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脊柱转移瘤(metastatic spine tumors, MST)可继发于体内任何恶性肿瘤, 60%以上来源于肺癌、乳腺癌和前列腺癌等。近年的研究表明, 恶性肿瘤的MST发生率约为10%, 发生器官转移并导致脊髓受压者占5%~20%[1-3]。由于脊柱各部分尤其是腰段多富含红骨髓成分, 其静脉系统(即Baston静脉丛)无瓣膜结构, 且邻近血管丰富, 因此, 有利于肿瘤细胞滞留并进一步发展为MST[4], 经椎静脉进入的瘤栓常首先停留于椎体后部, 引起局部骨质破坏, 然后进一步侵及椎弓、横突、椎板、棘突等; 此外还通过直接扩散, 种植于椎体毛细血管网内; 椎间盘因缺乏血运故不易受累。MST的发生部位中, 颈椎占28%;颈胸椎同时受累者占45%, 腰椎占27%。80%的病变累及椎体, 其次是脊柱后方结构[3]。
放射性核素骨显像在脊柱转移瘤诊断中的价值
Evaluate the diagnostic value of radionuclide bone imaging of metastatic spine tumors
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摘要: 脊柱转移瘤(MST)可发生于原发恶性肿瘤临床的各个阶段,传统X线片发现时多为中晚期病变;CT容易漏诊,不能直接显示脊髓的异常;MRI耗时长,病痛的患者不易配合,影响图像的质量。常规骨扫描能够对整个骨骼进行扫描,但特异性不高。核素SPECT骨显像可提高对MST诊断的敏感性和特异性,提示病灶累及的解剖结构或分布形态,并能定量分析放射性浓聚灶;PET-CT能够清楚鉴别脊柱病变,实现早期诊断,并可早期评估化疗或放疗疗效。该文进一步阐述核素骨显像在MST早期诊断中的价值。Abstract: Metastatic spine tumors(MST)can occur in many primary malignant tumors, but X-ray cannot find early metastatic disease; CT scans can not directly show abnormity of the spinal marrow; MRI need a long time, patients with spinal tumors can hardly to be suffered which will affect image quality.Conventional bone scan has the ability to scan the entire skeleton, but the specificity is not high.However, the sensitivity and specificity can be improved about the diagnosis of MST by bone SPECT imaging, the distribution of the anatomical structure or morphology of the metastatic spinal tumors can be clearly displayed.PET-CT could detect the metastases of spine and other parts of the body sensitively and accurately, primary tumors that were unknown before examination could be found at the same time.This paper describes the diagnostic value of radionuclide bone scintigraphy of MST.
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Key words:
- Spinal neoplasms /
- Bone /
- Radionuclide imaging
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