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甲状旁腺功能亢进性骨病是由于甲状旁腺功能亢进而导致骨骼异常的全身性代谢性骨病。患者多以不明原因全身或局部骨关节疼痛、骨骼畸形或病理性骨折等为首发症状而行局部影像学检查(X射线、CT及MRI),其表现缺乏特异性,甚至部分患者无明显骨关节症状或仅有轻微症状,但已伴严重骨骼并发症[1]。该病漏诊及误诊率较高,常常被延误治疗及过度治疗[2-3],准确诊断及评估其严重程度并采取合适的治疗措施对患者预后极为重要。99Tcm-MDP全身骨显像以其高灵敏度及全身骨骼成像的优势被广泛应用于代谢性骨病的诊断中,但其缺乏解剖学信息,且特异度较低。18F-NaF PET/CT骨显像实现了全身骨代谢特点与清晰解剖结构的有机结合。本研究主要观察甲状旁腺功能亢进性骨病18F-NaF PET/CT骨显像的影像学特点,并通过与99Tcm-MDP全身骨显像进行对比,探讨其临床应用的价值。
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
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摘要:
目的 探讨甲状旁腺功能亢进性骨病18F-NaF PET/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-NaF PET/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-NaF PET/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-NaF PET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-NaF PET/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-NaF PET/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-NaF PET/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。 -
关键词:
- 99 m锝美罗酸盐 /
- 氟化钠 /
- 正电子发射断层显像计算机体层摄影术 /
- 甲状旁腺功能亢进性骨病 /
- 骨显像
Abstract:Objective To explore the features and value of 18F-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. -
图 3 甲状旁腺功能亢进性骨病患者(女性,65岁,与图2为同一患者)的18F-NaF PET/CT骨显像断层融合显像图
Figure 3. 18F-NaF PET/CT imaging of patient with hyperparathyroid bone disease(female, 65 years old)
图 5 原发性甲状旁腺功能亢进性骨病患者(男性,18岁,与图4为同一患者)的18F-NaF PET/CT骨显像断层融合显像图
Figure 5. 18F-NaF PET/CT imaging of patient with primary hyperparathyroid bone disease(male, 18 years old)
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