全身影像学方法在多灶性骨坏死诊断中的评价：一项初步研究。
Evaluation of whole-body modalities for diagnosis of multifocal osteonecrosis-a pilot study.
机构信息
Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
Department of Diagnostic Imaging, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
出版信息
Arthritis Res Ther. 2021 Mar 11;23(1):83. doi: 10.1186/s13075-021-02473-3.
BACKGROUND
This study aimed to investigate the ability of whole-body bone scintigraphy (WB-BS) in the detection of multifocal osteonecrosis (ON) compared to whole-body magnetic resonance imaging (WB-MRI) and to clarify the characteristics of patients with multifocal ON among those with ON of the femoral head (ONFH) using WB-MRI.
METHODS
Forty-six patients who had symptomatic ONFH and underwent surgery in our hospital from April 2019 to October 2020 were included in the study. Data on patient demographics, including age, sex, body mass index (BMI), history of corticosteroid intake, alcohol abuse, smoking, and symptomatic joints, were collected from their medical records. All patients underwent WB-MRI and WB-BS before surgery.
RESULTS
The agreement in the detection of ON by WB-MRI vs the uptake lesions by WB-BS in the hip joints was moderate (κ = 0.584), while that in other joints was low (κ < 0.40). Among the 152 joints with ON detected by WB-MRI, 92 joints (60.5%) were symptomatic, and 60 joints (39.5%) were asymptomatic. Twelve out of the 46 (26.0%) patients had multifocal (three or more distinct anatomical sites) ON. Nonetheless, while WB-BS detected symptomatic ON detected by WB-MRI as uptake lesions in 82.6% (76/92) of the joints, asymptomatic ON detected by WB-MRI was detected as uptake lesions in 21.7% (13/60) of the joints. All patients with multifocal ON had a history of steroid therapy, which was significantly higher than that in patients with oligofocal ON (P = 0.035). The patients with a hematologic disease had multifocal ON at a higher rate (P = 0.015).
CONCLUSIONS
It might be difficult for WB-BS to detect the asymptomatic ON detected by WB-MRI compared to symptomatic ON. Considering the cost, examination time, and radiation exposure, WB-MRI might be useful for evaluating multifocal ON. Larger longitudinal studies evaluating the benefits of WB-MRI for detecting the risk factors for multifocal ON are required.
背景
本研究旨在探讨全身骨闪烁扫描（WB-BS）在检测多灶性骨坏死（ON）方面的能力，与全身磁共振成像（WB-MRI）相比，并阐明使用 WB-MRI 检测到的多灶性 ON 患者中，ON 患者的特征。股骨头（ONFH）。
方法
纳入 2019 年 4 月至 2020 年 10 月我院因症状性 ONFH 而行手术治疗的 46 例患者。从病历中收集患者人口统计学资料，包括年龄、性别、体重指数（BMI）、皮质类固醇摄入史、酗酒、吸烟和症状关节。所有患者均在术前进行 WB-MRI 和 WB-BS 检查。
结果
WB-MRI 检测到的 ON 与 WB-BS 检测到的髋关节摄取病变之间的一致性为中度（κ=0.584），而其他关节的一致性为低（κ<0.40）。在 152 个经 WB-MRI 检测到的 ON 关节中，92 个关节（60.5%）为症状性，60 个关节（39.5%）为无症状性。46 例患者中有 12 例（26.0%）有多灶性（三个或更多不同解剖部位）ON。尽管如此，WB-BS 在 82.6%（76/92）的关节中检测到 WB-MRI 检测到的症状性 ON 的摄取病变，但在 21.7%（13/60）的关节中检测到 WB-MRI 检测到的无症状性 ON 的摄取病变。所有多灶性 ON 患者均有类固醇治疗史，明显高于寡灶性 ON 患者（P=0.035）。血液病患者多灶性 ON 的发生率更高（P=0.015）。
结论
WB-BS 可能难以检测到 WB-MRI 检测到的无症状性 ON，与症状性 ON 相比。考虑到成本、检查时间和辐射暴露，WB-MRI 可能有助于评估多灶性 ON。需要进行更大的纵向研究，评估 WB-MRI 检测多灶性 ON 危险因素的益处。
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