Huić D, Ivancević V, Richter W S, Munz D L
Clinical Department of Nuclear Medicine and Radiation Protection, University Hospital Rebro, Zagreb, Croatia.
J Nucl Med. 1997 Nov;38(11):1755-8.
The aim of our study was to determine the normal range of the 99mTc-labeled anti-NCA 95 antigranulocyte antibody (AGAb) uptake in the bone marrow using the sacroiliac-to-background uptake ratio in the posterior view.
We made 169 planar bone marrow scans on 162 patients who were each injected with 555 MBq AGAb. Fifty patients with the diagnosis of infection/pyrexia of unknown origin (PUO) and with completely normal bone marrow scintigraphy were defined as the normal group. Uptake ratios were calculated drawing irregular regions of interest around the sacroiliac and a background area, respectively.
The normal group revealed a mean uptake ratio of 7.3 +/- 2.3 (range 4.4-12.6). Similar uptake ratios were obtained in patients with the primary diagnosis of infection/PUO and bone marrow extension (7.4 +/- 2.2, range 4.2-11.7), suggesting that the bone marrow reacts on infection primarily by extension into the periphery, without any significant increase of the activity of the central hemopoietic/granulopoietic bone marrow. Mean uptake ratios also were not significantly different in patients with normal bone marrow scintigraphy and the primary diagnosis of solid malignant tumors, lymphomas and plasmacytomas, and in patients with focal lesions visible on bone marrow scintigraphy (soft tissue inflammation or cold lesions in the bone marrow but with normal sacroiliac regions). Mean uptake ratios in the normal group were significantly age related, amounting to 8.5 +/- 1.8, 7.5 +/- 1.9 and 6.1 +/- 2.0 in patients younger than 40 yr, between 40 and 59 yr, and 60 yr or older, respectively (p = 0.0025). The method revealed good inter- and intraobserver agreement with correlation coefficients of about r = 0.90 and r = 0.95, respectively. Inter- and intraobserver coefficients of variation were 6.6% and 4.6%, respectively.
Determination of the bone marrow uptake ratio is simple and reproducible. The normal values established in this study were age dependent, which has to be considered when interpreting bone marrow uptake ratios. The presence of infection/PUO, solid malignant tumors, lymphomas and plasmacytomas does not seem to alter the AGAb uptake ratio significantly. The most important application of the quantitative analysis of bone marrow scintigraphy could be the diagnosis and follow-up of diseases with depression of the central hemopoietic activity.
我们研究的目的是使用后位图像中骶髂关节与本底摄取比值来确定99mTc标记的抗NCA 95抗粒细胞抗体（AGAb）在骨髓中的正常摄取范围。
我们对162例患者进行了169次平面骨髓扫描，每位患者注射555 MBq的AGAb。50例诊断为感染/不明原因发热（PUO）且骨髓闪烁显像完全正常的患者被定义为正常组。分别在骶髂关节和一个本底区域周围绘制不规则感兴趣区来计算摄取比值。
正常组的平均摄取比值为7.3±2.3（范围4.4 - 12.6）。初步诊断为感染/PUO且有骨髓扩展的患者也得到了相似的摄取比值（7.4±2.2，范围4.2 - 11.7），这表明骨髓对感染的反应主要是向外周扩展，而中央造血/粒细胞生成骨髓的活性没有显著增加。骨髓闪烁显像正常且初步诊断为实体恶性肿瘤、淋巴瘤和浆细胞瘤的患者，以及骨髓闪烁显像可见局灶性病变（软组织炎症或骨髓冷区但骶髂关节区域正常）的患者，其平均摄取比值也无显著差异。正常组的平均摄取比值与年龄显著相关，年龄小于40岁、40至59岁、60岁及以上患者的平均摄取比值分别为8.5±1.8、7.5±1.9和6.1±2.0（p = 0.0025）。该方法显示观察者间和观察者内一致性良好，相关系数分别约为r = 0.90和r = 0.95。观察者间和观察者内变异系数分别为6.6%和4.6%。
骨髓摄取比值的测定简单且可重复。本研究确定的正常值与年龄有关，在解释骨髓摄取比值时必须予以考虑。感染/PUO、实体恶性肿瘤、淋巴瘤和浆细胞瘤的存在似乎并未显著改变AGAb摄取比值。骨髓闪烁显像定量分析的最重要应用可能是对中央造血活性降低的疾病进行诊断和随访。
