1、v 放射性核素骨顯像Radionuclide bone imaging 第一節(jié)解剖與生理v全身骨由骨連接構(gòu)成骨骼,其構(gòu)成人體支架.具有支持運(yùn)動(dòng)保護(hù)內(nèi)臟的功能,同時(shí)對(duì)血液的生成與礦物質(zhì)儲(chǔ)存也起著重要作用.骨的分類v體內(nèi)位置分:中軸骨,四肢骨v基本形態(tài)分:長骨,短骨,扁骨,不規(guī)則骨.骨的組成v骨質(zhì)：骨密質(zhì)與松質(zhì)。v骨膜：內(nèi)外兩層。v骨髓：紅與黃骨髓。v神經(jīng)：主要存在于骨膜內(nèi)。v血管：滋養(yǎng)動(dòng)脈，骨膜動(dòng)脈，干骺端動(dòng)脈，骺動(dòng)脈等。 骨的化學(xué)成分v有機(jī)質(zhì): 約占1/3，骨膠原粘蛋白為主。v無機(jī)質(zhì)：約占2/3，主要為鈣、磷等的鹽類，主要成分為羥基磷灰石。關(guān)節(jié)v關(guān)節(jié)面：關(guān)節(jié)頭，關(guān)節(jié)窩。v關(guān)節(jié)囊v關(guān)節(jié)腔v血管v

2、神經(jīng)Static bone imaging (靜態(tài)骨顯像）原理（ Principles ）vBone Organic substances (有機(jī)物有機(jī)物) bone cell, collagen Minerals: （礦物質(zhì)）礦物質(zhì)）hydroxyapatite (HAP),Ca10(PO4)6(OH)2 （羥基磷灰石晶體）with a 3106m2 surface area 過程v BoneExtracellular fluid (ECF) Blood flow Radiopharmaceuticals (tracer) Ions exchangei. v. Tracer uptake i

3、ncrease (hot spot，熱區(qū)熱區(qū)) Tracer uptake decrease (cold defect，冷區(qū)冷區(qū)/缺損缺損) 1.blood flow increased 2.bone turnover increased osteoblastic activity 3.new bone formation 1.blood flow decreased 2.osteonecrosis change 3.destructive process. Blood flow Metabolic change The process of bone disease Reaction sta

4、ge Proliferate stage Stable stage 反應(yīng)期反應(yīng)期(6m) 影響骨聚集磷酸鹽 的因素v骨的代謝活躍v局部血流量v交感神經(jīng)的影響 顯像劑 Imaging agents （tracer） vP-O-P: Pyrophosphate (PYP, 焦磷酸鹽) vP-C-P: Methylene diphosphonate (MDP,亞甲基二膦酸鹽), and HMDP (亞甲基羥基二膦酸鹽) 劑量v99mTc-MDP is most widely used bone scan imaging agent. vThe usual dose of radiopharmaceu

5、tical is 20-25 mCi (740-925 MBq). vFor pediatric patients, the recommended dose is approximately 9.25MBq or 0.25mCi/kg Imaging protocol （顯像方法） v全身骨顯像v局部顯像Indications（適應(yīng)征） v早期尋找惡性腫瘤的骨轉(zhuǎn)移灶v骨腫瘤或活檢定位，判定病變手術(shù)范圍v局部骨痛v疑似某些代謝性骨病v疑為急性骨髓炎v觀察移植骨的血供和成活v股骨頭血供狀態(tài)的觀察Indications（適應(yīng)征）v判定X線攝影片難以觀察發(fā)現(xiàn)的骨折v早期診斷某些職業(yè)性骨疾病v鑒別陳舊

6、性和新近發(fā)生的壓縮性骨折v鑒別非膠原性疾病引起的血清堿性磷酸酶升高v診斷和觀察正常骨外的骨化組織或病變v燒傷后骨壞死的診斷Scan interpretation（圖像分析）v正常圖象：全身骨骼呈對(duì)稱性分布；基本規(guī)律是扁平骨較長骨管狀骨清晰；管狀骨骼兩端放射性多于骨干，大關(guān)節(jié)較小關(guān)節(jié)清晰；小兒和青少年骨質(zhì)生長活躍，在骨骺及干骺端顯影劑濃集較成人多。正常圖象 adult child 正常圖象 Pelvis SPECT imaging 骨盆的斷層顯像 異常圖象（Abnormal imaging ）v熱區(qū)v冷區(qū)hot spot Pagets disease Pagets disease 特殊骨顯像（S

7、uper bone scan ）v超級(jí)骨顯像(super-bong scan)v閃爍（flare phenomenon)v長骨骨密質(zhì)顯象濃集v胸部軟組織顯影濃集主要用途vWidespread metastases (廣泛性骨轉(zhuǎn)移，breast and prostate cancer) vHyperparathyroidism （甲狀旁腺功能亢進(jìn)）Abnormal radioactive decrease: cold defect（冷區(qū)/缺損） doughnut sign (炸面圈征) Osteonecrosis in thorax and lumbar spine 胸椎和腰椎的骨質(zhì)破壞 Mul

8、tiple bone metastasis, abnormal tracer uptake in lung and right calf muscle. 骨外病變或人工偽影所致異常v鈣化v軟組織v體位v污染v異物v標(biāo)記率骨顯像的敏感性與特異性v敏感性v非特異性Clinical applicationsvSearch bone metastasis at early stage. Whole body metastasis of prostate cancer lung cancer metastasis 肺癌骨轉(zhuǎn)移肺癌骨轉(zhuǎn)移 前列腺癌的全身骨轉(zhuǎn)移前列腺癌的全身骨轉(zhuǎn)移 right femur d

