乳腺癌术后伴SAPHO综合征1例

SAPHO综合征是一种罕见的非细菌性慢性炎症,其包含五种不同病变:滑膜炎(synovitis)、痤疮(acne)、脓疱病(pustulosis)、骨肥厚(hyperostosis)、骨炎(osteitis)[1-3]。由于SAPHO综合征临床较为罕见且无特异性实验室检查指标,该病诊断困难,尤其与恶性肿瘤转移所致骨性改变较难鉴别[4]。现将我院收治的1例乳腺癌术后伴SAPHO综合征患者的临床、影像学资料及病理结果进行分析,复习文献,以提高对该病的诊断能力。临床资料:女性,53岁,因体检偶然发现右乳结节入我院外科行单侧保乳乳腺改良根治术,术后病理提示乳腺浸润性癌。在院期间常规查胸部电子计算机断层扫描(CT)提示胸骨内多发骨质硬化增生伴骨破坏,转移不除外(图1A)。进一步磁共振成像(MR)检查示T2WI压脂相双侧胸锁关节、第1肋胸关节、胸骨柄体联合骨质增厚伴骨髓水肿,局部骨质破坏,周围滑膜增厚水肿(图1B)。放射性核素断层扫描(ECT)检查提示胸骨及右侧胸锁关节转移性骨病变可能(图1C)。查体可见患者皮肤多发脓疱(图1D),追问患者病史,患者自诉既往胸骨间断疼痛10余年伴皮肤脱屑及脓疱7年余。

DR、CT和ECT在骨转移瘤诊断中的临床研究

目的:对比研究数字化X线摄影系统(DR)、计算机断层扫描(CT)及放射性核素发射型计算机断层扫描(ECT)对于骨转移瘤的临床诊断价值。材料与方法:收集2012年1月至2015年1月,我院收治的病理确诊为恶性肿瘤怀疑为骨转移患者149例,对比分析其DR、CT及ECT表现及诊断情况。结果:ECT对骨转移瘤的诊断准确度、敏感度、阴性预测值(75.17%、71.67%、43.33%)均显著高于DR(51.68%、41.67%、27.84%)和CT(54.36%、55.50%、29.03%),差异具有统计学意义(P<0.05);ECT的特异度及阳性预测值(89.66%、96.63%)与DR(93.10%、96.15%)和CT(93.10%、96.43%)比较差异无统计学意义(P>0.05)。结论:ECT对于恶性肿瘤骨转移瘤的诊断效能优于DR和CT,三种方法联合应用能够提高诊断准确率。

Role of scintigraphy in inflammatory bowel disease

The diagnosis of inflammatory bowel disease(IBD) depends on direct endoscopic visualization of the colonic and ileal mucosa and the histological study of the obtained samples.Radiological and scintigraphic methods are mainly used as an adjunct to endoscopy.In this review,we focus on the diagnostic potential of nuclear medicine procedures.The value of all radiotracers is described with special reference to those with greater experience and more satisfactory results.Tc-99m hexamethylpropylene amine oxime white blood cells remain a widely acceptable scintigraphic method for the diagnosis of IBD,as well as for the evaluation of disease extension and severity.Recently,pentavalent Tc-99m dimercaptosuccinic acid has been recommended as an accurate variant and a complementary technique to endoscopy for the follow-up and assessment of disease activity.Positron emission tomography alone or with computed tomography using fluorine-18 fluorodeoxyglucose appears to be a promising method of measuring inflammation in IBD patients.