Milman N, Lund J O, Graudal N, Enevoldsen H, Evald T, Nørgård P
Department of Pulmonary Medicine, Naestved Hospital, Denmark.
Sarcoidosis Vasc Diffuse Lung Dis. 2000 Mar;17(1):67-70.
Routine use of diagnostic radioisotope bone scanning in patients with sarcoidosis has not previously been evaluated. The aim of this study was to assess whether routine radioisotope bone scanning might be of value in the detection of osseous lesions in sarcoidosis.
63 consecutive Caucasian patients (32 men) with a median age of 39 years (range 17-66) and biopsy proven pulmonary sarcoidosis were included. None had symptoms suggesting osseous sarcoidosis. Extrathoracic, non-osseous sarcoidosis was present in 24 patients; 13 patients were on oral steroids. Radioisotope bone scanning was performed with a gammacamera after intravenous injection of 99mTechnetium-methylenediphosphonate. An abnormal bone scan was followed by a radiograph of the region of interest.
39 patients (61.9%) had normal bone scans. Minor bone scan abnormalities were found in 24 patients (38.1%). Of these, 11 patients had bone foci (8 in the vertebral spine, 9 in the ribs, 1 in a finger). Radiographically only one of these 11 patients had a bony lesion being typical of sarcoidosis, located in the second finger. 17 patients had joint foci. Radiographs of the joints showed sequelae after a fracture in 1 patient, and degenerative osteoarthritis in 1 patient. There was no difference between clinical and paraclinical variables in patients with normal and abnormal bone scans.
There appears to be no indication for routine radioisotope bone scanning in patients with sarcoidosis. Scanning should be restricted to patients with clinical suspicion of osseous sarcoidosis.
此前尚未对结节病患者常规使用诊断性放射性核素骨扫描进行评估。本研究的目的是评估常规放射性核素骨扫描在检测结节病骨病变方面是否有价值。
纳入63例连续的白种人患者（32例男性），中位年龄39岁（范围17 - 66岁），经活检证实为肺结节病。均无提示骨结节病的症状。24例患者存在胸外非骨结节病；13例患者正在口服类固醇。静脉注射99m锝 - 亚甲基二膦酸盐后，用γ相机进行放射性核素骨扫描。骨扫描异常后对感兴趣区域进行X线摄影。
39例患者（61.9%）骨扫描正常。24例患者（38.1%）发现轻微骨扫描异常。其中，11例患者有骨病灶（8例在脊柱，9例在肋骨，1例在手指）。在这11例患者中，X线摄影仅1例有典型结节病骨病变，位于第二指。17例患者有关节病灶。关节X线片显示1例患者有骨折后遗症，1例患者有退行性骨关节炎。骨扫描正常和异常的患者在临床和辅助检查变量方面无差异。
结节病患者似乎没有常规进行放射性核素骨扫描的指征。扫描应仅限于临床怀疑有骨结节病的患者。
