骨髓增殖性疾病全身骨髓分布变化的研究

Studies on ^(99)Tc^m-sulfur colloid bone marrow scintigraphy in myeloproliferative disorders

目的 探讨用99Tcm 硫胶体显像观察骨髓增殖性疾病 (MPD)全身骨髓分布改变及特点的临床意义。方法 患者 85例 ,包括原发性骨髓纤维化 (IMF) 4 0例 ,真性红细胞增多症 (PV) 15例 ,原发性血小板增多症 (ET) 5例 ,慢性粒细胞性白血病 (CGL) 2 5例。99Tcm 硫胶体使用剂量 370～ 5 5 0MBq(2～ 5mL)。结果 全身骨髓分布异常占 88.2 % ,可见骨髓显像呈增强型、抑制型及抑制伴扩张型异常表现。中心性骨髓 (CBM)抑制率及外周性骨髓 (PBM)扩张率分别为 6 1.2 %及 5 6 .5 %。IMF骨髓抑制型较增强型外周血象降低程度差异有显著性 (P <0 .0 5 )。CGL患者CBM抑制及PBM扩张程度均随病情缓解而减轻。各疾病间PBM扩张形态有一定差异。结论 胶体骨髓显像的不同类型与MPD外周血象、临床病程及病情缓解状态有关 ;骨髓显像有助于MPD的鉴别诊断 。

Objective To discuss the imaging features and changing patterns of bone marrow scintigraphy in myeloproliferative disorders ( MPD ) as well as its clinical significance. Methods Bone marrow scintigraphy using 99Tc m-sulfur colloid 370～550 MBq was performed on 85 MPD patients, including 40 cases of idiopathic myelofibrosis (IMF), 15 of polycythemia vera (PV), 5 of essential thrombocythemia (ET), 30 of chronic granulocytic leukemia. Also, 40 cases of myelodysplastic syndroms (MDS) were observed in this study. Results Abnormal bone marrow imaging was found in 88.2% of the 85 patients. The suppression rate of central bone marrow (CBM) and expansion rate of peripheral bone marrow (PBM) in these MPD patients was 61.2% and 56.5%, respectively. The imaging patterns was classified into three types according to the distribution and activity of bone marrow. ①reduced imaging (31.8%); ②increased and expanded imaging (27.1%); ③depressed and expanded imaging (29.4%). Splenomegaly with minimal residual marrow activity was typical for late stages of MPD. Expansion of PBM was the further feature, but of no major importance for improving hematopoiesis of MPD, and it tended to retract during clinical recovery in chronic granulocytic leukemia (CGL). With expanding PBM, unmatched peripheral blood decreasing was found in MDS. The expansion pattern of PBM in different MPD was of relatively definite features. Conclusions The imaging pattern of bone marrow was correlated with blood work-up data and clinical course or stages of MPD. Bone marrow scintigraphy may be proven useful in differential diagnosis and evaluation of clinical staging and prognosis of MPD.