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。 Abstract:Objective To explore the imaging characteristics and clinical features of whole-body SPECT/CT for bone scintigraphy in patients with osteofibrous dysplasia. Methods The characteristics of SPECT/CT imaging were analyzed retrospectively in 34 patients with osteofibrous dysplasia. According to the number of lesions, the cases were divided into multi-lesion group(n=25)and single-lesion group(n=9). The indicators of two groups were compared. Results The symptom of pain was present in 20 cases (58.8%). The difference between the two groups was not significant (χ2=1.045, P=0.307). The age of the multi-lesion group was younger than that of the single-lesion group(t=17.315, P=0.018). The serum WBC levels, neutrophil levels, C-reactive protein, alkaline phosphatase and all the tumor markers (CEA, AFP, CA199, CA724, CYFRA21-1, NSE, ProGRP) had no statistically significant differences between two groups (P>0.05). The lesions were more common in the long bones of extremities, which showed ground glass and cystic changes. The probability of ground glass changes was higher in the multi-lesion group (χ2=8.579, P=0.003), while no significant difference in loofah, map, and cystic changes between the two groups (P>0.05). The SPECT imaging showed all the lesions in the thirty-four patients by high uptake of radiotracer, especially when focusing on one limb in polyostotic osteofibrous dysplasia. Conclusion Bone scintigraphy with SPECT/CT can be used as an important supplementary examination method for the differentiation and diagnosis of fibrous dysplasia by observing multiple bone lesions in the whole body, analyzing the anatomical structure and metabolic status of each lesion through one-time whole-body imaging. -
Key words:
- osteofibrous dysplasia /
- SPECT/CT /
- 99mTc-MDP /
- whole body bone scintigraphy
-
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.
-
[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. -
下载:
点击查看大图
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
