Srivastava Madhur Kumar, Pagala Ram Manohar, Kendarla Vinodh, Nallapareddy Kavitha
Department of Nuclear Medicine, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India.
World J Nucl Med. 2021 Nov 25;20(4):355-360. doi: 10.4103/wjnm.wjnm_155_20. eCollection 2021 Oct-Dec.
Insufficiency fractures (IFs) can be challenging to diagnose due to varied presentations, and sometimes, it changes the course of treatment, as in cancer patients in whom it has to be differentiated with metastatic disease. We present the role of Technetium 99m methylene diphosphonate (Tc-MDP) bone scan, which is a low-cost, simple to perform, whole body diagnostic investigation in the diagnosis of IFs. This is a retrospective analysis of all patients who underwent a Tc-MDP bone scan in a tertiary care teaching hospital during 2013-2017 and were diagnosed as having an IF on bone scan. The bone scans were performed on a dual-head gamma camera using low-energy high-resolution collimators. Of all the bone scan performed during 2013-2017, a total of 138 patients with a mean age of 57.5 ± 14.7 years were diagnosed as having IFs based on bone scan and final clinical diagnosis. Among them, the most common complaint was regional bony pain in 62% of patients, while the most common cause was osteoporosis in 47% of patients, both postmenopausal and senile osteoporosis. In all, 265 sites of fractures were identified with a fracture average of 1.9/patient, the most common site being dorsolumbar vertebrae, followed by ribs and lower limb bones. Many unusual sites were also identified such as talus, sternum, clavicle, and scapula. Tc-MDP bone scan, being noninvasive whole-body imaging, is a useful investigation for evaluation of IFs and in correlation with biochemical analysis and other imaging can be used to determine the etiology of IF.
由于表现形式多样，不全性骨折（IFs）的诊断可能具有挑战性，有时它还会改变治疗进程，比如在癌症患者中，必须将其与转移性疾病相鉴别。我们阐述了锝99m亚甲基二膦酸盐（Tc-MDP）骨扫描的作用，它是一种低成本、操作简单的全身诊断性检查，可用于IFs的诊断。这是一项对2013年至2017年期间在一家三级护理教学医院接受Tc-MDP骨扫描且经骨扫描诊断为IFs的所有患者的回顾性分析。骨扫描使用双头伽马相机和低能高分辨率准直器进行。在2013年至2017年期间进行的所有骨扫描中，共有138例平均年龄为57.5±14.7岁的患者经骨扫描和最终临床诊断被确诊为IFs。其中，最常见的主诉是62%的患者出现局部骨痛，而最常见的病因是47%的患者患有骨质疏松症，包括绝经后骨质疏松症和老年性骨质疏松症。总共确定了265处骨折部位，平均每位患者1.9处骨折，最常见的部位是胸腰椎，其次是肋骨和下肢骨骼。还发现了许多不常见的部位，如距骨、胸骨、锁骨和肩胛骨。Tc-MDP骨扫描作为一种无创的全身成像检查，对于评估IFs很有用，并且与生化分析及其他成像相结合可用于确定IF的病因。
