留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码
x

骨纤维结构不良的SPECT/CT骨显像及临床特点

谢龙 张冠杰 黄丽群 余小朋 苏应瑞 查金顺

谢龙, 张冠杰, 黄丽群, 余小朋, 苏应瑞, 查金顺. 骨纤维结构不良的SPECT/CT骨显像及临床特点[J]. 分子影像学杂志, 2022, 45(4): 497-505. doi: 10.12122/j.issn.1674-4500.2022.04.07
引用本文: 谢龙, 张冠杰, 黄丽群, 余小朋, 苏应瑞, 查金顺. 骨纤维结构不良的SPECT/CT骨显像及临床特点[J]. 分子影像学杂志, 2022, 45(4): 497-505. doi: 10.12122/j.issn.1674-4500.2022.04.07
XIE Long, ZHANG Guanjie, HUANG Liqun, YU Xiaopeng, SU Yingrui, ZHA Jinshun. SPECT/CT bone imaging and clinical features of osteofibrous dysplasia[J]. Journal of Molecular Imaging, 2022, 45(4): 497-505. doi: 10.12122/j.issn.1674-4500.2022.04.07
Citation: XIE Long, ZHANG Guanjie, HUANG Liqun, YU Xiaopeng, SU Yingrui, ZHA Jinshun. SPECT/CT bone imaging and clinical features of osteofibrous dysplasia[J]. Journal of Molecular Imaging, 2022, 45(4): 497-505. doi: 10.12122/j.issn.1674-4500.2022.04.07

骨纤维结构不良的SPECT/CT骨显像及临床特点

doi: 10.12122/j.issn.1674-4500.2022.04.07
详细信息
    作者简介:

    谢龙,硕士,主治医师,E-mail: xielong2728@qq.com

SPECT/CT bone imaging and clinical features of osteofibrous dysplasia

  • 摘要:   目的   分析骨纤维结构不良的SPECT/CT骨显像结果,探讨其核医学显像特征及鉴别要点。   方法   回顾性分析我院34例经病理或随诊证实为骨纤维结构不良患者的SPECT/CT影像学特点,按病灶数量分为单发骨纤维结构不良病灶组(n=25)及多发病灶组(n=9),比较两组患者的临床资料、病灶特点及放射性分布特点。   结果   34例病例中,20例有疼痛症状(58.8%),但两组差异无统计学意义(χ2=1.045,P=0.307)。多病灶组年龄较单病灶组小(t=17.315,P=0.018);两组血清白细胞水平、中性粒细胞水平、C反应蛋白、碱性磷酸酶及肿瘤指标(癌胚抗原、甲胎蛋白、CA199、CA724、CYFRA21-1、神经元特异性烯醇化酶、胃泌素释放肽前体)的差异均无统计学意义(P>0.05)。病变多见于四肢长骨,病变类型以磨玻璃样及囊状改变多见,多病灶型出现磨玻璃样改变的概率较大(χ2=8.579,P=0.003),而丝瓜络样、地图样及囊状改变等征象在两组间出现频率的差异无统计学意义(P> 0.05);34例全部病灶均为放射性异常浓聚,多病灶型常见集中于一侧的放射性浓聚优势灶。   结论   SPECT/CT可通过一次全身成像,观察全身骨多部位病灶,分析各病灶的解剖结构及代谢状态,可作为骨纤维结构不良的鉴别与诊断的重要补充检查方法。

     

  • 图  1  男31岁,发现骨纤维结构不良2年

    SPECT/CT图示左侧颅骨、脊柱、双肋、右股骨及右胫骨见多发骨质膨胀改变、呈磨玻璃样密度,伴放射性异常浓聚.

    Figure  1.  A 31-year-old male patient got OFD for 2 years.

    图  2  女,34岁,左下肢疼痛2月

    SPECT/CT图示左侧股骨及胫骨多发骨质膨胀,髓腔内见磨玻璃样密度,伴放射性异常浓聚.左股骨近端穿刺病理提示纤维结构不良.

