Bahk Yong-Whee, Hwang Seok-Ha, Lee U-Young, Chung Yong-An, Jung Joo-Young, Jeong Hyeonseok S
Department of Nuclear Medicine Department of Orthopedics, Sung-Ae General Hospital Department of Anatomy, Catholic Institute for Applied Anatomy Department of Radiology, Incheon St. Mary's Hospital Biomedical Engineering and Research Institute, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Medicine (Baltimore). 2017 Nov;96(45):e8419. doi: 10.1097/MD.0000000000008419.
We prospectively performed gamma correction pinhole bone scan (GCPBS) and histopathologic verification study to make simultaneous morphobiochemical diagnosis of trabecular microfractures (TMF) occurred in the femoral head as a part of femoral neck fracture.Materials consisted of surgical specimens of the femoral head in 6 consecutive patients. The specimens were imaged using Tc-99m hydroxymethylene diphosphonate (HDP) pinhole scan and processed by the gamma correction. After cleansing with 10% formalin solution, injured specimen surface was observed using a surgical microscope to record TMF. Morphological findings shown in the photograph, naive pinhole bone scan, GCPBS, and hematoxylin-eosin (H&E) stain of the specimen were reciprocally correlated for histological verification and the usefulness of suppression and enhancement of Tc-99m HDP uptake was biochemically investigated in TMF and edema and hemorrhage using gamma correction.On the one hand, GCPBS was able to depict the calcifying calluses in TMF with enhanced Tc-99m HDP uptake. They were pinpointed, speckled, round, ovoid, rod-like, geographic, and crushed in shape. The smallest callus measured was 0.23 mm in this series. On the other hand, GCPBS biochemically was able to discern the calluses with enhanced high Tc-99m HDP uptake from the normal and edema dipped and hemorrhage irritated trabeculae with washed out uptake.Morphobiochemically, GCPBS can clearly depict microfractures in the femoral head produced by femoral neck fracture. It discerns the microcalluses with enhanced Tc-99m HDP uptake from the intact and edema dipped and hemorrhage irritated trabeculae with suppressed washed out Tc-99m HDP uptake. Both conventional pinhole bone scan and gamma correction are useful imaging means to specifically diagnose the microcalluses naturally formed in TMF.
我们前瞻性地进行了伽马校正针孔骨扫描（GCPBS）和组织病理学验证研究，以对作为股骨颈骨折一部分的股骨头小梁微骨折（TMF）进行形态生物化学同步诊断。材料包括6例连续患者的股骨头手术标本。使用锝-99m亚甲基二膦酸盐（HDP）针孔扫描对标本进行成像，并通过伽马校正进行处理。用10%福尔马林溶液清洗后，使用手术显微镜观察损伤标本表面以记录TMF。将照片中显示的形态学结果、原始针孔骨扫描、GCPBS以及标本的苏木精-伊红（H&E）染色相互关联以进行组织学验证，并使用伽马校正对TMF以及水肿和出血中锝-99m HDP摄取的抑制和增强作用的实用性进行生物化学研究。一方面，GCPBS能够描绘出TMF中锝-99m HDP摄取增强的钙化骨痂。它们的形状有针尖状、斑点状、圆形、椭圆形、棒状、地图状和破碎状。在本系列中测量到的最小骨痂为0.23毫米。另一方面，GCPBS在生物化学上能够将锝-99m HDP摄取增强的骨痂与正常的、摄取减少的水肿浸润和出血刺激的小梁区分开来。在形态生物化学方面，GCPBS能够清晰描绘股骨颈骨折导致的股骨头微骨折。它能将锝-99m HDP摄取增强的微骨痂与摄取被抑制而减少的完整的、水肿浸润和出血刺激的小梁区分开来。传统针孔骨扫描和伽马校正都是特异性诊断TMF中自然形成的微骨痂的有用成像手段。
