Stokkel M P, Valdés Olmos R A, Hoefnagel C A, Richel D J
Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam.
Clin Nucl Med. 1993 Oct;18(10):821-8. doi: 10.1097/00003072-199310000-00001.
Bone scintigraphy is very sensitive in detecting metastases in an early stage, when changes in osteoblast function precede morphologic changes. In many oncologic situations, however, osteoarticular abnormal changes seen on the bone scan are not caused by tumor infiltration. They may be due to tumor associated conditions, such as carcinoma polyarthritis and hypertrophic pulmonary osteoarthropathy. They also may be due to therapy-associated conditions, such as the flare effect on metastases due to hormonal treatment, chemotherapy or radiotherapy, and osteonecrosis as a complication of radiotherapy or the use of corticosteroids. The introduction of Colony Stimulating Factors (CSF) to reduce myelotoxicity have allowed higher doses of chemotherapeutic agents to be administered. Currently, there is research being performed on the clinical effects of CSF in phase-II studies. In addition to the flare response of metastases, increased uptake in the axial skeleton and/or juxta-articular areas on bone scintigraphy in five patients receiving CSF has been observed. This new phenomenon could be explained by a reaction to a very cellular marrow caused by the use of CSF. The clinical relevance of this finding remains to be established. The authors present an overview of these old and new phenomena seen on the bone scan with clinical and roentgenologic correlation.
骨闪烁扫描术在早期检测转移瘤方面非常敏感，此时成骨细胞功能的变化先于形态学改变。然而，在许多肿瘤情况下，骨扫描上所见的骨关节异常改变并非由肿瘤浸润所致。它们可能归因于肿瘤相关情况，如癌性多关节炎和肥大性肺性骨关节病。它们也可能归因于治疗相关情况，如激素治疗、化疗或放疗对转移瘤的激发效应，以及放疗或使用皮质类固醇引起的骨坏死作为并发症。引入集落刺激因子（CSF）以降低骨髓毒性使得能够给予更高剂量的化疗药物。目前，正在进行CSF临床效果的II期研究。除了转移瘤的激发反应外，在接受CSF的5例患者中还观察到骨闪烁扫描时中轴骨骼和/或关节周围区域摄取增加。这种新现象可以用使用CSF导致的对非常活跃的骨髓的反应来解释。这一发现的临床相关性仍有待确定。作者结合临床和放射学相关性，对骨扫描上所见的这些新老现象进行了综述。
