无骨痛初治鼻咽癌患者核素骨显像阳性率及对患者处理的探讨

Positive Rate of Radionuclide Bone Imaging and Treatment in No Ostalgia Patients with New Nasopharyngeal Carcinoma

背景与目的:核素骨显像结合临床骨痛症状常用于诊断鼻咽癌骨转移,但无骨痛初治鼻咽癌患者核素骨显像阳性率的报道罕见。本文探讨无骨痛初治鼻咽癌患者全身核素骨显像阳性率及对此类患者的处理。方法:对住院的104例无骨痛初治鼻咽癌患者行全身核素骨显像检查。按显像结果分为两组,一组骨显像见异常代谢浓聚灶,并行薄层骨算法CT扫描了解情况20例。另一组未见异常84例。随诊6-30个月。结果:19.2%(20例)患者核素骨显像见异常代谢浓聚灶。薄层骨算法CT扫描1例骨质破坏,2例骨质退行性变,余无异常。但在随诊中本组有11例在6-10个月内出现骨痛,复查骨显像浓聚灶较前增大。81.8%(84例)核素骨显像阴性的患者有9例在随诊的4-20月内出现骨痛,复查骨显像出现新的代谢浓聚灶。两组患者骨转移30个月内发生率有高度显著性差异(P<0.01)。结论:无骨痛初治鼻咽癌患者全身核素骨显像阳性率为19.2%。骨转移发生率高于阴性组患者。此类患者的骨显像阳性浓聚灶两段诱导化疗不能减少骨痛的发生。因此对此类患者不需行常规则化疗,可结合临床选择随诊。CT扫描不能鉴别骨显像的假阳性。

Background &Objective:According to clinical symptom ostalgia,radionuclide bone imaging was often used to diagnose the bone metastasis of nasopharyngeal carcinoma.But th e reports of the positive rate of radi onulide bone imaging in no ostalgia patients with newly nasopharyngeal carcinoma is r arely.This study was designed to evaluate the positive rate of radionuclide bone i maging and treatment in no ostalgia p atients with new nasopharyngeal carcinoma.Methods:A total of 104no ostalgia patients wi th new nasopharyngeal carcinoma were examined by whole body radionuclid e bone imaging.All patients were divided into two groups:group A includes20patients which have the abnormal l esions of bone imaging,The abnormal lesions o f bone imaging were examined by 5mm slice bone-target computer tomograph y.Group B includes 84patients which have normal bone imaging.These patients were followed up from 6to 30months.Results:Twenty patients(19.2%)were with abnormal lesions of bone im aging.The lesions of bone imaging we re examined by 5mm slice bone-target computer tomogra phy.One patient was documeuted bone destraction ,2patients were deteriorative,other 17patients were no abnormal.With a follow up from 6to 10months,11patients appeared ostalgia.The lesions of bone imaging had developed when examined by bone i maging again,84(81.8%)patients were negative;but with a fo llow up from 4to20months,9patients appeared ostalgia and there were new lesions of bone imaging when examined by bone imagin g again.There was a higher significant diffe rence in incidence of bone metastasis in group A and group B.(P<0.01)The patients with ostalgia received local radiotherapy or combining therapy.Conclusion:The rate of radionuclide bone imagin g in no ostalgia patients with new nasopharyngeal carcinoma was 19.2%.The incidence of bone matastasis in positive patients of bone imaging was higher than that in n egative.Two cycles of neoadjuvant c hemotherapy can not reduced the appearing rate of ostalgia.Acording to clinical symp tom,The following up can be selected to the no ostalgia patient o f positive bone imaging with newly nasopharyngeal carinoma.But computer tomography can not determined the faulse positive o f radionuclide bone imaging.