瘤源性骨软化症的影像学诊断  

Imaging Diagnosis of Tumor-induced Osteomalacia

作　　者：孔西建[1] 刘玉珂[1] 李盈盈[1] 翟远坤[1] 吴丹[1] 叶进[1] 

机构地区：[1]河南省洛阳正骨医院,河南洛阳471002

出　　处：《中国医学影像学杂志》2014年第8期624-629,共6页Chinese Journal of Medical Imaging

摘　　要：目的探讨瘤源性骨软化症(TIO)的临床及影像学特点,提高临床对TIO的诊断水平。资料与方法回顾性分析经临床、影像学、病理及随访证实的7例TIO患者的临床资料及骨骼X线、CT、MRI、99Tcm-亚甲基二磷酸盐骨核素显像,99Tcm-奥曲肽显像及病理资料。结果 7例TIO患者以多发部位疼痛多见,常见部位为胸腰椎、胸肋部、髋部和四肢负重关节。7例患者均表现为血磷减低、血钙正常、碱性磷酸酶增高、骨转换加快。7例X线表现为骨小梁模糊,骨质结构呈"雾霾样"征象,多发假骨折线及多发骨折,2例病史长者胸廓、脊柱、骨盆变形;5例行骨核素扫描均呈多发异常放射性摄取增高,颅骨放射性摄取增高,即"黑颅征",4例显示假骨折影,3例肋骨呈串珠样;6例行奥曲肽显像,均确定肿瘤部位;7例肿瘤切除后血磷恢复正常,疼痛缓解。结论 TIO骨骼X线表现为骨小梁模糊,多发假骨折线或骨折线,骨骼变形;骨核素扫描显示多发浓聚;奥曲肽显像有利于肿瘤定位。Purpose To improve the clinical and imaging features of tumor-induced osteomalacia （TIO）, and to improve its clinical diagnosis. Materials and Methods Seven patients with TIO confirmed by clinical, imaging, pathological and follow-up results were retrospectively analyzed, including clinical data, bone X-ray, CT, MRI, 99Tc^m-MDP, 99Tc^m-OCT and pathological data. Results All 7 TIO patients manifested as weight-bearing joints ache in multiple parts, such as thoracic vertebra, ribs, the hips, arms and legs. All 7 patients had decreased serum phosphorus, normal serum calcium, increased serum alkaline phosphatase and fastened rate of bone turnover. The X-ray showed fuzzy bone trabecula, ＂haze-sign＂ bone structure, multiple pseudo-fracture and multiple bone fractures in 7 patients, 2 patients with long medical history showed deformed sternum, spine and pelvis; 99Tc^m-MDP showed increased abnormal uptake in multiple sites and skull in 5 patients, named ＂black skull sign＂; 4 showed pseudofi-acture, 3 showed ＂rachitic rosary＂. Six patients performed 99Tc^m-ocT and found out tumor sites. All the 7 patients serum phosphates returned to normal and the pain relieved after the tumor resection. Conclusion TIO patients manifests as fuzzy bone trabecula, multiple pseudo-fracture or bone fractures and bone detbrmation on X-ray; 99Tc^m-MDP displays multiple concentration and 99Tc^m-OCT helps for the tumor location.

关 键 词：骨软化症 肿瘤 放射摄影术 体层摄影术 X线计算机 磁共振成像 体层摄影术 发射型计算机 单光子 99M锝美罗酸盐 奥曲肽 

分 类 号：R681.3[医药卫生—骨科学] R445[医药卫生—外科学]