^(99)Tc^m-MDP、^(99)Tc^m(V)-DMSA和^(99)Tc4~m-Citrate显像对骨组织良恶性疾病鉴别诊断的对比研究  

A comparative study of ^(99)Tc^m-MDP, ^(99)Tc^m(V)-DMSA and ^(99)Tc^m-Citrate in diagnosis of bone malignant tumors and bone/joint infections

作　　者：武兆忠[1] 吴波以[1] 林伟[1] 魏学立[1] 邬恒夫[1] 范子文[1] 欧阳智[1] 吴长伟[1] 袁戈文[1] 

机构地区：[1]广州医学院附属第二医院,广州510260

出　　处：《核技术》2003年第8期633-637,共5页Nuclear Techniques

基　　金：广东省卫生厅科学研究基金(B1998063)资助

摘　　要：为评价99Tcm(V)二巯基丁二酸钠(DMSA)显像和99Tcm枸缘酸(Citrate)显像在骨转移癌和骨及骨关节炎症诊断中的意义,对骨转移癌患者和骨及骨关节炎症患者各18例分别进行99Tcm亚甲基二膦酸(MDP)、99Tcm(V)DMSA和99TcmCitrate全身显像,并比较了它们的显像结果。18例经病理学、CT或MRI证实有骨转移癌的患者,99TcmMDP显像共检出64个病灶,99Tcm(V)DMSA显像显示在与99TcmMDP显像相同部位同检出49个病灶,而99TcmCitrate显像仅检出1个病灶。18例经细菌学、CT或MRI证实的骨及骨关节炎症患者,99TcmMDP显像共检出22个病灶,99Tcm(V)DMSA显像显示在与99Tcm MDP显像相同部位同检出17个病灶,99TcmCitrate显像检出16个病灶。本组病例99Tcm(V)DMSA显像诊断骨转移癌的灵敏度为76.56%,特异性为22.73%; 99TcmCitrate显像诊断骨转移癌的灵敏度仅为1.56%,特异性为27.27%。99Tcm(V)DMSA显像诊断骨及骨关节炎症的灵敏度为77.27%,特异性为23.44%;99TcmCitrate显像诊断骨及骨关节炎症的灵敏度为72.73%,特异性为98.44%。以上结果表明,99Tcm(V)DMSA显像在诊断骨转移癌和骨组织炎症时应该慎重,因为它不能区分骨组织的良恶性病变性质,其对骨组织的良恶性病变性质的鉴别诊断应排除外骨组织炎症、骨折等骨组织良性病变的干扰。The purpose of this study was to assess the diagnostic value of scans with 99Tcm(V)-dimercaptosuccinic acid (DMSA) to localize bone metastases and to evaluate the capability to diagnose bone/joint infections with scans using 99TcmCitrate. Eighteen patients referred to bone metastases and eighteen patients referred to bone and joint in-fection were studied. In all patients, a bone scan of 99TcmMDP was obtained initially. Subsequently, comparative scans with 99Tcm (V)DMSA and 99TcmCitrate were conducted successively. Pathologic finding and/or microbi-ological finding, X-ray CT and /or MRI, and /or clinical follow-up (until symptoms disappeared) were considered to be proof of the presence of bone metastases and bone/joint infection. All of the eighteen patients with diagnosed bone metastases and of the eighteen patients with diagnosed bone and joint infection had positive 99TcmMDP scintigraphy. The fifteen patients with diagnosed bone metastases and the fifteen patients with diagnosed bone/joint infection had increased 99Tcm(V) DMSA accumulation at certain areas matched with those shown in 99TcmMDP scans, and only one patient with diagnosed bone metastases and the fifteen patients with diagnosed bone and joint infection had in-creased 99TcmCitrate accumulation at certain areas matched with those shown in 99TcmMDP scans. 99TcmMDP scans show 64 bone lesions in the bone metastases while 49 lesions by the 99Tcm(V) DMSA scans and only one le-sion by the 99TcmCitrate scans respectively. And 99TcmMDP scans show 22 bone lesions in the bone and joint infec-tion while 17 lesions by the 99Tcm(V) DMSA imaging and 16 lesions by the 99TcmCitrate imaging respectively. For bone metastases diagnosis, the sensitivity of 99Tcm(V) DMSA imaging and 99TcmCitrate imaging were 76.56% and 1.56%, respectively, and the specificity were only 22.73% and 27.27%, respectively. For bone and joint infection di-agnosis, the sensitivity of two kinds of imaging were 77.27% and 72.73%, respectively, and the specificity were 23.44% and 98.44%, respectiv

关 键 词：骨恶性肿瘤 骨及骨关节炎症 ^99Tc^m核素骨显像 亚申基二膦酸 二巯基丁二酸钠 枸缘酸 

分 类 号：R817.4[医药卫生—影像医学与核医学]