Zhang Yanyan, Zhang Yifan, Ma Jing
Department of Nuclear Medicine, The Third Hospital of Peking University, Beijing, People's Republic of China.
Clin Nucl Med. 2007 Jun;32(6):435-9. doi: 10.1097/RLU.0b013e318053ed4d.
The potential roles of bone scintigraphy in the evaluation of tuberculosis are not well-defined. It is commonly considered that skeletal tuberculosis occurs only after pulmonary tuberculosis. Bone scintigraphy was not known to be an effective imaging modality in the evaluation of skeletal tuberculosis, especially in those without known systemic tuberculosis.
To assess the prospect of bone scintigraphy in the detection of skeletal tuberculosis in patients who came to the department of nuclear medicine to evaluate back pain.
Patient records and the images of 1817 cases of consecutive bone scintigraphy performed for the evaluation of unknown causes of back pain were retrospectively reviewed. The imaging findings were compared with the status of tuberculosis before and after scintigraphy.
Sixteen patients had skeletal tuberculosis confirmed by histopathological examination. Six patients had solitary while 10 had multifocal skeletal lesions. Before bone scintigraphy, 2 patients were suspected but not confirmed to have pulmonary tuberculosis, 4 were suspected to have skeletal tuberculosis by other modalities while the remaining 10 patients were not suspected to have tuberculosis in any part of the body. Following bone scintigraphy, among those 10 patients who were unsuspected of having tuberculosis, further tests demonstrated that 3 had pulmonary tuberculosis in addition to skeletal tuberculosis and 1 had cervical tuberculous lymphadenitis. In total, among those 16 patients with confirmed skeletal tuberculosis, only 6 had concurrent extraskeletal tuberculosis while 10 patients had their tuberculosis limited to the skeletal system.
Our results indicate that pulmonary or systemic tuberculosis is not a prerequisite for skeletal tuberculosis. Skeletal tuberculosis should be among the differential diagnoses when there is a positive bone scan in patients without a malignancy in an endemic region.
骨闪烁显像在结核病评估中的潜在作用尚未明确界定。通常认为骨结核仅在肺结核之后发生。骨闪烁显像在评估骨结核方面并非被视为一种有效的成像方式，尤其是在那些无已知全身性结核病的患者中。
评估骨闪烁显像在核医学科因背痛前来就诊的患者中检测骨结核的前景。
回顾性分析1817例因评估不明原因背痛而连续进行骨闪烁显像的患者记录及图像。将影像学检查结果与骨闪烁显像前后的结核状况进行比较。
16例患者经组织病理学检查确诊为骨结核。6例为单发病灶，10例为多发病灶。在骨闪烁显像前，2例患者疑似但未确诊为肺结核，4例经其他检查怀疑有骨结核，其余10例患者身体任何部位均未被怀疑患有结核病。骨闪烁显像后，在这10例未被怀疑患有结核病的患者中，进一步检查显示3例除骨结核外还患有肺结核，1例患有颈部结核性淋巴结炎。总共，在这16例确诊为骨结核的患者中，仅6例同时患有骨外结核，10例患者的结核局限于骨骼系统。
我们的结果表明，肺结核或全身性结核病并非骨结核的必要前提。在地方病流行地区，对于无恶性肿瘤且骨扫描呈阳性的患者，骨结核应列入鉴别诊断范围。
