Buckwalter J A, Brandser E A
University of Iowa Hospitals and Clinics, Iowa City, USA.
Am Fam Physician. 1997 Apr;55(5):1761-8.
Metastatic cancer is among the most frequent causes of skeletal pain associated with a destructive bone lesion or pathologic fracture in adults. Patients with a known primary carcinoma should undergo systematic evaluation and monitoring to determine the extent of skeletal disease and risk of pathologic fracture. Patients without a known primary carcinoma who have symptoms consistent with metastatic disease of the skeleton present a diagnostic dilemma. Plain radiographs may not reveal a metastatic lesion until extensive marrow replacement has occurred. Bone scans are more sensitive than radiographs and provide a survey of the entire skeleton. However, increased uptake on a bone scan is not specific and some neoplasms are poorly detected by scintigraphy. Computed tomography can identify bone destruction or neoplastic bone formation that is not easily demonstrated by plain radiographs and can help the clinician assess the risk of pathologic fracture. Magnetic resonance imaging may be helpful in detecting and defining the extent and precise location of marrow lesions and soft tissue extension of neoplasms.
转移性癌症是成人骨骼疼痛最常见的原因之一，常伴有破坏性骨病变或病理性骨折。已知患有原发性癌的患者应接受系统评估和监测，以确定骨骼疾病的范围和病理性骨折的风险。没有已知原发性癌但有与骨骼转移性疾病相符症状的患者面临诊断难题。普通X线片在广泛骨髓替代发生之前可能无法显示转移性病变。骨扫描比X线片更敏感，可对整个骨骼进行检查。然而，骨扫描摄取增加并不具有特异性，一些肿瘤通过闪烁扫描术难以检测到。计算机断层扫描可以识别普通X线片不易显示的骨破坏或肿瘤性骨形成，并有助于临床医生评估病理性骨折的风险。磁共振成像可能有助于检测和确定骨髓病变的范围和精确位置以及肿瘤的软组织延伸情况。
