Seo Y, Shuke N, Yamamoto W, Usui K, Aburano T
Department of Radiology, Asahikawa Medical College, Japan.
Ann Nucl Med. 1999 Oct;13(5):351-4. doi: 10.1007/BF03164875.
A 67-year-old man presented with malaise and marked anemia. A diagnostic workup revealed severe pancytopenia on a complete blood count and diffuse sclerotic change in the axial skeleton on a plain abdominal radiograph. Bone metastases being suspected from these findings, bone scintigraphy was performed. The bone scan demonstrated uniformly increased skeletal activity with faint soft-tissue activity. The findings of the bone scan, however, appeared atypical of the super scan caused by diffuse bone metastases, without any decrease in radioactivities of the appendicular skeleton and kidneys. Bone marrow scintigraphy with In-111 chloride demonstrated central marrow failure and peripheral expansion, which indicated the possibility of myelophthisis. The patient underwent bone marrow biopsy, which revealed replacement of the bone marrow by metastatic adenocarcinoma. Further examinations detected the primary lesion in the prostate. In this case, the findings of the bone scan were insufficient for the super scan, and might be categorized as a sub-super scan. It would be important to recognize this incomplete form of super scan as a rare scintigraphic pattern of diffuse bone marrow metastases.
一名67岁男性,出现全身乏力和显著贫血。诊断性检查发现全血细胞计数显示严重全血细胞减少,腹部平片显示中轴骨骼弥漫性硬化改变。基于这些发现怀疑有骨转移,遂进行了骨闪烁显像。骨扫描显示骨骼放射性均匀增加,伴有轻微软组织放射性。然而,骨扫描结果并不典型,并非由弥漫性骨转移引起的超级骨显像,四肢骨骼和肾脏的放射性并未降低。氯化铟-111骨髓闪烁显像显示中央骨髓功能衰竭和外周骨髓扩张,提示存在骨髓痨的可能性。患者接受了骨髓活检,结果显示骨髓被转移性腺癌替代。进一步检查发现前列腺为原发病灶。在该病例中,骨扫描结果不符合典型的超级骨显像,可能归类为亚超级骨显像。认识到这种不完全形式的超级骨显像作为弥漫性骨髓转移罕见的闪烁显像模式很重要。