcm-MDP骨显像的1817例骨痛患者进行回顾性分析,并对其中56例骨病理结果提示为骨结核及骨肿瘤的患者分组进行影像学对比研究。结果:本研究中骨转移瘤与原发恶性肿瘤多发病灶比单发病灶有增多趋势。骨结核累及关节高达73%,并均出现在中轴骨;恶性病变可出现在中轴骨、四肢骨或同时出现在中轴与四肢骨。骨结核病灶的多发病灶中,比邻分布占优势,为83%;而骨转移瘤的无规律分布占优势,为84%。70%的骨结核病变呈放射性摄取增浓程度较低、分布均匀的表现,而80%骨转移瘤及70%骨原发瘤则表现出放射性的异常浓聚、分布不均匀的表现。结论:全身骨显像恶性病变多发及无规律地出现于中轴和四肢骨上,绝大多数病灶呈形态不规则及放射性分布不均匀。骨结核易累及中轴骨,多发病灶中比邻分布占优势,病灶摄取放射性较淡且均匀,易累及关节是其显著特征。Objective： To search the specific features that can differentiate malignant skeletal disease and skeletal tuber- culosis on bone scintigraphy and compare with pathology. Materials and Methods： For 1817 patients with pain of bone un- derwent bone scan. Fifty-six cases of skeletal malignant disease and skeletal tuberculosis were confirmed by pathology. Pa- tients were divided into 3 groups according to the results of pathology： skeletal tuberculosis; bone metastasis and primary ma- lignant bone tumors. Results： Bone metastasis and primary malignant bone tumors multiple lesions were more than solitary le- sions. In bone tuberculosis 73% had joint involvement. The loci of bone metastasis bone disease were found in axial skeleton or extremities or both simultaneously, but skeletal tuberculosis were found in axial skeleton only in this study. Adjacent bone involvement was found in 90% of skeletal tuberculosis and in metastatic bone tumor, were distributed diversely. Seventy per- cent of bone tuberculosis absorbed imaging agent uniformly. The foei was irregular in 82% of metastatic bone tumors and in 94% of primary malignant bone tumors. Conclusion： Multiple lesions in malignant bone diseases could be seen diversely in axial skeleton and extremity bone. Foci were irregular and radioactive uptake not uniform in most malignant bone diseases. Most foei of bone tuberculosis distributed in axial bones, and they were regular and uniform as well as after accompanied by joint involvement.

关 键 词：结核 骨关节 骨肿瘤 放射性核素显像 

分 类 号：R529.2[医药卫生—内科学] R738.1[医药卫生—临床医学]