核素骨显像与X线摄片对多发性骨髓瘤诊断的评价

The Clinical Evaluation of Bone Scintigraphy and Radiography in Diagnosis of Multiple Myeloma

目的 探讨多发性骨髓瘤 (MM )的核素全身骨显像和X线影像特征 ,评估核素显像在MM诊断中的临床应用价值。方法 对 46例多发性骨髓瘤的核素骨显像与X线片进行对比研究。结果 核素全身骨显像阳性率为 6 7.9% ( 188/ 2 77个 )。共发现病灶 188个 ( 31例 )。X线摄片诊断阳性率为 70 .8% ( 196 / 2 77个 ) ,共发现病灶 196个 ( 33例 )。 2种显像的诊断符合率为 38.6 %( 10 7/ 2 77个 )。对全身受累骨髓病灶多少的检出顺序 ,核素骨显像为肋骨 ( 2 3 .9% )、腰椎 ( 17.6 % )、颅骨 ( 16 .5 % )、胸椎 ( 14 .4% )、肩胛骨 ( 8.5 % )、下肢 ( 7.9% )、上肢 ( 1.6 % )。而X线为颅骨 ( 18.4% )、腰椎 ( 17.9% )、肋骨 ( 17.3 % )、胸椎 ( 14 .8% )、下肢 ( 9.2 % )、肩胛骨 ( 6 .6 % )、上肢 ( 4 .6 % )。表明肋骨对核素显像更敏感 ;X线则更适于颅骨病变的检查。结论 对多发性骨髓瘤的诊断 ,核素全身骨显像与X线摄片同等重要 ,两者不能相互取代 ,只能相互取长补短 。

Objective To compare the different images of scintigraphy and radiography in multiple myeloma and to probe into the clinical evaluation in scintigraphic images for diagnosis of multiple myeloma.Methods Radionuclide images and skeletal radiography of 46 patients with multiple myeloma were analyzed.Results The positive rate of the bone scintigraphy was 67.9%( 188/277 ),188 lesions were detectable,(31 patients).While plain X rays had a positive rate of 70.8%(196/277),196 lesions were found,(33 patients).The concordance of both scintigraphy and plain X rays was only 38.6%(107/277).With scintigraphy,the sequence numbers of bone lesions involved were ribs(23.9%),lumbar(17.6%),skull(16.5%),thoracic(14.4%),scapula(8.5%),lower limbs( 7.9% ),upper limbs(1.6%).Whereas,it were skull(18.4%),lumbar(17.9%),ribs(17.3%),thoracic(14.8%),lower limbs( 9.2% ),scapula(6.6%),upper limbs(4.6%) with plain X rays.The results showed that scintigraphy was sensitive to rib while X ray was sensitive to skull.Conclusion The patients with multiple myeloma underwent radionuclide images and radiography is equal of importance.The combination of bone scintigraphy and plain X rays has obviously mutual benefit to the diagnosis of multiple myeloma.