SPECT/CT bone imaging and clinical features of osteofibrous dysplasia
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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
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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.
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