肝癌骨转移的特点及核素骨显像的价值

Bone scan characteristics of bone metastasis from hepatocellular carcinoma

目的 :探讨肝癌骨转移的特点及核素骨显像的价值。方法 :回顾性分析 2 76例经CT或病理学证实的肝癌病例的临床资料及骨显像表现。结果 :①肝癌骨转移率为 2 0 .3 % ( 5 6/2 76) ,最常累及部位为椎体 ( 2 8/5 6) ,依次是肋骨、肩胛骨及四肢、骨盆、颅骨和胸骨 ,其中多发性转移 67.9% ( 3 8/5 6) ;②相同部位CT或X线平片检出的病灶数较骨显像少 ,均表现为溶骨性 ,核素骨显像对溶骨性转移灶的检出率为 95 .5 % ( 4 4/4 6) ;③ 3 5 .7% ( 2 0 /5 6)的患者以骨转移为首发症状 ,其中80 % ( 16/2 0 )伴有骨痛 ,15例骨痛患者骨转移灶数在 2个或以上。结论 :晚期肝癌骨转移常见 ,好发部位为椎体 ,常多发转移 ,肝癌术前分期检查应常规包括放射性核素骨显像。

Objective:To analyse the characteristics of bone metastasis from hepatocellular carcinoma and evaluate the application of bone scintigraphy.Methods:The clinical records and planar skeletal scintigraphs in 276 patients with hepatocellular carcinoma were reviewed retrospectively.Results:① bone metastasis was detected in 20.3% of the patients with hepatocellular carcinoma,it occured most commonly in vertebra,(50%,28/56),followed by rib,scapula and limb,pelvis,skull and sternum in order;multiple metastases occured in 38 cases(67.9%);②CT and/or X-ray detected less tumors than bone scintigraphy,all lesions were osteolytic.The sensitivity of 99m Tc MDP bone scintigraphy in detecting osteolytic lesions was 95.5%(44/46),30 lesions were shown as increased radiotracer uptake (68.2%),the others showed decreased uptake spots.Bone metastasis was observed as the first sign in 20 cases (35.7%),and pain was the main symptom among 80% (16/20)of them.All cases had two or more lesions.Conclusion:Most bone metastasis from HCC occurs in patients with advanced stage,vertebra is most commonly involved,and multiple metastases are common.Bone scintigraphy should be a routine examination for HCC and for preoperative staging of HCC.