四肢骨肿瘤及肿瘤样病变患者^(99m)Tc-MDP骨显像特点及其鉴别诊断意义

Characteristics of ^(99m)Tc-MDP bone imaging in patients with bone tumors and tumor-like lesions of extremities and their differential diagnosis significances

目的:探讨四肢骨肿瘤及肿瘤样病变^(99m)Tc-亚甲基二磷酸盐(^(99m)Tc-MDP)骨显像放射性分布特点,阐明不同病理类型的四肢骨肿瘤及肿瘤样病变^(99m)Tc-MDP骨显像放射性分布特点在鉴别诊断中的应用价值,为其临床诊断提供线索。方法:选择行^(99m)Tc-MDP骨显像表现为四肢骨放射性分布异常患者76例,将^(99m)Tc-MDP骨显像检查结果与最终临床诊断结果进行对照,分析不同病理类型患者年龄、病变部位和放射性分布特点的差异,采用半定量法(T/N)检测病灶的放射性摄取程度和良恶性病变组间T/N值的差异。结果:(1)76例四肢骨肿瘤及骨肿瘤样病变中良性病变24例,恶性病变52例。(2)年龄及病变部位。良性病变中骨巨细胞瘤患者年龄为(42.1±17.4)岁,发生部位为膝关节周围;纤维结构不良患者年龄为(48.0±17.1)岁,发生部位为股骨近端。恶性病变中转移癌患者年龄为(64.0±14.2)岁,均发生在股骨干;骨肉瘤患者年龄为(30.3±15.3)岁,发生部位为长骨骨骺端;尤文氏肉瘤患者年龄为(49.2±4.7)岁,股骨骨骺及骨干均可见;纤维肉瘤患者年龄为(39.5±17.2)岁,发生部位为长骨远端;软骨肉瘤患者年龄为(63.0±14.8)岁,发生部位为长骨近端,长骨骨骺端及长骨骨干均可见。(3)放射性分布特点。骨巨细胞瘤、骨肉瘤、尤文氏肉瘤、纤维肉瘤和软骨肉瘤呈"楔形"和"团块状"分布为主,骨巨细胞瘤缺损范围较尤文氏肉瘤及纤维肉瘤更大,骨肉瘤及软骨肉瘤中心区缺损罕见;纤维结构不良和骨转移癌主要呈"条形"分布,骨转移癌累及双侧骨皮质为多见伴中心区放射性缺损,而纤维结构不良沿单侧骨皮质放射性分布均匀。(4)恶性病变组T/N值(3.38±1.95)高于良性病变组(1.43±0.51)(t=-11.35,P<0.01)。结论:根据四肢骨肿瘤和肿瘤样病变^(99m)Tc-MDP骨显像特点可初步推测病变的病理类型,为临床诊断及鉴别诊断提供可靠的参考。

Objective:To explore the radionuclide distribution characteristics of 99m Tc-MDP bone imaging of bone tumors or tumor-like lesions in extremities,to clarify the application value of radionuclide distribution characteristics of 99m Tc-MDP bone imaging of bone tumor and tumor-like lesions with different pathological types in the differential diagnosis,and to provide the clues for clinical diagnosis.Methods:A total of 76 patients with abnormal radionuclide distribution characterics of exetremities showed in 99m Tc-MDP bone imaging were selected.The results of 99m Tc-MDP bone imaging were compared with the results of the final clinica diagnosis.The differences in the age,lesion location,radienuclide distribution characteristics of the patients with different pathological types were analyzed.Semi quantitative method(T/N)was used to detect the degree of radioactivity and the differences in T/N between benign and malignant lesions groups.Results:①Among 76 patients with bone tumors and tumor-like lesions,the pathological benign findings were in 24 cases and the malignant findings were in 52 cases.②The age of the patients with giant cell tumor of bone around knee joint was(42.1±17.4)years old,and the age of the patients with fibrous dysplasia in proximal femur was(48.0±17.1)years old.In malignant lesions,the age of the patients with metastatic carcinoma located in femoral shaft was(64.0±14.2)years old;the age of the patients with osteosarcoma around epiphysis end was(30.3±15.3)years old;the age of the patient with Ewing’s sarcoma located in femur was(49.2±4.7)years old;the age of patients with fibrosarcoma in long bone was(39.5±17.2)years old;the age of patients with chondrosarcoma occurred in long bone was(63.0±14.8)years old.③The radionuclide distribution characteristics of giant cell tumor,osteosarcoma,Ewing’s sarcoma,chondrosarcoma and fibrosarcoma were“wedge”or“lumpy”;the radiological defect of giant cell tumor was greater than Ewing’s sarcoma and fibrosarcoma,while osteosarcoma and chondrosarcoma rarely had center defects;the radionuclide distribution characteristics of fibrous dysplasia and metastasis were“strip-type”,and the metastases involving bilateral cortical bone had the radioactive defect in the central region,but fibrous dysplasia distributed uniformly along with the unilateral cortical bone.④The average value of T/N in malignant lesions(3.38±1.95)was higher than that in benign lesions(1.43±0.51)(t=-11.35,P<0.01).Conclusion:The pathological types of lesions can be preliminarily speculated according to the characteristics of 99m Tc-MDP bone imaging of bone tumors and tumor-like lesions of extremities,which can provide a reliable reference for clinical diagnosis and differential diagnosis.