^(99)Tc^m-MDP核素骨扫描评估继发性肥大性骨关节病

Imaging observation of secondary hypertrophic osteoarthropathy by ~ （99） Tc^m-methylene diphosphonate bone scans

目的 评价继发性肥大性骨关节病 (HOA)放射性核素显像的特点与鉴别 .方法 放射性核素 99Tcm- MDP全身骨显像结合临床表现 ,对继发性 HOA的肿瘤患者 5 5例进行了核素闪烁显像分析 .参照 Ali分级方法 ,观察了四肢骨、肩胛骨、锁骨、颅骨、肋骨、骨盆及骨关节的放射性分布和摄取强度 .同时对 11例患者进行了疗效的影像学随访观察 .结果 5 5例患者的四肢长管骨均有“双条征”表现 ,48例 (87% )下肢骨的放射性聚集活度较上肢明显 ,46例 (84% )伴有对称、规律性骨皮质放射性增加 ,49例 (89% )呈均匀态的累及 ,31例患者有对称性关节周围放射性浓集的增加 .疗效观察 11例患者有 6例随原发病灶的去除 HOA影像特征及临床表现得到明显改善或消失 ,2例呈波动性 ,1例无变化 ,2例影像学及症状、体征加重 .结论 “双条征”为 HOA主要影像学改变 .HOA的放射性核素影像特征易与骨转移瘤等相鉴别 .HOA的影像随访观察有助于疗效。

AIM To evaluate the characteristic findings of the secondary hypertrophic osteoarthropathy (or called hypertrophic pulmonary osteoarthropathy, HPO) and differentiate the bone metastases or some osteoarthropathy diseases from HPO. METHODS Fifty five tumor cases were confirmed on HPO with 99 Tc m MDP the whole body bone scintigraphy combined X ray imaging and clinical manifestation. It was observed to grading scale and distribution of radionuclide in extremities, scapulae, clavicles, skull, ribs, pelvis, patella and joints referring to Ali's method. At the same time, 11 cases with HPO were followed after operation, radio therapy and/or chemical therapy. RESULTS Double stripe sign mainly in long bones was found in all 55 cases. Involvement of the extremities was invariably present, 44 cases (87%) almost always appeared more active in the lower than in the upper extremities. There was a symmetrical , regular increase of activity along cortical margins in 46 cases (84%) and uniformity involvement in 49 cases (89%). There was also an abnormally increased activity in and around the joints in 31 cases. Whereas the observation of curative effects on HPO, there were some changes of clinical symptoms, signs and bone scan within 6~24 mo after appropriate therapy of the associated disease process, such as a complete remission or subsided in 6 cases, a fluctuating intensity of uptake in 2 cases, no improved in 1 case and aggravating in 2 cases. CONCLUSION Double stripe sign is a main characteristic findings for HPO. The distribution of the activity between bone metastases and HPO is entirely different. The follow up for HPO by bone scan will make for observation and evaluation of curative effect.