Coakley F V, Jones A R, Finlay D B, Belton I P
Department of Radiology, Leicester Royal Infirmary.
Clin Radiol. 1995 May;50(5):327-30. doi: 10.1016/s0009-9260(05)83426-9.
To determine the aetiology of solitary spinal hot spots on planar bone scans and to determine which radiographic and scintigraphic features aid in distinguishing benign from malignant lesions.
81 bone scans showing a solitary hot spot in the spine were identified. Aetiology was determined in 73 based on imaging and clinical findings, including clinical follow-up. The location of the hot spot was classified as paravertebral (related to the lateral spinal margin), panvertebral (diffuse uptake confined within a vertebra), hemivertebral (uptake confined between the midline and lateral spinal margin) or complex (all others).
The aetiology of the spinal hot spot was benign in 55 patients and malignant in 18. The latter all belonged to the subgroup of 42 patients with a known malignancy. Only eight of the 18 malignant cases had suggestive plain radiographic findings. There was no significant relationship between aetiology and age. The spinal level of the hot spot was cervical in three (all benign), thoracic in 16 (eight benign) and lumbar in 54 (44 benign). The hot spot was paravertebral in 21 (all benign), panvertebral in 24 (20 benign), hemivertebral in 13 (10 benign) and complex in 15 (only four benign).
Most (75%) solitary spinal hot spots are benign, and even in patients with known malignancy just over half (57%) are benign. Malignant lesions are often (56%) radiographically occult. Thoracic or complex hot spots are more likely to be malignant while paravertebral hot spots are characteristically benign. These features may be helpful in distinguishing benign and malignant lesions in patients with a known malignancy and unremarkable radiographs. Other scintigraphic features are unhelpful in distinguishing benign from malignant lesions.
确定平面骨扫描中孤立性脊柱热点的病因，并确定哪些影像学和闪烁显像特征有助于区分良性与恶性病变。
识别出81例脊柱出现孤立性热点的骨扫描病例。基于影像学和临床发现（包括临床随访），确定了73例的病因。热点的位置分为椎旁（与脊柱外侧缘相关）、全椎体（局限于一个椎体内的弥漫性摄取）、半椎体（摄取局限于中线与脊柱外侧缘之间）或复合型（其他所有情况）。
55例患者脊柱热点的病因是良性的，18例是恶性的。后者均属于42例已知患有恶性肿瘤患者的亚组。18例恶性病例中只有8例有提示性的X线平片表现。病因与年龄之间无显著关系。热点位于颈椎的有3例（均为良性），位于胸椎的有16例（8例良性），位于腰椎的有54例（44例良性）。热点为椎旁的有21例（均为良性），全椎体的有24例（20例良性），半椎体的有13例（10例良性），复合型的有15例（仅4例良性）。
大多数（75%）孤立性脊柱热点是良性的，即使在已知患有恶性肿瘤的患者中，也有略超过一半（57%）是良性的。恶性病变在影像学上通常（56%）隐匿。胸椎或复合型热点更可能是恶性的，而椎旁热点典型地为良性。这些特征可能有助于在已知患有恶性肿瘤且X线平片无明显异常的患者中区分良性与恶性病变。其他闪烁显像特征无助于区分良性与恶性病变。
