Reinartz P, Schaffeldt J, Sabri O, Zimny M, Nowak B, Ostwald E, Cremerius U, Buell U
Department of Nuclear Medicine, Aachen University of Technology, Germany.
Eur J Nucl Med. 2000 Jun;27(6):721-6. doi: 10.1007/s002590050568.
Bone scanning is a well-accepted and frequently performed diagnostic procedure with a high sensitivity, especially when single-photon emission tomography (SPET) acquisitions are added. However, the differentiation of benign from malignant osseous lesions often poses difficulty. The purpose of this study was to find out whether the particular localisation of an intraosseous lesion in a lumbar vertebra is an indicator of its aetiology. Bone scintigraphy including planar whole-body scans as well as SPET imaging of the lumbar spine was performed in 109 patients. The diagnoses of osseous lesions in the lumbar vertebrae were made strictly on the basis of the findings of magnetic resonance imaging, computed tomography or plain radiography. Sixteen patients had to be excluded from the study because they did not undergo adequate radiological examination. To determine the particular localisation of vertebral lesions in the bone scan, two experienced nuclear medicine physicians examined the studies independently while blinded to the radiological results. Four anatomical regions were differentiated within the vertebra: the vertebral body, the pedicle, the facet joints and the spinous process. Clopper-Pearson analysis, which takes into account the number of examinations, yielded the following probability intervals for the malignancy of intraosseous lesions in the lumbar spine: vertebral body 36.8%-57.3%, pedicle 87.7%-100%, facet joints 0.8%-21.4% and spinous process 18.7%-81.3%. It was concluded that lesions affecting the pedicle are a strong indicator for malignancy, whereas involvement of the facet joints is usually related to benign disease. Lesions affecting the vertebral body or the spinous process do not show a clear tendency towards either malignancy or benignity. In contrast to other studies, a significant probability of malignancy (35.6%) was observed in lesions affecting exclusively the vertebral body.
骨扫描是一种被广泛接受且经常进行的诊断程序，具有很高的灵敏度，尤其是在增加单光子发射断层扫描（SPET）采集时。然而，良性与恶性骨病变的鉴别常常存在困难。本研究的目的是查明腰椎骨内病变的特定定位是否为其病因的一个指标。对109例患者进行了包括全身平面扫描以及腰椎SPET成像的骨闪烁显像。腰椎骨病变的诊断严格基于磁共振成像、计算机断层扫描或普通X线摄影的结果。16例患者因未接受充分的放射学检查而被排除在研究之外。为了确定骨扫描中椎体病变的特定定位，两名经验丰富的核医学医师在对放射学结果不知情的情况下独立检查这些研究。在椎骨内区分出四个解剖区域：椎体、椎弓根、小关节和棘突。考虑到检查数量的克洛珀-皮尔逊分析得出了腰椎骨内病变恶性的以下概率区间：椎体36.8%-57.3%，椎弓根87.7%-100%，小关节0.8%-21.4%，棘突18.7%-81.3%。得出的结论是，影响椎弓根的病变是恶性的有力指标，而小关节受累通常与良性疾病有关。影响椎体或棘突的病变在恶性或良性方面没有明显倾向。与其他研究不同，在仅影响椎体的病变中观察到了显著的恶性概率（35.6%）。
