Jones D N
Department of Radiology, Duke University Medical Center, Durham, NC 27710.
J Nucl Med. 1994 Aug;35(8):1347-50.
This report describes the development of multiple-site, biopsy-proven osteonecrosis in a patient with small-cell bronchogenic carcinoma who had received chemotherapy and short-term administration of corticosteroid. Multifocal osteonecrosis has a wide variety of etiologies, but is most often encountered in the clinical setting of corticosteroid administration, connective tissue disorders, transplantation, hemoglobinopathies and dysbarism. In the oncology patient, chemotherapy, corticosteroids and bone marrow transplantation (with associated preparation therapy) have all been implicated as possible causes. There may be a synergistic effect when corticosteroids are used in combination with chemotherapy and radiation treatment. Multiple periarticular abnormalities appearing on serial radionuclide bone scanning of the cancer patient, particularly when symmetric and in a distribution not suggestive of osseous metastatic disease, raise the possibility of multifocal osteonecrosis. Also to be considered in the differential diagnosis are multifocal infection and polysynovitis/arthritis of other etiology. MRI has a high sensitivity and specificity in the diagnosis of osteonecrosis and should be used when this condition is suspected. Early diagnosis of osteonecrosis is important to prevent irreversible bone and joint destruction.
本报告描述了一名小细胞支气管癌患者在接受化疗和短期使用皮质类固醇后发生多部位、经活检证实的骨坏死情况。多灶性骨坏死病因多样，但最常见于皮质类固醇使用、结缔组织疾病、移植、血红蛋白病和气压病的临床环境中。在肿瘤患者中，化疗、皮质类固醇和骨髓移植（以及相关的预处理治疗）都被认为是可能的病因。当皮质类固醇与化疗和放射治疗联合使用时，可能会产生协同作用。癌症患者连续放射性核素骨扫描出现多个关节周围异常，特别是当异常对称且分布不提示骨转移性疾病时，提示多灶性骨坏死的可能性。鉴别诊断中还应考虑多灶性感染和其他病因的多滑膜炎/关节炎。MRI在骨坏死诊断中具有高敏感性和特异性，当怀疑有这种情况时应使用。骨坏死的早期诊断对于预防不可逆的骨和关节破坏很重要。
