Lin W Y, Wang S J, Cheng K Y, Shen Y Y, Changlai S P
Department of Nuclear Medicine, Taichung Veterans General Hospital, Taiwan.
Clin Nucl Med. 1998 Nov;23(11):743-6. doi: 10.1097/00003072-199811000-00004.
Tuberculosis (TB) remains a major cause of skeletal infection in many parts of the world. Bone scintigraphy is an excellent screening test for bone lesions and Ga-67 scintigraphy is a useful tool for detecting inflammatory lesions. This study determined the value of bone and Ga-67 scans in patients with skeletal TB. Tc-99m MDP and Ga-67 whole-body scans were performed in 24 patients with proved skeletal TB. Twenty-six TB lesions were found in these 24 patients, 8 in the spine, 5 in the knee, 5 in the wrist, 4 in the ankle, 2 in the elbow, 1 in the finger, and 1 in the sacroiliac joint. Of the 26 TB lesions, Tc-99m MDP bone imaging detected 24 and Ga-67 scans revealed 23. The sensitivity rates were 92% (24 of 26) and 88.5% (23 of 26) for bone scans and Ga-67 scans, respectively. When the scans were evaluated in combination, the detection sensitivity was 96.1% (25 of 26). Two lesions that the bone scan failed to detect were in the spine. Ga-67 imaging failed to detect two spinal lesions and one lesion in the knee. The detection sensitivities of bone and gallium scans were high for skeletal TB, although neither scan was specific for TB lesions. Either the bone or Ga-67 scan can be used in the clinical setting as a convenient screening test to detect multiple sites of bone involvement in TB, and to indicate the sites for further detailed evaluation by CT, MRI, or biopsy.
在世界许多地区，结核病（TB）仍然是骨骼感染的主要原因。骨闪烁扫描是检测骨病变的一项出色筛查试验，而镓-67闪烁扫描是检测炎性病变的一种有用工具。本研究确定了骨扫描和镓-67扫描在骨骼结核患者中的价值。对24例已证实患有骨骼结核的患者进行了锝-99m亚甲基二膦酸盐（Tc-99m MDP）和镓-67全身扫描。在这24例患者中发现了26处结核病灶，其中8处在脊柱，5处在膝关节，5处在腕关节，4处在踝关节，2处在肘关节，1处在手指，1处在骶髂关节。在这26处结核病灶中，Tc-99m MDP骨显像检测出24处，镓-67扫描显示出23处。骨扫描和镓-67扫描的灵敏度分别为92%（26处中的24处）和88.5%（26处中的23处）。当联合评估扫描结果时，检测灵敏度为96.1%（26处中的25处）。骨扫描未能检测到的两处病灶在脊柱。镓-67显像未能检测到两处脊柱病灶和一处膝关节病灶。尽管两种扫描都对结核病灶不具有特异性，但骨扫描和镓扫描对骨骼结核的检测灵敏度较高。在临床环境中，骨扫描或镓-67扫描均可作为一种便捷的筛查试验，用于检测结核病中骨骼受累的多个部位，并指明需要通过CT、MRI或活检进行进一步详细评估的部位。
