Department of Nuclear Medicine, Borough Wing; Guy's Hospital, King's College London School of Medicine, St. Thomas Street, London SE1 9RT, UK.
Eur J Nucl Med Mol Imaging. 2012 Feb;39(2):326-36. doi: 10.1007/s00259-011-1974-y. Epub 2011 Nov 5.
Visual changes on radionuclide bone scans have been reported with teriparatide treatment. To assess this, serial studies were evaluated and quantified in ten postmenopausal women with osteoporosis treated with teriparatide (20 μg/day subcutaneous) who had (99m)Tc-methylene diphosphonate (MDP) bone scans (baseline, 3 and 18 months, then after 6 months off therapy).
Women were injected with 600 MBq (99m)Tc-MDP, and diagnostic bone scan images were assessed at 3.5 h. Additional whole-body scans (10 min, 1, 2, 3 and 4 h) were analysed for (99m)Tc-MDP skeletal plasma clearance (K(bone)). Regional K(bone) differences were obtained for the whole skeleton and six regions (calvarium, mandible, spine, pelvis, upper and lower extremities). Bone turnover markers (BTM) were also measured.
Most subjects showed visual changes on 3- and 18-month bone scan images that disappeared after 6 months off therapy. Enhanced uptake was seen predominantly in the calvarium and lower extremities. Whole skeleton K(bone) displayed a median increase of 22% (3 months, p = 0.004) and 34% (18 months, p = 0.002) decreasing to 0.7% (6 months off therapy). Calvarium K(bone) changes were three times larger than other sites. After 6 months off therapy, all K(bone) and BTM values returned towards baseline.
The increased (99m)Tc-MDP skeletal uptake with teriparatide indicated increased bone formation which was supported by BTM increases. After 6 months off therapy, metabolic activity diminished towards baseline. The modulation of (99m)Tc-MDP skeletal uptake during treatment was the result of teriparatide's metabolic activity. These findings may aid the radiological evaluation of similar teriparatide patients having radionuclide bone scans.
已有报道称甲状旁腺素治疗可引起放射性核素骨扫描的视觉变化。为了评估这一点，对 10 名接受甲状旁腺素（20μg/天皮下）治疗的骨质疏松绝经后妇女进行了系列研究，并对其进行了评估和量化，这些妇女在基线、3 个月和 18 个月时接受了（99m）Tc-亚甲基二膦酸盐（MDP）骨扫描，然后在停药 6 个月后进行了检查。
妇女接受 600MBq（99m）Tc-MDP 注射，在 3.5 小时时评估诊断性骨扫描图像。还对全身扫描（10 分钟、1、2、3 和 4 小时）进行了分析，以获取（99m）Tc-MDP 骨骼血浆清除率（K（bone））。对整个骨骼和六个区域（颅骨、下颌骨、脊柱、骨盆、上肢和下肢）获得了骨骼 K（bone）的区域差异。还测量了骨转换标志物（BTM）。
大多数患者在 3 个月和 18 个月的骨扫描图像上显示出视觉变化，停药 6 个月后这些变化消失。增强摄取主要见于颅骨和下肢。整个骨骼 K（bone）显示中位数增加 22%（3 个月，p=0.004）和 34%（18 个月，p=0.002），降低至 0.7%（停药 6 个月）。颅骨 K（bone）的变化是其他部位的三倍。停药 6 个月后，所有 K（bone）和 BTM 值均恢复到基线。
甲状旁腺素治疗后（99m）Tc-MDP 骨骼摄取增加表明骨形成增加，这得到了 BTM 增加的支持。停药 6 个月后，代谢活性向基线下降。治疗期间（99m）Tc-MDP 骨骼摄取的调节是甲状旁腺素代谢活性的结果。这些发现可能有助于对接受放射性核素骨扫描的类似甲状旁腺素患者进行影像学评估。
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