Yuasa K, Sugimura K, Okizuka H, Mihara Y, Sugihara M, Ishida T
Department of Radiology, Shimane Medical University.
Kaku Igaku. 1991 Jan;28(1):91-6.
Parallel studies of radionuclide bone marrow imaging and bone scanning are helpful in the early diagnosis of skeletal metastasis. In bone marrow imaging, most lesions are observed as a local defect. We had two cases of nonmetastatic lesions which appeared as local defects in bone marrow imaging. The first case was a male Hodgkin's disease patient, aged 48, who had been treated with frequent chemotherapy, including the administration of a large quantities of steroids. He complained of slight pain in the left shoulder. Without increased uptake in bone scanning, abnormal accumulation of 67Ga-citrate and a local defect in bone marrow imaging appeared, corresponding to localization of the pain. Suspecting bone marrow metastasis, we performed magnetic resonance imaging (MRI). An area of slightly decreased intensity in T1-weighted spin-echo images and lower intensity than fat tissue in T2-weighted images were observed, although it was slightly enhanced by Gd-DTPA. This lesion was diagnosed by biopsy as a bone infarction. The second case was that of a 69-year-old male lung cancer patient. Though no abnormality was revealed by bone scanning or 67Ga-citrate scintigraphy, an apparent defect at the 10th thoracic vertebra was observed in bone marrow imaging. It was not accompanied by pain. MRI was also performed in this case. This was depicted as a clearly defined high intensity area. This was diagnosed as a fat island, and no change has been seen in the seven months of follow up. In conclusion, it is necessary to consider the possibility of nonmetastatic lesions, when local defects appear in bone marrow imaging performed on cancer patients.
放射性核素骨髓显像与骨扫描的平行研究有助于骨骼转移瘤的早期诊断。在骨髓显像中，大多数病变表现为局部缺损。我们有两例非转移性病变在骨髓显像中表现为局部缺损。第一例是一名48岁的男性霍奇金病患者，他接受了频繁的化疗，包括大量使用类固醇。他主诉左肩轻微疼痛。骨扫描未见放射性摄取增加，而67Ga枸橼酸盐出现异常聚集且骨髓显像有局部缺损，与疼痛部位相符。怀疑有骨髓转移，我们进行了磁共振成像（MRI）检查。在T1加权自旋回波图像上可见一个强度略降低的区域，在T2加权图像上其强度低于脂肪组织，尽管用钆喷替酸葡甲胺（Gd-DTPA）增强后略有强化。经活检，该病变诊断为骨梗死。第二例是一名69岁的男性肺癌患者。骨扫描和67Ga枸橼酸盐闪烁显像均未发现异常，但骨髓显像在第10胸椎处可见明显缺损。该部位无疼痛。此例也进行了MRI检查。其表现为一个边界清晰的高信号区。诊断为脂肪岛，随访7个月未见变化。总之，对癌症患者进行骨髓显像时若出现局部缺损，有必要考虑非转移性病变的可能性。
