Rotés-Sala D, Monfort J, Solano A, Miralles E, Vila J, Carbonell J
Department of Rheumatology, Hospital del Mar i l'Esperança, Universitat Autònoma, Barcelona, Spain.
Bone. 2004 Apr;34(4):605-8. doi: 10.1016/j.bone.2003.10.014.
Bone scintigraphy used as a diagnostic technique frequently yields non-specific intense uptake by vertebrae. Bone biopsy may therefore be required to establish a diagnosis in cases of Paget's disease of bone. The aim of the study was to ascertain the sensitivity and specificity of two new images-heart sign and clover sign-in Paget's disease of bone.
Two expert rheumatologists analyzed 294 bone scintigraphies of patients with vertebral involvement: 204 without and 90 with Paget's disease. The presence or absence of the clover or heart signs was determined in each scintigraphy. A specificity and sensitivity study was performed with the data obtained. A study of concordance was made between two radiologists blinded to the real diagnosis. Each one analyzed 120 scintigraphies for the presence and absence of the signs: 40 with Paget's disease and clover and/or heart signs (selected from the initial 90 cases), 40 with Paget's disease with neither sign and 40 selected from the pool of 4000 scintigraphies of patients with vertebral involvement, with images easily mistaken for these signs (vertebral collapse, osteoarthritis and bone metastases). Kappa statistics were calculated.
Sensitivity of both signs for Paget's disease of bone was low: 44% (95% CI 34.0 to 55.3). However, specificity was excellent: 100% (95% CI 98.2 to 100). Inter-radiologist concordance was almost perfect: Kappa 0.86 (95% CI 0.77 to 0.95).
The heart and clover signs are highly specific (probably pathognomonic) of Paget's disease of bone. In cases with doubtful radiologic images, these findings on scintigraphic vertebral images may afford a definitive diagnosis of Paget's disease of bone and thus obviate further confirmatory invasive diagnostic procedures.
骨闪烁扫描术作为一种诊断技术，常常会出现椎体非特异性的强烈摄取。因此，在骨Paget病的病例中可能需要进行骨活检来确诊。本研究的目的是确定两种新影像——心脏征和三叶草征——在骨Paget病中的敏感性和特异性。
两位专家级风湿病学家分析了294例有椎体受累的患者的骨闪烁扫描图像：204例无Paget病，90例有Paget病。在每张闪烁扫描图像中确定是否存在三叶草征或心脏征。利用获得的数据进行特异性和敏感性研究。对两位不知真实诊断结果的放射科医生进行一致性研究。每人分析120张闪烁扫描图像以确定征像的有无：40例有Paget病且有三叶草征和/或心脏征（从最初的90例中选取），40例有Paget病但无上述征像，以及从4000例有椎体受累患者的闪烁扫描图像库中选取的40例，其图像容易与这些征像混淆（椎体塌陷、骨关节炎和骨转移）。计算Kappa统计量。
两种征像对骨Paget病的敏感性较低：44%（95%置信区间34.0至55.3）。然而，特异性极佳：100%（95%置信区间98.2至100）。放射科医生之间的一致性几乎完美：Kappa值为0.86（95%置信区间0.77至0.95）。
心脏征和三叶草征对骨Paget病具有高度特异性（可能具有确诊意义）。在放射学图像存疑的病例中，这些椎体闪烁扫描图像上的表现可能有助于确诊骨Paget病，从而避免进一步的侵入性确诊诊断程序。