    Figure  2.  A 34-year-old female patient got pain in left lower limb for 2 months.

    图  3  女,43岁,因摔倒致左大腿畸形、疼痛,活动受限6 d

    SPECT/CT图示左侧股骨中段见不规则骨质破坏,骨皮质变薄、中断,断端移位,病灶区域见团块状放射性异常浓聚. 术后病理提示左股骨病灶纤维结构不良并发骨折.

    Figure  3.  A 34-year-old female patient got pain, deformity in left thigh and movement limitation caused by fall for 6 d.

    图  4  女,44岁,右侧腰腿疼1月余,病理提示骨化纤维瘤

    SPECT/CT图示右股骨颈囊状低密度灶,周围可见硬化边,囊内见结节状稍高密度影,病灶呈放射性稍浓聚.

    Figure  4.  A 44-year-old female patients got pain on the right side of the waist and legwas for more than 1 month, the pathology revealed ossified fibroma.

    图  5  女,66岁,发现右额骨占位1年,病理提示不典型脑膜瘤

    SPECT/CT图示右额骨内外板骨质破坏,可见软组织肿块,病灶周围骨质见放射性异常浓聚.

    Figure  5.  A 66- year- old female patient, whose right frontal bone was found space occupying lesion for 1 year, and the pathology revealed atypical meningioma.

    图  6  女,31岁,发现右顶骨占位半月余,病理提示骨纤维结构不良

    SPECT/CT图示右顶骨外板及板障处见椭圆形低密度影,边缘硬化,伴放射性异常浓聚.

    Figure  6.  A 31-year-old female patient, whose right parietal was found space occupying lesion for more than half of a month, and the pathology revealed OFD.

    图  7  女,37岁,发现左侧乳腺肿物2 d,术后病理提示乳腺纤维腺瘤,左髋臼活检提示骨纤维结构不良

    SPECT/CT图示颅骨、脊柱、骨盆、右肋多处见囊状或磨玻璃样改变,伴放射性异常浓聚.

    Figure  7.  A 37- year-old female patient was diagnosed with fibroadenoma of breast for 2 d, and the pathology of biopsy on the left acetabulum revealed OFD.

    图  8  女,55岁,确诊肺癌4年

    SPECT/CT图示右肱骨、脊柱及左髋臼多发放射性异常浓聚灶,CT上可见成骨或溶骨性骨质改变,考虑多发骨转移.

    Figure  8.  A 55-year-old female patient was diagnosed with lung cancer for 4 years.

    图  9  女,46岁,右髋部酸痛2年余,活动受限

    SPECT/CT图示血流相(A)及血池相(B)均未见异常放射性浓聚灶;C~D:延迟相示右侧股骨颈局部略膨胀,髓腔内见片状磨玻璃影,伴放射性异常浓聚.右股骨颈穿刺病理提示纤维结构不良.

    Figure  9.  A 46-year-old female patient got pain in right hip and movement limitation for 2 years.

    图  10  男,17岁,反复左下肢疼痛3月余

    A:血流相未见异常放射性浓聚灶;B:血池相示左股骨颈及左股骨上段处缓慢处出现条、片状放射性浓聚灶;C:延迟相示左第8肋、左髂骨、左股骨及左胫骨多发放射性异常浓聚灶;D:左侧股骨上段膨胀畸形,髓腔内见大片磨玻璃影,伴放射性异常浓聚.左股骨病灶术后病理提示骨纤维结构不良.

    Figure  10.  A 17-year-old male patient got pain in left leg for more than 3 months.

    图  11  女,19岁,发现右前臂肿物6月余,病理提示骨巨细胞瘤

    A~C:延迟相、血流相、血池相均见右腕部团状放射性异常浓聚灶;D:右侧桡骨偏心膨胀,溶骨性骨质破坏,伴放射性异常浓聚.

