Department of Radiology, Derriford Hospital, Plymouth Hospitals NHS Trust, Derriford Rd, Crownhill, Plymouth, Devon PL6 8DH, England.
Radiographics. 2012 Jan-Feb;32(1):105-27. doi: 10.1148/rg.321115041.
Increasing use of a wide variety of therapeutic drugs with known musculoskeletal side-effect profiles necessitates a rigorous understanding and approach when evaluating imaging features suggestive of drug-induced musculoskeletal abnormalities. The etiology of such abnormalities is diverse, and the clinical and imaging manifestations may be nonspecific. The recognition of adverse effects depends, first, on the physician's vigilant review of clinical information for relevant drug history and indicative signs, and second, on the radiologist's ability to detect musculoskeletal changes consistent with known potential effects of specific drugs. Musculoskeletal abnormalities induced by therapeutic drugs may be broadly categorized as embryopathic, juvenile, or postmaturation. Embryopathic skeletal abnormalities result from the teratogenic effects of drugs administered to pregnant women (eg, thalidomide, anticonvulsants). Other therapeutic agents characteristically lead to abnormalities during postnatal skeletal maturation (eg, high-dose vitamins or prostaglandin) either because they are used exclusively in children or because they have idiosyncratic effects on immature musculoskeletal structures. Many drugs (eg, statins) may have musculoskeletal side effects that, although independent of the stage of skeletal maturation, are most often seen in adults or elderly people because they are commonly prescribed for people in these age groups. Drug-induced musculoskeletal abnormalities may be further characterized according to the predominant skeletal manifestations as osteomalacic, proliferative, or osteoporotic and according to the involvement of soft tissues as musculotendinous or chondral.
随着具有已知肌肉骨骼副作用特征的各种治疗药物的广泛使用，在评估提示药物引起的肌肉骨骼异常的影像学特征时，需要严格理解和采用方法。此类异常的病因多种多样，临床表现和影像学表现可能不具有特异性。识别不良反应首先取决于医生仔细审查与药物史和指示性体征相关的临床信息，其次取决于放射科医生检测与特定药物潜在作用一致的肌肉骨骼变化的能力。治疗药物引起的肌肉骨骼异常可大致分为胚胎型、青少年型或成熟后型。胚胎骨骼异常是由于孕妇接受的药物（如沙利度胺、抗惊厥药）的致畸作用引起的。其他治疗药物在骨骼成熟后的后期（如大剂量维生素或前列腺素）通常会导致异常，这要么是因为它们仅用于儿童，要么是因为它们对不成熟的肌肉骨骼结构有特异性作用。许多药物（如他汀类药物）可能有肌肉骨骼副作用，尽管这些副作用与骨骼成熟阶段无关，但由于它们通常开给这些年龄段的人群，因此最常见于成年人或老年人。根据主要的骨骼表现，药物引起的肌肉骨骼异常可进一步分为佝偻病、增生性和骨质疏松性，根据软组织受累情况可分为肌肉肌腱或软骨。
