多发热区一定意味着转移性骨肿瘤?

2017-09-12 屈婉莹 核医学

看了以下老年女性的全身骨显像和胸部SPECT/CT融合骨显像,您能作出诊断吗?

看了以下老年女性的全身骨显像和胸部SPECT/CT融合骨显像,您能作出诊断吗?

1﹒病史和检查目的

患者女,72岁,12年前左乳腺癌术,15年前左甲状腺癌切除术。自诉1年前脊柱摔跤骨折,1个月前摔跤,坐地上,不能走路。胸片显示T12~L1轻度楔形改变,T11椎体内可见高密度结节影,L3椎体骨质密度稍高。

2﹒方法

静脉注入99mTc‐MDP 740MBq(20mCi),注射后至显像前1小时饮水1000ml,3小时后行全身骨显像,随后行胸部SPECT/CT融合骨显像。

3﹒检查表现

(1)全身骨显像:颈椎下段横向型放射性增高区,左后第7肋条状(沿肋骨走行)放射性增高区,T11和L3似整个椎体呈放射性浓聚,右侧髂骨近髋臼处有一放射性浓聚区;T12、L1、L2横向型放射性增高或稍高区,骶、尾骨有一不均匀的放射性增高区。

(2)T11断层所见:T11椎体后部和双侧椎弓根放射性增高;矢状面:骶尾骨放射性增高;冠状面:右髂骨髋臼处放射性增高。

(3)L3断层所见:横断面:L3椎体和左侧椎弓根放射性增高;矢状面:骶尾骨放射性增高;冠状面:右髂骨髋臼处放射性增高。

4﹒诊断意见

(1)颈椎下段、T11和L3考虑骨转移。

(2)右侧髂骨髋臼骨转移可能。

(3)左后第7肋局部侵犯可能。

(4)骶、尾骨放射性增高区,不能除外近期外伤所致(H型骨折?)。

(5)T12、L1、L2横向型放射性增高或稍高区,考虑陈旧压缩性骨折。

5﹒随访结果

临床最后诊断:恶性肿瘤骨转移,伴T12~L2、骶、尾骨骨折,化疗中。


图2‐14 骨盆断层骨显像图

【讨论】

1﹒诊断要点

(1)椎体的部分髓质、椎弓根放射性增高区,常考虑骨转移;椎小关节放射性增高区,常考虑退行性骨关节病;整个椎体均呈放射性增高区,矢状面椎体缩短,压缩性骨折可能。

(2)肋骨沿肋骨走行的放射性增高区,常提示骨转移;3D图像观察肋骨,比断层更有意义。

(3)椎体横向型放射性增高区,常提示压缩性骨折。

2﹒鉴别诊断

(1)椎体压缩性骨折:横断面可见整个椎体的放射性增高,矢状面椎体缩短,好发部位为T11~L2。

(2)肋骨外伤:常累及多个肋骨,呈线型排列。

(3)H型骨折:好发人群为老年女性,常有外伤或骨盆放疗史。

(4)膀胱憩室:做断层可以判断。

3﹒临床表现

(1)骨痛:同前。

(2)外伤史:几乎都有。

4﹒病理

(1)骨质疏松症:骨含量(包括无机质和有机质)明显减低和骨小梁微结构的破坏,在轻微外伤和无外伤的情况下容易发生骨折。脊椎的骨折为压缩性骨折,骶尾骨的骨折多为H型骨折。

(2)骨转移瘤:同前。

5﹒原理

99mTc‐MDP骨显像的原理同全身骨显像。SPECT/CT骨显像可同时获得骨功能和骨解剖断层图像,不仅能够对骨显像的阳性病灶精确定位,提高了诊断的准确性,而且对诊断骨转移的类型有重要价值。

6﹒注意事项

(1)多发热区的鉴别诊断非常重要,不能一概认为是转移性骨肿瘤。

(2)脊椎放射性增高区的精确定位,有助于病变定性。

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    2017-09-17 䖝二

    学习了

    0

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    2017-09-15 ylzr123

    好文.值得点赞!认真学习.应用于实践!谢谢分享给广大同好!

    0

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    2017-09-14 yfjms

    学习了

    0

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    2017-09-13 hfuym10906

    学习了学习了学习了学习了学习了学习了学习了学习了

    0

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由此可见,心肌梗死后发热可以预测接受经皮冠状动脉介入治疗的ST段抬高性心肌梗死患者进一步的心肌损伤和较少的心肌挽救。

Stroke:急性卒中患者,应积极控制发热、血糖及吞咽困难

背景:在19个澳大利亚急性卒中单元(2005-2010)进行的QASC试验中,实施护士发起的,管理卒中后发热、高血糖和吞咽功能障碍,减少卒中后90天的死亡和残疾。现在研究者探讨管理发热、高血糖及吞咽功能障碍与长期全因死亡率的关系。方法:使用澳大利亚国家死亡指数确定死亡率。应用cluster sandwich(Huber White估计)方法校正卒中单元相关性,通过Cox比例风险回归模型比较到死亡的

JAHA:发热与ST段抬高型心梗患者预后呈显著相关

双相炎症反应在ST段抬高型心肌梗死(STEMI)后的心肌愈合和全身动脉粥样硬化的进展中起重要作用。近日,在国际心血管权威杂志JAHA上发表了一篇旨在评估STEMI后第一和第二炎症时相的发热对心脏远期预后影响的临床研究。本研究共纳入了550名ST段抬高型心肌梗死的患者。对纳入的研究对象测量腋下的体温,并分别测量记录第一时相(入院后3天内,max‐BT1-3d)和第二时相(入院后4-10天,max‐B