    Figure  11.  A 19-year-old female patient was found a giant cell tumor of bone on the right forearm for more than 6 months.

    图  12  女,3岁,性早熟1年,临床诊断为McCune-Albright综合征

    A~C:SPECT/CT图示双髋及左股骨多发磨玻璃样改变,伴放射性异常浓聚;D:臀部皮肤“牛奶咖啡斑”.

    Figure  12.  A 3-year-old girl, who was diagnosed with precocious puberty and McCune-Albright syndrome for 1 year.

  • [1] Rosario MS, Hayashi K, Yamamoto N, et al. Functional and radiological outcomes of a minimally invasive surgical approach to monostotic fibrous dysplasia[J]. World J Surg Oncol, 2017, 15(1): 1. doi: 10.1186/s12957-016-1068-1
    [2] 冯瑾, 张连娜, 高璇, 等. 骨纤维异常增殖症全身骨显像影像特征分析[J]. 标记免疫分析与临床, 2021, 28(9): 1452-6, 1463. https://www.cnki.com.cn/Article/CJFDTOTAL-BJMY202109003.htm
    [3] 钟建秋, 张金赫, 尹吉林. 骨纤维异常增殖症及其影像学诊断的研究进展[J]. 中国中西医结合影像学杂志, 2017, 15(2): 238-41. doi: 10.3969/j.issn.1672-0512.2017.02.038
    [4] 史志勇. 骨纤维异常增殖症的影像诊断[J]. 中国中西医结合影像学杂志, 2010, 8(1): 35-7. doi: 10.3969/j.issn.1672-0512.2010.01.011
    [5] 连晓萌. 颅面部骨纤维异常增殖症DR及MSCT影像学表现分析[J]. 中国CT和MRI杂志, 2022, 20(3): 162-4. https://www.cnki.com.cn/Article/CJFDTOTAL-CTMR202203062.htm
    [6] 耿敬标, 李文进, 柏根基. 骨纤维异常增殖症的影像学表现[J]. 临床放射学杂志, 2006, 25(6): 551-3. doi: 10.3969/j.issn.1001-9324.2006.06.015
    [7] 高峰, 谢莉, 周利, 等. 全身多发性骨纤维结构不良骨显像一例[J]. 中华核医学与分子影像杂志, 2018, 38(12): 815-6. doi: 10.3760/cma.j.issn.2095-2848.2018.12.011
    [8] 张林启, 何巧, 李伟, 等. 99Tcm-MDP SPECT/CT融合显像诊断骨纤维异常增殖症[J]. 中国医学影像技术, 2016, 32(7): 1102-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX201607042.htm
    [9] Liu XX, Xin X, Yan YH, et al. Imaging characteristics of a rare case of monostotic fibrous dysplasia of the sacrum: a case report[J]. World J Clin Cases, 2021, 9(5): 1111-8. doi: 10.12998/wjcc.v9.i5.1111
    [10] 叶为民, 竺涵光, 郑家伟, 等. 46例颌面部骨纤维异常增殖症临床分析[J]. 中国口腔颌面外科杂志, 2008, 6(3): 170-3. doi: 10.3969/j.issn.1672-3244.2008.03.003
    [11] Pannone G, Nocini R, Santoro A, et al. Expression of beta-catenin, cadherins and P-Runx2 in fibro-osseous lesions of the jaw: tissue microarray study[J]. Biomolecules, 2022, 12(4): 587. doi: 10.3390/biom12040587
    [12] Ling ZJ, Xiao N, Li YJ, et al. Differential expression profiles and function prediction of tRNA-derived fragments in fibrous dysplasia[J]. Arch Oral Biol, 2022, 135: 105347. doi: 10.1016/j.archoralbio.2022.105347
    [13] Yang QF, Liu J, Tan L, et al. Polyostotic fibrous dysplasia complicated by pathological fracture of right femoral shaft with nonunion: a case report[J]. Front Surg, 2022, 9: 879550. doi: 10.3389/fsurg.2022.879550
