Howarth D M, Mullan B P, Wiseman G A, Wenger D E, Forstrom L A, Dunn W L
Department of Nuclear Medicine and Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota, USA.
J Nucl Med. 1996 Sep;37(9):1456-60.
An analysis of patients with proven Langerhans' cell histiocytosis (LCH) was undertaken with the aim of evaluating the role of bone scintigraphy in the diagnosis and staging of LCH.
Radiographic skeletal surveys and whole-body bone scintigraphy study results were reviewed for all patients treated at the Mayo Clinic in Rochester, Minnesota during 1965-1994 with histologic proven LCH. All available studies were then reported in a randomized and blinded fashion.
Of the 73 patients with the histologic diagnosis, 56 (76%) had a definite lesion reported on radiographs and subsequent biopsy-proven bone involvement. For this population, the sensitivity and specificity of radiographic survey were 100% and 61%, respectively, compared to 91% and 55% for bone scintigraphy. Solitary bone lesions were reported on 21 radiographic surveys and 24 bone scintigrams. For solitary lesions, radiograph sensitivity and specificity were 95% and 73%, respectively, compared to 88% and 77% for bone scintigraphy. Bone scintigraphy receiver operating characteristic curves showed the region of greatest diagnostic accuracy to be skull, facial bones and mandible (88% sensitivity, 52% specificity). Radiation dosimetry to adult reproductive organs was less favorable for radiographic skeletal survey compared to bone scintigraphy.
Our results support the use of radiographic skeletal survey in the initial diagnosis of LCH. Bone scintigraphy may have a role in monitoring a patient's progress in which the initial scintigram and radiographic survey show good correlation.
对确诊为朗格汉斯细胞组织细胞增多症（LCH）的患者进行了分析，目的是评估骨闪烁显像在LCH诊断和分期中的作用。
回顾了1965年至1994年期间在明尼苏达州罗切斯特市梅奥诊所接受组织学确诊为LCH治疗的所有患者的X线骨骼检查和全身骨闪烁显像研究结果。然后以随机和盲法报告所有可用的研究。
在73例经组织学诊断的患者中，56例（76%）在X线片上报告有明确病变，随后经活检证实有骨受累。对于这一人群，X线检查的敏感性和特异性分别为100%和61%，而骨闪烁显像的敏感性和特异性分别为91%和55%。在21次X线检查和24次骨闪烁显像中报告了孤立性骨病变。对于孤立性病变，X线片的敏感性和特异性分别为95%和73%，而骨闪烁显像的敏感性和特异性分别为88%和77%。骨闪烁显像的受试者工作特征曲线显示，诊断准确性最高的区域是颅骨、面骨和下颌骨（敏感性88%，特异性52%）。与骨闪烁显像相比，成人生殖器官的放射剂量测定对X线骨骼检查不太有利。
我们的结果支持在LCH的初始诊断中使用X线骨骼检查。骨闪烁显像可能在监测患者病情进展中发挥作用，其中初始闪烁显像和X线检查显示出良好的相关性。
