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99Tcm-MDP全身骨显像是评估肿瘤骨转移最常用的检查方法。99Tcm-MDP主要分布在骨骼局部血流丰富、代谢更新旺盛及成骨活跃的骨组织,但在一些骨外疾病的病变部位,如:肺癌、乳腺癌、骨化性肌炎、胸腔积液、骨肉瘤等常常发现99Tcm- MDP的聚集。本研究主要回顾性分析本院全身骨显像中肝脏异常摄取99Tcm-MDP病例资料,探讨肝脏异常显影的原因及其临床意义。
99Tcm-MDP骨显像肝脏异常显影原因分析
Analysis of abnormal liver uptake of 99Tcm-MDP in bone scan
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摘要:
目的 分析99Tcm-MDP全身骨显像肝脏异常显影的可能原因。 方法 回顾性分析2013年1月至2015年7月于我院核医学科行99Tcm-MDP全身骨显像患者中肝脏异常显影20例,显像结果与其他影像学检查和(或)病理结果、实验室检查进行对比分析。 结果 20例肝脏异常显影的患者中,原发性肝损伤3例、继发性肝损伤17例[其中包括多发性骨髓瘤引发肝功能异常1例,恶性肿瘤化疗后肝功能异常8例,肿瘤肝转移7例(结肠癌肝转移5例、肝癌肝内转移1例、肺癌肝转移1例)、慢性肾衰竭铁剂治疗后肝脏摄取1例]。 结论 99Tcm-MDP全身骨显像肝脏异常显影的原因较多,除显像技术原因外,应警惕各种原因导致的肝脏损伤,为患者提前进行临床干预提供一定参考。 Abstract:Objective To analyze the possible causes of liver uptake in 99Tcm-MDP bone scan. Methods A retrospective analysis was performed on 20 cases of abnormal liver uptake in bone scan in our hospital from January 2013 to July 2015. The results were compared with other imaging examinations and/or pathological findings and laboratory examinations. Results Twenty patients were found to have abnormal liver uptake of the imaging agent, including 3 cases with primary liver injury, 17 cases with secondary liver injury, which include 1 case with multiple myeloma and 7 cases with liver metastasis(5 cases with colorectal cancer, 1 with from hepatocellular carcinoma, 1 case with lung cancer), and 1 case of liver uptake after iron treatment. Conclusion Abnormal liver uptake of 99Tcm-MDP in bone imaging is associated with several reasons; barring technical reasons, we should be alert to the liver injury caused by various reasons to provide reference for patients prior to clinical intervention. -
Key words:
- Technetium Tc 99m methylenediphosphonate /
- Bone imaging /
- Liver /
- Abnormal uptake
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图 3 99Tcm-MDP全身骨显像(前位、后位)和肝脏CT图 患者男性,68岁,因“胸椎病理性骨折入院”。胸椎CT示胸7椎体及附件骨质吸收破坏,考虑转移可能性大。肝肾功能多个指标异常,腹部超声未见异常,临床诊断为肾衰竭尿毒症。因血红蛋白<70 g/L,肝功能无异常。患者输注红细胞悬液1个单位后第2天行99Tcm-MDP骨显像观察全身骨转移情况。图中,A:99Tcm-MDP全身骨显像示除骨异常摄取外,软组织及肝脏弥漫性摄取。B:肝脏CT未见明显异常。最终怀疑铁剂治疗所致99Tcm-MDP骨显像时肝脏显影可能性大,但也不排除为慢性肾功能衰竭引起的肝脏代谢改变导致的肝脏显影。
Figure 3. 99Tcm-MDP whole body bone imaging(anterior and posterior)and liver CT
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