CAJ | 학술논문

目的评价继发性肥大性骨关节病（HOA）放射性核素显像的特点与鉴别. 方法放射性核素99Tcm-MDP全身骨显像结合临床表现，对继发性HOA的肿瘤患者55例进行了核素闪烁显像分析. 参照Ali分级方法，观察了四肢骨、肩胛骨、锁骨、颅骨、肋骨、骨盆及骨关节的放射性分布和摄取强度. 同时对11例患者进行了疗效的影像学随访观察. 结果 55例患者的四肢长管骨均有“双条征”表现，48例(87%)下肢骨的放射性聚集活度较上肢明显，46例（84%）伴有对称、规律性骨皮质放射性增加，49例（89%）呈均匀态的累及，31例患者有对称性关节周围放射性浓集的增加. 疗效观察11例患者有6例随原发病灶的去除HOA影像特征及临床表现得到明显改善或消失，2例呈波动性，1例无变化，2例影像学及症状、体征加重. 结论“双条征”为HOA主要影像学改变. HOA的放射性核素影像特征易与骨转移瘤等相鉴别. HOA的影像随访观察有助于疗效、病情发展及预后的评估.
목적평개계발성비대성골관절병（HOA）방사성핵소현상적특점여감별. 방법방사성핵소99Tcm-MDP전신골현상결합림상표현，대계발성HOA적종류환자55례진행료핵소섬삭현상분석. 삼조Ali분급방법，관찰료사지골、견갑골、쇄골、로골、륵골、골분급골관절적방사성분포화섭취강도. 동시대11례환자진행료료효적영상학수방관찰. 결과 55례환자적사지장관골균유“쌍조정”표현，48례(87%)하지골적방사성취집활도교상지명현，46례（84%）반유대칭、규률성골피질방사성증가，49례（89%）정균균태적루급，31례환자유대칭성관절주위방사성농집적증가. 료효관찰11례환자유6례수원발병조적거제HOA영상특정급림상표현득도명현개선혹소실，2례정파동성，1례무변화，2례영상학급증상、체정가중. 결론“쌍조정”위HOA주요영상학개변. HOA적방사성핵소영상특정역여골전이류등상감별. HOA적영상수방관찰유조우료효、병정발전급예후적평고.
AIM　To evaluate the characteristic findings of the secondary hypertrophic osteoarthropathy （or called hypertrophic pulmonary osteoarthropathy， HPO） and differentiate the bone metastases or some osteoarthropathy diseases from HPO. METHODS　Fifty-five tumor cases were confirmed on HPO with 99Tcm-MDP the whole body bone scintigraphy combined X-ray imaging and clinical manifestation. It was observed to grading scale and distribution of radionuclide in extremities, scapulae, clavicles, skull, ribs, pelvis, patella and joints referring to Ali's method. At the same time, 11 cases with HPO were followed after operation, radio-therapy and/or chemical therapy. RESULTS　Double stripe sign mainly in long bones was found in all 55 cases. Involvement of the extremities was invariably present, 44 cases (87%) almost always appeared more active in the lower than in the upper extremities. There was a symmetrical , regular increase of activity along cortical margins in 46 cases (84%) and uniformity involvement in 49 cases (89%). There was also an abnormally increased activity in and around the joints in 31 cases. Whereas the observation of curative effects on HPO, there were some changes of clinical symptoms, signs and bone scan within 6～24 mo after appropriate therapy of the associated disease process, such as a complete remission or subsided in 6 cases, a fluctuating intensity of uptake in 2 cases, no improved in 1 case and aggravating in 2 cases. CONCLUSION　Double stripe sign is a main characteristic findings for HPO. The distribution of the activity between bone metastases and HPO is entirely different. The follow up for HPO by bone scan will make for observation and evaluation of curative effect.