Davenport Matthew S, Brown Richard K J, Frey Kirk A
Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr., UH B1-D502, Ann Arbor, MI 48109-5030, USA.
AJR Am J Roentgenol. 2009 Aug;193(2):338-42. doi: 10.2214/AJR.08.2142.
The purpose of this study was to determine the diagnostic yield and clinical importance of delayed whole-body bone scintigraphy in directed three-phase examinations.
The records of 400 consecutively registered patients who underwent combined three-phase and delayed whole-body (99m)Tc-methylene diphosphonate bone scintigraphy for a variety of indications were reviewed. Clinical indications, findings, recommendations, and outcome were assessed.
Three-phase bone scintigraphy was performed on 156 men and boys and 244 women and girls (61%). Fifty-two patients (13%) were 17 years old or younger, and 236 patients (59%) were older than 40 years. The mean increase in study duration due to whole-body imaging was 25 minutes (range, 21-31 minutes). Excluding the three-phase area of interest, the whole-body examination had a normal tracer distribution in 131 examinations (33%), showed solely degenerative changes in 103 (26%), and showed findings unrelated to the area of interest in 166 patients (41%). In no case did the findings outside the area of interest alter the diagnosis or diagnostic certainty in the three-phase study, but those findings did generate 82 recommendations for additional diagnostic investigation. As a direct result of the recommendations, clinicians requested 18 radiographic, two CT, one MRI, and one ultrasound examinations, one additional bone scan, and two referrals to a consultant. Recommendations based on findings outside the three-phase area of interest affected treatment in one case: Temporomandibular joint uptake resulted in a referral for physical therapy.
For most indications, delayed whole-body imaging after directed three-phase bone scintigraphy does not improve diagnostic yield, does not alter patient care, and may be an unnecessary use of medical resources.
本研究旨在确定延迟全身骨闪烁显像在定向三相检查中的诊断率及临床重要性。
回顾了400例因各种适应证接受三相联合延迟全身（99m）锝-亚甲基二膦酸盐骨闪烁显像的连续登记患者的记录。评估临床适应证、检查结果、建议及结果。
对156名男性和男孩以及244名女性和女孩进行了三相骨闪烁显像（61%）。52例患者（13%）年龄在17岁及以下，236例患者（59%）年龄超过40岁。由于全身显像导致的检查时间平均增加25分钟（范围为21 - 31分钟）。排除三相感兴趣区域后，全身检查中131次检查（33%）示踪剂分布正常，103次（26%）仅显示退行性改变，166例患者（41%）显示与感兴趣区域无关的结果。在任何情况下，感兴趣区域外的结果均未改变三相研究中的诊断或诊断确定性，但这些结果确实产生了82条额外诊断检查的建议。作为这些建议的直接结果，临床医生要求进行18次X线摄影、2次CT、1次MRI和1次超声检查、1次额外的骨扫描以及2次转介给顾问。基于三相感兴趣区域外结果的建议在1例中影响了治疗：颞下颌关节摄取导致转介至物理治疗。
对于大多数适应证，定向三相骨闪烁显像后的延迟全身显像不能提高诊断率，不改变患者护理，可能是对医疗资源的不必要使用。
