18F-NaF PET/CT骨显像在甲状旁腺功能亢进性骨病中的应用

Application of 18F-NaF PET/CT bone scintigraphy to hyperparathyroid bone disease

目的探讨甲状旁腺功能亢进性骨病18F-NaFPET/CT骨显像的影像学特点及其应用价值。方法收集30例经临床及术后病理证实为甲状旁腺功能亢进症患者[男性11例、女性19例,年龄18~71(52.3±13.5)岁]的18F-NaFPET/CT骨显像及99Tcm-亚甲基二膦酸盐(99Tcm-MDP)全身骨显像资料,回顾性分析其18F-NaFPET/CT骨显像特点,对比两种骨显像方法对该病局部骨骼病灶的检出情况,并根据Mirels评分标准对棕色瘤进行评分。结果两种骨显像方法定性结果一致,即骨显像阴性15例,阳性15例。甲状旁腺功能亢进性骨病在18F-NaFPET图像上大部分表现为以全身多骨弥漫性骨代谢增高为主的多种代谢性骨病征象,并发棕色瘤、骨硬化及病理性骨折等时表现为单发或多发局灶性显像剂异常分布,其中棕色瘤表现为局灶性显像剂浓聚、显像剂稀疏或病灶中心显像剂分布缺损伴边缘显像剂不均匀浓聚;同机CT图像上均表现为全身多骨多种形式的骨质吸收,其中,表现为广泛骨质疏松13例、伴棕色瘤7例、骨质硬化6例、骨质软化3例、病理性骨折3例。15例甲状旁腺功能亢进性骨病患者共检出局部骨骼病灶(棕色瘤、骨硬化、病理性骨折、假骨折)53个,其中,18F-NaFPET/CT骨显像全部检出,99Tcm-MDP全身骨显像检出32个。7例甲状旁腺功能亢进性骨病患者伴棕色瘤,位于长骨的棕色瘤病灶数共24个,其中9个Mirels评分大于9分。结论甲状旁腺功能亢进性骨病在18F-NaFPET/CT骨显像上的全身骨代谢及解剖学表现有一定的特征性表现,18F-NaFPET/CT骨显像结合同机CT上全身骨骼病灶的详细信息,在甲状旁腺功能亢进性骨病的诊断、鉴别诊断及病情严重程度评估中有更好的应用价值。

Objective To explore the features and value of18F-NaF PET/CT bone scintigraphy in patients with hyperparathyroid bone disease. Methods Thirty cases [11 men and 19 women, aged 18–71 (52.3±13.5) years] were confirmed through clinical and postoperative pathology as hyperparathyroidism. All patients underwent 18F-NaF PET/CT and 99Tcm-methylenediphosphonate(99Tcm-MDP) whole-body bone scintigraphy, and the characteristics of the obtained 18F-NaF PET/CT bone images were retrospectively analyzed. Results of the detection rate of local bone disease were compared between the two types of bone scintigraphy, and brown tumors were evaluated according to Mirels' criteria. Results The qualitative results of the two bone scintigraphy methods were identical. A total of 15 cases with negative bone scintigraphy and 15 cases with positive bone scintigraphy were analyzed. The osteopathy of hyperparathyroid bone disease on the 18F-NaF PET images was characterized by a variety of bone diseases that were mainly composed of diffuse bone metabolism in multiple bones throughout the body. When brown tumors, bone sclerosis, pathological fractures, and pseudofractures were concurrently present, they manifested as an abnormal distribution area of single or multiple focal imaging agents. Among the lesions found, brown tumors showed focal imaging agent concentration, imaging agent sparseness, or focal center imaging agent distribution defects with uneven imaging of the edge imaging agent. Fifteen cases of multiple forms of bone resorption, 13 cases of extensive osteoporosis, 7 cases of brown tumors, 6 cases of bone sclerosis, 3 cases of osteomalacia, and 3 cases of pathological fractures were observed. A total of 53 local bone lesions (i.e., brown tumors, bone sclerosis, pathological fractures, false fractures) were detected in 15 positive patients. All lesions were detected by 18F-NaF PET/CT bone scintigraphy, and only 32 lesions were detected by 99Tcm-MDP whole-body bone scintigraphy. Seven positive patients had long bone brown tumors with a total of 24 lesions, of which nine had a Mirels score greater than 9 points. Conclusions Hyperparathyroid bone disease shows characteristic features related to bone metabolism and anatomy on 18F-NaF PET/CT bone scintigraphy, a technique that shows more lesions, as well as details of these lesions, than 99Tcm-MDP whole-body bone scintigraphy. Taken together, the results reveal that 18F-NaF PET/CT bone scintigraphy has important value in the diagnosis, differential diagnosis, and severity assessment of hyperparathyroid bone disease.