Lewin J S, Rosenfield N S, Hoffer P B, Downing D
Radiology. 1986 Mar;158(3):795-804. doi: 10.1148/radiology.158.3.3945755.
This retrospective study was done to determine the value of combined bone (technetium-99m methylene-diphosphonate) and gallium-67 citrate imaging in selected children with complicated clinical situations. Thirty-one children were evaluated for suspected osteomyelitis by bone scan followed within 4 days by a gallium scan. These 31 children represented a subpopulation in whom the Tc-99m scan is known to be potentially unreliable in diagnosing acute osteomyelitis. Eight children had acute osteomyelitis by strict criteria, while 23 did not. The bone scan successfully identified five of the eight with osteomyelitis but was positive in ten of the other 23. The gallium scan correctly identified all eight with osteomyelitis but was positive in seven of the other 23. The gallium scan was significantly less specific when the suspected lesion was in the extremities compared with central locations; causes of false-positive gallium scans included fracture and juvenile rheumatoid arthritis. Combined gallium and bone scanning increased accuracy of the scintigraphic diagnosis of acute osteomyelitis. Both tests may, however, be abnormal in conditions other than osteomyelitis. These findings emphasize the importance of correlating all imaging studies in detection of osteomyelitis.
本回顾性研究旨在确定联合骨显像（锝-99m亚甲基二膦酸盐）和枸橼酸镓-67显像在选定的临床情况复杂的儿童中的价值。对31例疑似骨髓炎的儿童先进行骨扫描评估，随后在4天内进行镓扫描。这31名儿童代表了一个亚群体，已知在该群体中锝-99m扫描在诊断急性骨髓炎时可能不可靠。严格按照标准，8名儿童患有急性骨髓炎，23名儿童未患急性骨髓炎。骨扫描成功识别出8例骨髓炎患儿中的5例，但在另外23例中的10例呈阳性。镓扫描正确识别出所有8例骨髓炎患儿，但在另外23例中的7例呈阳性。与病变位于身体中央部位相比，当疑似病变位于四肢时，镓扫描的特异性显著降低；镓扫描假阳性的原因包括骨折和幼年类风湿关节炎。联合镓扫描和骨扫描提高了急性骨髓炎闪烁显像诊断的准确性。然而，在骨髓炎以外的情况下，这两种检查结果都可能异常。这些发现强调了在骨髓炎检测中关联所有影像学检查的重要性。
