Hundeshagen H, Diehl V, Creutzig H
Strahlentherapie. 1985 Aug;161(8):502-5.
The importance of bone scintigraphy for the classification of stages of lymphogranulomatosis is judged differently, the indications in literature are not unanimous. The high sensitivity of this method is uncontested, but it is said to be not very reliable in the exclusion of a bone manifestation because of its low specificness. Bone scintigraphy demonstrates a disturbance in bone metabolism; in clinical examination this has to be checked by X-ray view in order to exclude not tumor-induced reasons for the increased or decreased concentration. In a prospective study we have investigated if this combined radiologic approach allows to use scintigraphy in the classification of stages. Four out of 23 patients in stage I showed a tumor-suspicious scintigram which was confirmed by X-ray examination within 1 1/2 years in two patients. One quarter of 133 patients in stage II and III had a pathologic scintigram. In 34 out of 36 patients who could be followed up, this was confirmed later on by an X-ray finding in the same site. 15 out of 36 patients in stage III with initially normal scintigram showed a conversion to a tumor-suspicious scan during the later course of the disease. The tumor-suspicious scintigraphy found at the time of classification of stages has been confirmed later on by X-ray examination in 91% of our series. So, scintigraphy may be considered to be valuable for the classification of stages. Furthermore the conformity of tumor-suspicious scintigram and bone marrow biopsy was investigated. Whereas in 62% of patients with M+ a bone manifestation could be demonstrated by scintigraphy, only 46% of patients with scintigraphic 0+ showed a histologic manifestation in bone marrow. Consequently, bone scintigraphy cannot be used to demonstrate or to exclude a manifestation in bone marrow. As the metabolism is modified by therapy in case of a demonstrated bone manifestation, scintigraphy should be a sensitive parameter in these cases, too, for an early indication of response to cytostatic treatment. The scintigram became normal in 46 patients coming to a complete remission; eight out of nine patients the scintigraphic findings of whom became worse were non-responders. Five out of twelve patients with unchanged scintigram came to a remission. A normalizing scintigram indicates a response to therapy, whereas a deterioration suggests a non-response. Bone scintigraphy can also be used to judge the success of a cytostatic therapy.
骨闪烁显像在淋巴肉芽肿病分期中的重要性存在不同看法，文献中的指征并不一致。该方法的高敏感性无可争议，但因其特异性低，据说在排除骨表现方面不太可靠。骨闪烁显像显示骨代谢紊乱；在临床检查中，必须通过X线检查来核实，以排除非肿瘤性原因导致的浓度升高或降低。在一项前瞻性研究中，我们调查了这种联合放射学方法是否能使闪烁显像用于分期。23例I期患者中有4例显示出可疑肿瘤的闪烁显像图，其中2例在1年半内通过X线检查得到证实。133例II期和III期患者中有四分之一有病理闪烁显像图。在36例可随访的患者中，有34例后来在同一部位的X线检查证实了这一点。36例III期患者中有15例最初闪烁显像正常，但在疾病后期转为可疑肿瘤扫描。在我们的系列研究中，91%在分期时发现的可疑肿瘤闪烁显像后来通过X线检查得到证实。因此，闪烁显像可被认为对分期有价值。此外，还研究了可疑肿瘤闪烁显像图与骨髓活检的一致性。在62%的M+患者中，闪烁显像可显示骨表现，而闪烁显像0+的患者中只有46%在骨髓中显示出组织学表现。因此，骨闪烁显像不能用于显示或排除骨髓中的表现。由于在已证实有骨表现的情况下，治疗会改变代谢，闪烁显像在这些病例中也应是一个敏感参数，用于早期提示对细胞毒性治疗的反应。46例完全缓解的患者闪烁显像图恢复正常；9例闪烁显像结果恶化的患者中有8例无反应。12例闪烁显像无变化的患者中有5例缓解。闪烁显像图恢复正常表明对治疗有反应，而恶化则提示无反应。骨闪烁显像也可用于判断细胞毒性治疗的效果。
