肺性肥大性骨关节病^(99m)Tc-MDP骨显像与X线平片对比分析

Comparative study of ^(99m)Tc-MDP bone imaging and radiography in hypertrophic pulmonary osteoarthropathy

目的:比较分析肺性肥大性骨关节病(HPO)X线平片和核素骨显像影像特征,旨在提高对该病的诊断准确率。方法:对57例HPO的X线和核素骨显像图像进行分析,总结其影像学特性并比较两种检查方法的优缺点。结果:核素骨显像表现为所有病例的关节放射性核素浓聚,96.5%(55例)有下肢骨"平行管"征,3.5%(2例)HPO有双侧膝、踝、肘关节周围放射性浓集。核素骨显像对该病的诊断符合率为61.4%(35/57)。X线片表现为50例关节有明显关节病变,具有特征性的X线表现,其中杵状指(趾)占22.8%(13/57),双侧管状骨对称性骨膜增生占22.8%(13/57),表现为增生的骨膜呈层状、葱皮样、花边样等,骨膜新生骨与骨皮质有透亮线占19.3%(11/57),本组X线诊断该病诊断符合率为77.2%(44/57)。HPO在X线片与核素骨显像上都有特征性的表现,但X线特异性更高,而核素骨显像敏感性更高。结论:对疑似HPO患者应及早行X线检查,必要时行核素骨显像以提高诊断符合率。

Objective：To analyze the imaging characteristics of radiography and nuclide imaging of hypertrophic pul monary osteoarthropathy （HPO） ,in order to improve the accuracy of diagnosis. Methods：57 cases with HPO having radio- graphy and nuclide bone imaging were analyzed, the imaging characteristics were studied and their advantages and disadvan- tages were compared. Results： All patients had radionuelide accumulation, 96.5%（55 patients） showed ＂parallel sign＂ of lower extremeties, 3.5 % （2 patients） had radionuelide accumulation around bilateral knee, ankle, elbow joints. The diagnos- tic accuracy was 61.4%（35/57 patients）. 50 patients showed obvious bone lesion around the joints on radiography, with 22.8%（13/57 patients） had clubbed finger （toe）, 22.8%（13/57 patients） had periosteal hyperplasia of tubular bone, showing layering,onion-skin like or lace-like patterns. Periosteal new bone and translucent lines of bone cortex could be seen in 19. 3% （11/57patients）. The diagnosis accuracy of radiography was 77. 2% （44/57patients）. Characteristic features could be assessed on radiography and nuclide bone imaging,radiography had higher specificity, nudide had higher sensitivi- ty. Conclusion：For patient who is suspecting of HPO,radiography should be undertaken early, the diagnosis accuracy could be improved by nuclide bone imaging when necessary.