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目的探讨多发性骨髓瘤(MM)的核素全身骨显像和X线影像特征,评估核素骨显像在MM骨病诊断中的临床应用价值。方法对49例多发性骨髓瘤患者53例次99mTc-MDP核素骨显像与X线摄片结果进行对比研究。结果1核素全身骨显像阳性率为84.8%(151/178个),共发现病灶151个。X线摄片阳性率为56.7%(101/178个),共发现病灶101个。两种显像的诊断符合率为41.6%(74/178个)。2对受检病例骨损害的好发部位及频率的统计表明:核素显像依次为脊柱(37.1%)、肋骨(25.2%)、骨盆(10.6%)、长管状骨6.6%、肩关节及肩胛骨(6.6%)、颅骨(3.3%);X线摄片结果为脊柱(36.6%)、肋骨(15.8%)、颅骨(14.9%)、骨盆(14.9%)、长管状骨(8.9%)、肩关节及肩胛骨(4.0%)。核素显像对肋骨病灶的显示较X线更敏感,而颅骨病变则更适于行X线检查。核素骨显像对X线阳性的不同影像特征病灶的检出率亦不同(P<0.01),分别为病理性骨折100%、溶骨性破坏68.4%、弥漫性骨质疏松62.5%。3X线摄片和核素骨显像相结合与单独X线摄片(部分加做局部CT或MRI)探测骨损害对受检病例MM分期结果有一定影响。结论核素骨显像与常规X线摄片检查对多发性骨髓瘤的骨损害探测各有所长,二者相互补充,核素骨显像可以作为探测多发性骨髓瘤骨损害的常规方法。
Objective To investigate the radionuclide bone imaging and radiographic features of multiple myeloma (MM) and to evaluate the clinical value of radionuclide bone imaging in the diagnosis of MM bone disease. Methods Fifty-nine patients with multiple myeloma underwent 99mTc-MDP radiography and X-ray radiography. Results The positive rate of 1 nuclide bone imaging was 84.8% (151/178). A total of 151 lesions were found. X-ray positive rate was 56.7% (101/178), a total of 101 lesions were found. The coincidence rate of the two imaging diagnosis was 41.6% (74/178). 2 The statistics of the frequency and the incidence of bone lesions in the examined cases showed that the radionuclide imaging was followed by spine (37.1%), rib (25.2%), pelvis (10.6%), long tubular bone (36.6%), rib (15.8%), skull (14.9%), pelvis (14.9%), long tubular bone (8.9%), Shoulder and shoulder blades (4.0%). Radionuclide imaging of rib lesions showed more sensitive than the X-ray, and skull lesions are more suitable for X-ray examination. The detection rate of radionuclide bone imaging in different X-ray-positive imaging lesions was also different (P <0.01), which were pathological fracture 100%, osteolytic destruction 68.4% and diffuse osteoporosis 62.5% respectively. 3X line radiography and radionuclide bone imaging combined with radiographic (partial plus local CT or MRI) to detect bone lesions on the MM patients staged results have an impact. Conclusions Radionuclide bone imaging and routine radiography have different effects on detecting bone damage in multiple myeloma. The two are complementary to each other. Radionuclide bone imaging can be used as a routine method to detect multiple myeloma bone damage.