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足踝部的解剖结构和功能极为复杂,因此对于其相关疾病的诊断和定位一直是一个难题。传统的影像学检查包括X线平片、超声、CT、MRI等均可以辅助临床进行诊断并指导治疗,以MRI最为常用,其对于软组织的显示和对比度更为清晰,因而更容易发现异常。早期的研究使用99Tcm-MDP平面骨显像来识别足踝部骨代谢的改变,尽管这种方法有着较高的灵敏度,但其空间分辨率较低,难以对异常部位进行定位,也无法与其他常规影像学检查结果相匹配[1]。SPECT/CT断层骨显像则解决了这一难题,它能将骨代谢的异常部位与CT图像完美融合,从而对骨代谢异常部位进行精确定位,并可以借助CT图像观察骨质改变,提供诊断所需形态学信息。因此,SPECT/CT断层骨显像在足踝关节疼痛的诊断与治疗中的应用越来越多,其主要包括引导封闭治疗的定位、骨性关节炎、骨软骨炎、应力性骨折、撞击综合征、骨桥形成、籽骨与副骨炎、足底筋膜炎的诊断等。
SPECT/CT骨显像在足踝关节病诊治中的应用进展
Application of SPECT/CT in diagnosis and treatment of foot and ankle diseases
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摘要: 足踝关节复杂的解剖结构给检查带来了较大的困难。目前足踝关节病的初步检查方法是行X线评估,MRI检查则用于进一步明确诊断。99Tcm-MDP平面骨显像对骨代谢的病变具有很高的灵敏度,但由于分辨率低和缺乏解剖结构信息,因而对足踝关节的检查缺乏特异性。99Tcm-MDP SPECT/CT断层骨显像将骨显像的高灵敏度与CT提供的精细解剖结构完美结合,从而更好地显示99Tcm-MDP摄取的位置和解剖结构的改变。近年来SPECT/CT断层骨显像已逐步用于足踝关节病变的辅助诊断。笔者对SPECT/CT断层骨显像在足踝关节病变诊断中的临床应用进行了综述。
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关键词:
- 足关节 /
- 踝关节 /
- 单光子发射计算机体层摄影术
Abstract: The complex function of the ankle joint has greatly complicated the examination of its related diseases. The preliminary method for the assessment of foot and ankle diseases involves radiographic assessment, while MRI is used for further diagnosis. Although 99Tcm-MDP bone scintigraphy is sensitive to changes in bone metabolism, it has poor specificity because of its low resolution and inability to provide anatomical structural information. 99Tcm-MDP SPECT/CT combines the sensitivity of 99Tcm-MDP bone scintigraphy with the anatomical structural information provided by CT to show the localization of uptaken MDP and the structural changes associated with foot and ankle diseases. In recent years, SPECT/CT has been gradually used to assist the diagnosis of foot and ankle diseases. In this article, we discuss the clinical application of SPECT/CT tomographic bone scintigraphy in the diagnosis of foot and ankle diseases. -
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