骨软化症核素骨显像影像特征分析

Characteristics analysis of osteomalacia on bone scan

目的研究骨软化症患者的核素全身骨显像表现特征,探讨骨显像在诊断和鉴别诊断中的应用价值。方法回顾性分析9例经病理或临床随访证实的骨软化症患者的全身骨显像表现特征,以13例原发性甲状旁腺机能亢进患者的骨显像为对照组,比较两种疾病在影像表现及实验室检查方面的差异。结果 9例骨软化症患者(OM组)的99 mTc-亚甲基二磷酸盐(99 mTc-MDP)全身骨显像的整体表现为严重骨质疏松征,颅骨普遍性放射性摄取增高,脊柱及四肢长骨皮质对称性放射性摄取增高,肩、骶髂、髋、膝、踝等关节部位对称性放射性摄取增高。9例患者均有不同部位的假骨折;5例患者出现"串珠肋"表现;7例患者胸椎下段及腰椎条状放射性浓集;2例患者长骨骨骺出现对称性线状放射性摄取增高。而13例原发性甲状旁腺机能亢进患者全身骨显像均表现为典型的代谢性骨病或超级影像。两组生化指标比较显示两组患者的血清碱性磷酸酶、钙及甲状旁腺激素水平的差异有统计学意义(P<0.01)。结论全身骨显像可作为诊断骨软化症的一种重要的影像手段,能更灵敏、全面地探测假骨折部位;结合患者的影像特征及相关实验室检查指标有助于与肿瘤性疾病和其他类型代谢性骨病的鉴别;详细询问病史及合并疾病有助于明确骨软化发生的原因及后续诊疗决策。

Objective To study the characteristic feature of osteomalacia（OM） on radionuclide bone scan and investigate the value of bone scan in the diagnosis and differential diagnosis. Methods The findings of whole body bone scan in 9 osteomalacia patients who had been proven by pathology or clinical followed - up were investigated restrospectively. Thirteen patients of primary hyperparathyfiodism were included into the control group. The differences between the two group in imaging manifestation and laboratory examination were compared. Results Nine osteomalacia cases （ OM group）showed severe osteoporosis sign on whole body bone imaging. Radioactive uptake increased symmetrically in skull, spine and extremities. The tracer uptake increased symmetrically in joints including shoulder, sacroiliac, hip, knee and ankle. Pseudofracture were seen in all 9 cases. Five cases showed ＂rachitic rosary＂, and 7 cases presented radioactive enrich in low thoracec vertebrae and lumbar vertebrae. Two cases showed symmetric linear uptake increase in long bone epiphyses. Thirteen patients of primary hyperparathyriodism（PHPT group）demonstrated typical metabolic bone disease sign or super scan. The comparison of laboratory examine results between two groups showed the differences, which statistical difference in the aspect of serum AKP （ P 〈0.05）, calcium （ P 〈0.01） and PTH level （ P 〈0.01）. Conclusion Osteomalacia has a certain characteristic finding on ralioncuclide whole body bone scan. Bone scan can detect pseudofracture roundly and sensitively and should be an essential imaging modality for the chagnosis of osteomalacia. Combining the imaging character with laboratory examination is helpful of differential diagnosis of osteomalacia.