399例恶性肿瘤核素骨显像的特征分析

Analyses of Characteristic of Radionuclide Bone Imaging in 399 Cases with Malignant Tumor

目的探讨不同类型恶性肿瘤骨转移特点和规律。方法回顾性分析399例经病理学证实的不同类型肿瘤患者核素骨显像结果。结果(1)骨转移发生率为47.1%,各类肿瘤骨转移发生率差别有显著性(P<0.01)。(2)骨转移分布躯干骨明显多于四肢及颅骨,且病灶的发生存在一定的伴随关系,62例四肢、29例颅骨病灶全部同时伴随有躯干骨病灶的发生,颈椎病灶伴随胸、腰椎发生的患者发病率为95.5%。(3)点状、团块状病灶的发生率明显多于条状、片状。单发或两病灶患者中,肺癌90.9%、乳腺癌86.7%、消化系统肿瘤90.9%呈点状或团块状,且多数位于胸部、脊柱;前列腺癌2例皆位于骨盆,呈团块状。(4)约有15.4%骨转移患者伴有溶骨性改变,大多发生于多发病灶患者;17例前列腺癌皆为成骨性改变。结论依据不同类型肿瘤骨转移的发生率、好发部位、病灶形态等特点,应用核素骨显像评价恶性肿瘤病人的分期、治疗方案选择、预后及转移瘤的定位等方面有重要的临床参考价值。

Objective To investigate the characteristic and regularity of bone metastasis with malignant tumor of different pathological types. Methods Radionuclide bone imaging was analyzed retrospectively in 399 cases of malignant tumor of different pathological types proven by pathology. Results（1）The incidence rate of bone metastasis was 47.1%, There was significant differ- ences in different tumors （P〈0.01）. （2）Truncal bones were the frequently involved metastatic sites. Different focuses of bone metastasis existed in the concomitance. All focuses of limbs（62 cases） and skull（29 cases） accompanied that of the truncal bones and the incidence rate of focuses of cervical vertebrae accompanied that of thoracic vertebrae or lumbar vertebrae was 95.5%. （3） The incidence rate of punctiform and clump form lesions was bigger than that of streak like and massive lesions. It was 90.9% of lung cancer, 86.7% of breast cancer and 90.9% of gastrointestinal cancer that appeared punctiforrn and clump form le- sions in patients of less than three focuses, and more occurred in thoracic bones and spine; clump form lesions of 2 cases of prostate cancer occurred in pelvis. （4）15.4% of bone metastasis was accompanied with lesions of osteolysis which occurred frequently in patients with multiple lesions. All focuses of prostate cancer were the lesions of osteogenesis. Conclusion According to the characteristic of bone metastasis with malignant tumor of different pathological types, radionuclide bone imaging is useful for staging, treating, prognosing and locating malignant tumor.