同济《核医学》13骨与关节.ppt

Chapter 13.Musculoskeletal system骨、关节 The most frequently performed nuclear medicine procedure, is an extremely sensitive method for detecting bony abnormalities. As functional change in bone occurs earlier than structural change, the bone scan will often detect abnormalities before they are seen on an X-ray. Section 1. Static bone imaging 1. Principles Bone The process of bone disease 2. Methods Imaging agents （tracer） P-O-P: Pyrophosphate (PYP, 焦磷酸盐) P-C-P: Methylene diphosphonate (MDP,亚甲基二膦酸盐), and HMDP (亚甲基羟基二膦酸盐) 99mTc-MDP is most widely used bone scan imaging agent. The usual dose of radiopharmaceutical is 20-25 mCi (740-925 MBq). For pediatric patients, the recommended dose is approximately 9.25MBq or 0.25mCi/kg. Imaging protocol （显像方法） Preparation 300 mg Potassium perchlorate（过氯酸钾）, drink 1 liter water, void urine frequently Whole body bone imaging（全身骨显像） 3-4 hrs after injection, Spot bone imaging（局部骨显像） SPECT bone imaging（断层骨显像） overlap body part, such as lesion in skull, spine, pelvis and hip joint. Indications（适应征） P174 Search for metastases; Musculoskeletal pain of unknown causes; Detection of primary benign and malignant tumors, to exclude bony tumor; Evaluation of trauma; find out stress fracture, covert fracture that radiography cannot detect; Metabolic bone disease and joint disease; Bone tissue biopsy localization; Evaluate therapeutic effects of bone diseases. Scan interpretation（图像分析） Normal imaging Abnormal imaging Abnormal radioactive uptake increase - hot spot （热区） Super bone scan （超级骨显像） Widespread metastases (广泛性骨转移，breast and prostate cancer) Hyperparathyroidism （甲状旁腺功能亢进） Imaging: tracer uptake increase in whole skeleton, with high contrast between bone and soft tissue, renals and bladder are not visualized. Abnormal radioactive decrease: cold defect（冷区/缺损） Abnormal radioactive accumulation outside bone tissue. Clinical applications: 1. Sear