Murray I P, Dixon J, Kohan L
Department of Nuclear Medicine, The Prince of Wales Hospital, Sydney, Australia.
Clin Nucl Med. 1990 Nov;15(11):828-40. doi: 10.1097/00003072-199011000-00015.
In the assessment of acute knee pain following recent trauma frequently related to sporting activities, bone scintigraphy was performed on 52 patients; in 40 of these patients, scintigraphy immediately preceded arthroscopy. SPECT was critical in providing delineation and sitting of the abnormalities; this would not have been feasible with conventional planar imaging in 45 of the patients. Multiple sites of focal uptake were frequently visualized at ligamentous insertions or in intra-articular areas of cartilaginous erosion. Damaged anterior cruciate ligaments were only identified in 5 out of 10 patients, occurring when there was avulsion of the tibial attachment, but changes resulting from patellar injury were demonstrated in all 8 patients. The most characteristic scintigraphic change resulted from meniscal tears, which was diagnosed in 31 out of 35 patients in whom the lesion had been suspected clinically. In the identification of this common injury, SPECT had a sensitivity of 88%, specificity of 87%, and diagnostic accuracy of 88%. Thus, although trauma readily induces scintigraphic abnormalities in and around the knee, the patterns of alteration associated with particular lesions can be identified by SPECT and can provide considerable assistance in management, particularly in determining the need for arthroscopy.
在评估近期与体育活动相关的创伤后急性膝关节疼痛时，对52例患者进行了骨闪烁扫描；其中40例患者在关节镜检查前立即进行了闪烁扫描。单光子发射计算机断层扫描（SPECT）对于明确异常情况的位置至关重要；对于45例患者，传统平面成像无法做到这一点。在韧带附着处或软骨侵蚀的关节内区域经常可见多个局灶性摄取部位。10例患者中只有5例识别出前交叉韧带损伤，发生在胫骨附着点撕脱时，但所有8例髌骨损伤患者均显示出相关变化。半月板撕裂导致的闪烁扫描变化最具特征性，在临床怀疑有该病变的35例患者中，31例被诊断出。在识别这种常见损伤时，SPECT的敏感性为88%，特异性为87%，诊断准确性为88%。因此，尽管创伤很容易在膝关节及其周围诱发闪烁扫描异常，但SPECT可以识别与特定病变相关的改变模式，并在治疗管理中提供很大帮助，特别是在确定是否需要进行关节镜检查方面。
