放射性核素骨显像不典型表现248例临床分析

Clinical analysis of radionuclide whole bone imaging of untypical lesions in 248 cases

目的探讨放射性核素骨显像不典型表现的临床价值.方法对248例核素骨显像呈不典型表现的病例,分别进行病理活检,或X线、CT、MRI检查,或定期复查核素骨显像等进行随访,评价随访结果.结果 (1)骨显像不典型表现的病例中,有肿瘤病史者骨转移的阳性率为22.4%(47/210),无肿瘤病史者骨转移的阳性率为7.9%(3/38),二者相差显著(P＜0.01);(2)肺癌、乳腺癌、前列腺癌患者中,好发部位的骨转移阳性率为30.5%(29/95),非好发部位则为19.4%(7/36),二者相差显著(P＜0.01);(3)60.4%(150/248)的骨显像表现不典型的病例是通过补充X线、CT、MRI检查或随访而最终明确诊断的;(4)28.0%(10/48)的不典型表现病例随访3个月时病灶无明显变化而6个月或12个月后病灶明显扩大或出现新的病灶.结论肿瘤骨转移非好发部位或无肿瘤病史患者的放射性异常浓聚灶也须高度重视,必要时考虑'双癌';应密切结合X线、CT、MRI检查综合分析;骨显像随访时间一般应为3～6个月以上,必要时可超过12个月.

Objective To study clinical value of radionuclide whole bone imaging of untypical lesion cases. Methods The untypical lesions in 248 patients on whole hone imaging were followed-up with pathology, or X-ray, CT, MRI examination, or reviews of whole bone imaging. And results were valuated. Results （1）The rate of bone metastasis was 22.40% in 210 untypical lesion cases with primary malignancy, the rate of bone metastasis was 7. 9% in 38 untypical lesion cases without primary malignancy, there were significant differences between them（P〈0.01）. （2）In 131 cases diagnosed as lung cancer, breast cancer and prostate cancer, the rate of bone metastasis found in the most frequent region was 30.50%（29/95）, in the less frequent region was 19.40%（7/36）, there were significant differences between them（P〈0.01）. （3）60.4%（150/248） of untypical lesion cases were confirmed with the examination or reviews of X-ray, CT or MRI. （4）28.0 % （10/48） of untypical lesion cases, which didn＇t have obvious change after 3 months, were found progressive after 6 or 12 months. Conclusion The strong up-take of radioactivity in the less frequent region of bone metastasis or in the patients without primary malignancy should be paid more attention to, double cancer couldn＇t fully be ignored; X-ray, CT or MRI examination can provide help for the diagnosis of untypical lesions; The follow-up time of whole bone imaging should exceed 3-6 months, if necessary, even exceed 12 months.