Pomeranz S J, Pretorius H T, Ramsingh P S
Department of Nuclear Medicine, The Christ Hospital, Cincinnati, OH 45219.
Semin Nucl Med. 1994 Jul;24(3):188-207. doi: 10.1016/s0001-2998(05)80010-8.
The integration of multiple imaging modalities in the assessment of musculoskeletal neoplasia is complex. Although no two instances are identical, certain guidelines can be gleaned from our experience as well as that reported in the literature. Assessment of most soft tissue masses is best carried forth with a combination of conventional radiography and magnetic resonance imaging (MRI). Screening skeletal scintigraphy without localizing symptomatology that includes axial and appendicular skeleton is best carried out initially with bone scintigraphy. Screening the axial skeleton in the presence of clinical symptomatology or a strong suspicion of axial skeletal metastases or pathology is best implemented as a total spine screening examination with MRI and specialized pulsing sequences. Computed tomography is reserved primarily for assessment of cortical and juxtacortical lesions, fracture fragment positioning and/or configuration, and characterization of lesion matrix calcification or ossification when conventional radiographs are indeterminate. Although physical examination and conventional radiography still remain the initial medical algorithms used to evaluate possible musculoskeletal neoplasia, primary skeletal tumors may require multimodality imaging to segregate aggressive and nonaggressive processes. In this multimodality scenario, bone scintigraphy has a critical role in assisting with differentiation between malignant and benign neoplasms.
在肌肉骨骼肿瘤的评估中，多种成像模态的整合较为复杂。尽管没有两个病例是完全相同的，但我们的经验以及文献报道中仍可总结出某些指导原则。对于大多数软组织肿块的评估，最好结合传统放射摄影和磁共振成像（MRI）进行。在没有局部症状（包括轴向和附属骨骼）的情况下，最初最好通过骨闪烁显像进行骨骼闪烁显像筛查。在存在临床症状或高度怀疑轴向骨骼转移或病变时，对轴向骨骼进行筛查最好采用MRI和专门的脉冲序列进行全脊柱筛查检查。计算机断层扫描主要用于评估皮质和皮质旁病变、骨折碎片的定位和/或形态，以及在传统放射照片不确定时对病变基质钙化或骨化进行特征描述。尽管体格检查和传统放射摄影仍然是用于评估可能的肌肉骨骼肿瘤的初始医学方法，但原发性骨肿瘤可能需要多模态成像来区分侵袭性和非侵袭性病变。在这种多模态情况下，骨闪烁显像在协助区分恶性和良性肿瘤方面具有关键作用。
