外侧血池成像在疑似胫骨应力性骨折患者中的价值。

Department of Nuclear Medicine Guys, St. Thomas Hospital, London, United Kingdom.

Clin Nucl Med. 2011 Mar;36(3):173-7. doi: 10.1097/RLU.0b013e318208ef88.

AIM

To critically evaluate the use of lateral blood pool imaging in athletes with lower limb pain and with a clinical suspicion of stress fracture.

METHODS

Two experienced nuclear medicine physicians evaluated 3-phase bone scans using 99mTc-methylene diphosphonate performed in 50 consecutive patients referred from a specialist sports injury clinic for suspected tibial stress fracture. The vascularity to the tibia as seen on the blood pool (second phase) images in the anterior/posterior views was compared with the lateral/medial view assessments. Stress fractures were presumed to be present when on the delayed images (third phase) there was a focal or fusiform area of increased tracer uptake involving the tibial cortex. Shin splints which are a recognized cause of lower limb pain in athletes mimicking stress fracture were diagnosed if increased tracer uptake was seen extending along the posterior tibial surface with no significant focal or fusiform area of uptake within this. Inter-reviewer agreement for the assessment of vascularity was also assessed using Cohen's Kappa scores.

RESULTS

Twenty-four stress fractures in 24 patients and 66 shin splints in 40 patients were diagnosed. In 18 patients stress fracture and shin splints coexisted. In 10 patients no tibial pathology was identified. Of the 24 patients diagnosed with stress fractures, lateral/medial blood pool imaging was superior in the assessment of blood pool activity (P < 0.001) identifying increased vascularity in 21 cases compared with the anterior/posterior views positive in only 11 cases. The inter-reviewer agreement was near perfect for lateral/medial views, κ = 0.86 while very good for anterior/posterior views, κ = 0.68.

CONCLUSION

In patients with suspected tibial stress fractures, lateral views of the tibia provide the optimal method for evaluation of vascularity. Prospective studies with quantitative or semi-quantitative assessment of skeletal vascularity could provide supplementary information relating to the pathophysiology of stress fractures, for example, the time scale of vascular changes after a tibial stress fracture, and potentially could have clinical relevance as to the assessment of the severity of stress fractures and their prognosis.

目的

批判性地评估下肢疼痛且临床疑似应力性骨折的运动员中使用侧血池成像的情况。

方法

两名经验丰富的核医学医师使用 99mTc-亚甲基二膦酸盐对 50 例连续患者进行了三相骨扫描进行评估，这些患者是从专门的运动损伤诊所转诊过来的，疑似胫骨应力性骨折。在前后位（第二相）图像上观察到的胫骨血池（血流相）中的血管分布与外侧/内侧视图评估进行了比较。当延迟图像（第三相）上存在涉及胫骨皮质的焦点或梭形放射性示踪剂摄取增加的区域时，假定存在应力性骨折。如果在后胫骨表面上看到放射性示踪剂摄取增加而无明显的焦点或梭形摄取区域，则诊断为胫骨后肌劳损，这是运动员下肢疼痛的一种公认原因，类似于应力性骨折。还使用 Cohen 的 Kappa 评分评估了评估血管分布的两位审阅者之间的一致性。

结果

在 24 名患者中诊断出 24 例应力性骨折和 40 名患者中的 66 例胫骨后肌劳损。在 18 名患者中，应力性骨折和胫骨后肌劳损同时存在。在 10 名患者中，未发现胫骨病变。在诊断为应力性骨折的 24 名患者中，与仅在 11 例中呈阳性的前后位视图相比，外侧/内侧血流池成像在评估血流活性方面更具优势（P <0.001），可识别出 21 例增加的血管生成。对于外侧/内侧视图，审阅者之间的一致性非常接近完美，κ=0.86，而对于前后视图，一致性非常好，κ=0.68。