9、oughnut sign, right hip joint hot spot 右股骨炸面圈征，右髖關(guān)節(jié)濃聚灶右股骨炸面圈征，右髖關(guān)節(jié)濃聚灶 Whole body metastasis of prostate cancer 前列腺癌 Super bone scan (超級(jí)骨顯像超級(jí)骨顯像) 3 m after prostate cancer surgery,18 m after surgery A: Multiple bone metastases B: after 89Sr therapy (8 m) 2 m, 13m, 19m after prostate cancer surgery, 2

10、. Primary bone tumor Upper side, lower side of of left femur osteogenic sarcoma （成骨肉瘤） multiple myeloma 多發(fā)性骨髓瘤多發(fā)性骨髓瘤 骨折（Fracture） vTo find out fracture in early stage. vOccult or covert fracture （隱匿性骨折） vStress fracture（應(yīng)力性骨折） vInsufficiency fracture （不完全性骨折） Calcaneus (跟骨) Left foot 4th toe 代謝性疾病v骨

11、質(zhì)疏松v甲狀旁腺功能亢進(jìn)v骨軟化癥v畸形性骨炎Vertebral fracture in lumbar spine 骨質(zhì)疏松的腰椎椎體骨折 骨髓炎v12-48小時(shí)v熱區(qū)與冷區(qū)移植骨v血供v新骨形成股骨頭血供v早期發(fā)現(xiàn)v病變期與修復(fù)期Dynamic bone imaging 骨動(dòng)態(tài)顯像骨動(dòng)態(tài)顯像 Principles and Method v三時(shí)相v四時(shí)相Three、four-phase bone imagingv（three-phase bone imaging，骨三、四相） Imaging agent and dosage Imaging protocol（血流相、血池相、延遲相） Bloo

12、d flow phase: 3s / frame, 60s Blood pool phase: 2-3 min after injection, 60s /frame, 5 f Delayed phase: 2-4hrs 24 hrs after injection, static imaging Indications 適應(yīng)癥 vSurvey blood supply and metabolic situation of bone and soft tissue; vDifferentiate malignant tumor from benign tumor vIschemic necro

13、sis of the femoral head (aseptic necrosis of femoral head) vDifferentiate acute osteomyelitis from cellulitis; vEvaluate viability and blood supply of bone graft 顯像劑vP-O-P: Pyrophosphate (PYP, 焦磷酸鹽)vP-C-P: Methylene diphosphonate (MDP,亞甲基二膦酸鹽), and HMDP (亞甲基羥基二膦酸鹽)劑量vThe usual dose of radiopharmaceu

14、tical is 20-25 mCi (740-925 MBq).方法v3s / frame, 60sv2-3 min after injection, 40-60s /frame, 5-10 framev2-4hrsv24 hrs after injection, static imagingNormal imaging 正常影像 vBlood flow phase vBlood pool phase vDelayed phase Normal imaging 正常影像A: Blood flow phase B: Time-active curve of ROI C: Blood pool

15、phase 感興趣區(qū)的時(shí)間放射性曲線 Clinical applications and interpretation vDifferentiate malignant tumor from benign tumor（骨腫瘤良惡性鑒別） vIschemic necrosis of the femoral head (aseptic necrosis of femoral head，股骨頭缺血性壞死) vDifferentiate acute osteomyelitis（急性骨髓炎 ） from cellulitis（蜂窩組織炎） vEvaluate viability and blood su

16、pply of bone graft （移植骨存活的判斷）v診斷血管疾病 Left femur osteogenic sarcoma A: Blood flow phase B: Time-active curve of ROI 時(shí)間-放射性曲線 C: Blood pool phase D: Delayed phase Right knee giant cell sarcoma A: Blood flow phase B: Time-active curve of ROI C: Delayed phase Cold defect in right femur head hot spot in

17、right femur head Ischemic necrosis of the femoral head Joint imaging關(guān)節(jié)顯像關(guān)節(jié)顯像 Principles and method v關(guān)節(jié)炎癥、退變、骨性關(guān)節(jié)壓力異常，該部位無機(jī)鹽代謝增強(qiáng)，局部血供增加，導(dǎo)致關(guān)節(jié)周圍骨更新旺盛vTc-MDP +蛋白顯像劑v反映炎癥滑膜局部血供的顯像劑：99mTc（ 99mTcO4）-白蛋白v骨顯像劑： 99mTc-MDP v選擇性聚集于炎癥病灶：111In（ 99mTc、Ga）- WBC（HIG ）Imaging protocol （顯像方法）v檢查前口服過氯酸鉀400毫克v確定興趣區(qū)vthre

18、e-phase bone imagingIndications 適應(yīng)癥 vJoint disease骨關(guān)節(jié)病 vArthritis 關(guān)節(jié)炎 vSuspect joint disease, without radiography finding 可疑骨關(guān)節(jié)病 vFollow up of joint disease關(guān)節(jié)疾病的隨訪 vFollow up of prosthesis人工關(guān)節(jié)的隨訪 vReflex sympathetic dystrophy syndrome, RSDS 放射性交感營養(yǎng)不良綜合征 Normal imaging Normal imaging異常表現(xiàn)Abnormal imaging vhot spotvthree-phase bone imagingClinical applications and interpretation vRheumatoid arthritis類風(fēng)濕性關(guān)節(jié)炎 vOsteoarthritis骨關(guān)節(jié)炎/退行性關(guān)節(jié)病 vProsthesis人工關(guān)節(jié) vRef