    [14] Girsh YV, Kareva MA, Makazan NV, et al. Early manifestation and progressive multicomponent current of McCune-Albright-Braitsev syndrome in a girl 9 years old: a clinical case and literature review[J]. Probl Endokrinol (Mosk), 2021, 68(2): 72-89. doi: 10.14341/probl12847
    [15] Van de Voorde N, Mortier GR, Vanhoenacker FM. Fibrous dysplasia, Paget's disease of bone, and other uncommon sclerotic bone lesions of the craniofacial bones[J]. Semin Musculoskelet Radiol, 2020, 24 (5): 570-8. doi: 10.1055/s-0039-3400292
    [16] Zhang LQ, He Q, Li W, et al. The value of 99mTc-methylene diphosphonate single photon emission computed tomography/ computed tomography in diagnosis of fibrous dysplasia[J]. BMC Med Imaging, 2017, 17(1): 1-7. doi: 10.1186/s12880-016-0171-7
    [17] 张一秋, 石洪成, 陈曙光, 等. SPECT/CT联合三相骨显像对骨骼良恶性病变鉴别诊断的增益价值[J]. 中华核医学与分子影像杂志, 2012, 32(5): 363-7. doi: 10.3760/cma.j.issn.2095-2848.2012.05.011
    [18] Shamim SA, Arora G, Kumar N, et al. Comparison of 99mTcmethyl diphosphonate bone scintigraphy and 68Ga-DOTANOC PET/computed tomography in articular manifestation of rheumatoid arthritis[J]. Nucl Med Commun, 2022, 43(4): 428-32. doi: 10.1097/MNM.0000000000001532
    [19] Wang J, Du ZY, Li DS, et al. Increasing serum alkaline phosphatase is associated with bone deformity progression for patients with polyostotic fibrous dysplasia[J]. J Orthop Surg Res, 2020, 15(1): 583. doi: 10.1186/s13018-020-02073-y
    [20] 杨慧, 吴元魁, 陈卫国. 骨纤维异常增殖症的影像分析(附47例报告)[J]. 医学影像学杂志, 2007, 17(7): 767-8. doi: 10.3969/j.issn.1006-9011.2007.07.040
    [21] 孙祥水, 侯华成, 王邦, 等. 儿童四肢长骨骨纤维性结构不良影像学与病理学表现对照分析[J]. 中华解剖与临床杂志, 2018, 23(2): 99-103. doi: 10.3760/cma.j.issn.2095-7041.2018.02.003
    [22] 兰仕金. 骨化性纤维瘤和骨纤维异常增殖症的影像学比较分析[J]. 中外健康文摘, 2014, 25: 288. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX200411014.htm
    [23] 高振华, 孟悛非, 陈应明, 等. 骨良性纤维病变的影像与病理学分析[J]. 临床放射学杂志, 2008, 27(1): 72-6. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS200801023.htm
    [24] Fournel L, Rapicetta C, Fraternali A, et al. Fibrous dysplasia of the rib mimicking a malignant bone tumor at SPECT/CT with 99mTc-MDP[J]. Clin Nucl Med, 2018, 43(5): 346-8. doi: 10.1097/RLU.0000000000002015
    [25] Wei WJ, Sun ZK, Shen CT, et al. Value of 99mTc- MDP SPECT/ CT and 18F-FDG PET/CT scanning in the evaluation of malignantly transformed fibrous dysplasia[J]. Am J Nucl Med Mol Imaging, 2017, 7(3): 92-104.
  • 加载中
图(12)
计量
  • 文章访问数:  633
  • HTML全文浏览量:  358
  • PDF下载量:  26
  • 被引次数: 0
出版历程
  • 收稿日期:  2022-04-26
  • 网络出版日期:  2022-07-25
  • 刊出日期:  2022-07-20

目录

    /

    返回文章
    返回