早期成人股骨头缺血坏死核素扫描和MRI对比研究

A CONTROLLED STUDY OF RADIONUCLIDE SCANNING AND MRI IN THE EARLY STAGE OF ISCHEMIC NECROSIS OF FEMORAL HEAD IN ADULTS

目的 探讨早期成人股骨头缺血坏死（FHN）核素扫描和MRI征象之间的对应关系及其诊断的灵敏度。方法 分析比较48例72髋经随访和病理证实或具有典型X线和CT表现的早期（FICATⅠ～Ⅱ期）成年FHN病人的髋关节核素扫描和MRI资料。全部病例核素扫描和MRI检查均于5d内完成。结果 核素扫描示股骨头局限性稀疏3髋，MRI上“线样征”远侧区均呈正常骨髓信号；核索扫描示典型或不典型“炸面圈征”35髋，弧形或环形浓集区对应MRI上“线样征”及其远侧的异常信号区；核素扫描示股骨头上方轻度浓集、基底部和（或）颈部条带状明显浓集8髋，条带状明显浓集区对应MRI“线样征”及其远侧的异常信号区，轻度浓集区对应“线样征”包绕的异常信号区；核素扫描示局限性浓集6髋，MRI上“线样征”包绕区均较小；核素扫描示股骨头或头颈部弥漫性浓集17髋，MRI上15髋显示“线样征”，12髋“线样征”远侧区信号异常，2髋弥漫性长T、长T2信号，无“线样征”；核素扫描示3髋正常，MRI示“线样征”远侧区均正常。核素扫描和MRI诊断灵敏度分别为95．83％和100．00％，两者比较无显著性差别（P=0．122）。结论 早期成人FHN不同核素扫描表现类型与MRI示“线样征”及其包绕区大小信号和远侧区表现有一定的对应关系。核素扫描诊断灵敏度与MRI相当。

Objective To investigate the correlation of radionuclide bone scanning and MRI in the early stage of femoral head necrosis （FHN） in adults. Methods Data of 72 hips from 48 adults with early FHN （FICAT stage Ⅰ -Ⅱ） confirmed by follow up or pathology or typical X-ray and CT were analyzed. The radionuclide scanning and MRI were all completed within five days. Results Three hips showed localized osteoporosis in femoral head on radionuclide bone scan, while on MRI, the signals in distal area of ＂line like sign＂ showed normal; 35 hips showed atypical or typical bread-fried ring sign on radionuclide bone scan, which correlated to MRI ＂line-like sign＇;eight hips showed slightly increased uptake in the superior end of femoral head and bandlike region of obviously increased uptake in inferior end of femoral head and/or femoral neck, the former corresponded to the area surrounded by ＂line-like sign＂ on MRI, and the latter to ＂line-like sign＂ as well as the outer nearby area;six hips showed localized uptake increased which corresponded to smaller area surrounded by ＂line-like sign＂ on MRI; 17 hips showed diffuse uptake in the head on radionuclide bone scan,in which, 12 showed abnormal signal beneath ＂line-like sign＂ near femoral neck, and two showed diffuse abnormal signal of femoral head without ＂line-like sign＂, and three showed normal manifestations on radionuclide bone scan with normal signal outside the ＂line-like sign＂. The sensitivity of radionuclide bone scan and MRI was 95.83% and 100.00%, respectively, the difference between them was not significant （P=0. 122）. Conclusion There is a certain correlation between radionuclide bone scan manifestations and MRI signs in early stage of femoral head necrosis. The sensitivity of radionuclide bone scan is nearly equal to that of MRI.