核医学骨关节系统.ppt

Musculoskeletalsystem骨、关节,Musculoskeletalsystem骨、关节,放射性核素骨显像Radionuclideboneimaging,第一节解剖与生理,全身骨由骨连接构成骨骼,其构成人体支架.具有支持运动保护内脏的功能,同时对血液的生成与矿物质储存也起着重要作用.,骨的分类,体内位置分:中轴骨,四肢骨基本形态分:长骨,短骨,扁骨,不规则骨.,骨的组成,骨质：骨密质与松质。骨膜：内外两层。骨髓：红与黄骨髓。神经：主要存在于骨膜内。血管：滋养动脉，骨膜动脉，干骺端动脉，骺动脉等。,骨的化学成分,有机质:约占1/3，骨胶原粘蛋白为主。无机质：约占2/3，主要为钙、磷等的盐类，主要成分为羟基磷灰石。,关节,关节面：关节头，关节窝。关节囊关节腔血管神经,Staticboneimaging(静态骨显像）,原理（Principles）,Bone,Organicsubstances(有机物)bonecell,collagen,Minerals:（矿物质）hydroxyapatite(HAP),Ca10(PO4)6(OH)2（羟基磷灰石晶体）witha3106m2surfacearea,过程,Bone,Extracellularfluid(ECF),Bloodflow,Radiopharmaceuticals(tracer),Ionsexchange,i.v.,Traceruptakeincrease(hotspot，热区),Traceruptakedecrease(colddefect，冷区/缺损),1.bloodflowincreased2.boneturnoverincreasedosteoblasticactivity3.newboneformation,1.bloodflowdecreased2.osteonecrosischange3.destructiveprocess.,BloodflowMetabolicchange,Theprocessofbonedisease,ReactionstageProliferatestageStablestage反应期(6m),影响骨聚集磷酸盐的因素,骨的代谢活跃局部血流量交感神经的影响,显像剂Imagingagents（tracer）,P-O-P:Pyrophosphate(PYP,焦磷酸盐)P-C-P:Methylenediphosphonate(MDP,亚甲基二膦酸盐),andHMDP(亚甲基羟基二膦酸盐),剂量,99mTc-MDPismostwidelyusedbonescanimagingagent.Theusualdoseofradiopharmaceuticalis20-25mCi(740-925MBq).Forpediatricpatients,therecommendeddoseisapproximately9.25MBqor0.25mCi/kg,Imagingprotocol（显像方法）,全身骨显像局部显像,Indications（适应征）,早期寻找恶性肿瘤的骨转移灶骨肿瘤或活检定位，判定病变手术范围局部骨痛疑似某些代谢性骨病疑为急性骨髓炎观察移植骨的血供和成活股骨头血供状态的观察,Indications（适应征）,判定X线摄影片难以观察发现的骨折早期诊断某些职业性骨疾病鉴别陈旧性和新近发生的压缩性骨折鉴别非胶原性疾病引起的血清碱性磷酸酶升高诊断和观察正常骨外的骨化组织或病变烧伤后骨坏死的诊断,Scaninterpretation（图像分析）,正常图象：全身骨骼呈对称性分布；基本规律是扁平骨较长骨管状骨清晰；管状骨骼两端放射性多于骨干，大关节较小关节清晰；小儿和青少年骨质生长活跃，在骨骺及干骺端显影剂浓集较成人多。,正常图象,adultchild,正常图象,PelvisSPECTimaging骨盆的断层显像,异常图象（Abnormalimaging）,热区冷区,hotspot,Pagetsdisease,Pagetsdisease,特殊骨显像（Superbonescan）,超级骨显像(super-bongscan)闪烁（flarephenomenon)长骨骨密质显象浓集胸部软组织显影浓集,主要用途,Widespreadmetastases(广泛性骨转移，breastandprostatecancer)Hyperparathyroidism（甲状旁腺功能亢进）,Abnormalradioactivedecrease:colddefect（冷区/缺损）,doughnutsign(炸面圈征),Osteonecrosisinthoraxandlumbarspine胸椎和腰椎的骨质破坏,Multiplebonemetastasis,abnormaltraceruptakeinlungandrightcalfmuscle.,骨外病变或人工伪影所致异常,钙化软组织体位污染异物标记率,骨显像的敏感性与特异性,敏感性非特异性,Clinicalapplications,Searchbonemetastasisatearlystage.,Wholebodymetastasisofprostatecancerlungcancermetastasis肺癌骨转移前列腺癌的全身骨转移rightfemurdoughnutsign,righthipjointhotspot右股骨炸面圈征，右髋关节浓聚灶,Wholebodymetastasisofprostatecancer前列腺癌Superbonescan(超级骨显像),3mafterprostatecancersurgery,18maftersurgery,A:MultiplebonemetastasesB:after89Srtherapy(8m),2m,13m,19mafterprostatecancersurgery,2.Primarybonetumor,Upperside,lowersideofofleftfemurosteogenicsarcoma（成骨肉瘤）,multiplemyeloma多发性骨髓瘤,骨折（Fracture）,Tofindoutfractureinearlystage.Occultorcovertfracture（隐匿性骨折）Stressfracture（应力性骨折）Insufficiencyfracture（不完全性骨折）,Calcaneus(跟骨),Leftfoot4thtoe,代谢性疾病,骨质疏松甲状旁腺功能亢进骨软化症畸形性骨炎,Vertebralfractureinlumbarspine骨质疏松的腰椎椎体骨折,骨髓炎,12-48小时热区与冷区,移植骨,血供新骨形成,股骨头血供,早期发现病变期与修复期,Dynamicboneimaging骨动态显像,PrinciplesandMethod,三时相四时相,Three、four-phaseboneimaging,（three-phaseboneimaging，骨三、四相）ImagingagentanddosageImagingprotocol（血流相、血池相、延迟相）Bloodflowphase:3s/frame,60sBloodpoolphase:2-3minafterinjection,60s/frame,5fDelayedphase:2-4hrs24hrsafterinjection,staticimaging,Indications适应症,Surveybloodsupplyandmetabolicsituationofboneandsofttissue;DifferentiatemalignanttumorfrombenigntumorIschemicnecrosisofthefemoralhead(asepticnecrosisoffemoralhead)Differentiateacuteosteomyelitisfromcellulitis;Evaluateviabilityandbloodsupplyofbonegraft,显像剂,P-O-P:Pyrophosphate(PYP,焦磷酸盐)P-C-P:Methylenediphosphonate(MDP,亚甲基二膦酸盐),andHMDP(亚甲基羟基二膦酸盐),剂量,Theusualdoseofradiopharmaceuticalis20-25mCi(740-925MBq).,方法,3s/frame,60s2-3minafterinjection,40-60s/frame,5-10frame2-4hrs24hrsafterinjection,staticimaging,Normalimaging正常影像,BloodflowphaseBloodpoolphaseDelayedphase,Normalimaging正常影像,A:BloodflowphaseB:Time-activecurveofROIC:Bloodpoolphase感兴趣区的时间放射性曲线,Clinicalapplicationsandinterpretation,Differentiatemalignanttumorfrombenigntumor（骨肿瘤良恶性鉴别）Ischemicnecrosisofthefemoralhead(asepticnecrosisoffemoralhead，股骨头缺血性坏死)Differentiateacuteosteomyelitis（急性骨髓炎）fromcellulitis（蜂窝组织炎）Evaluateviabilityandbloodsupplyofbonegraft（移植骨存活的判断）诊断血管疾病,LeftfemurosteogenicsarcomaA:BloodflowphaseB:Time-activecurveofROI时间-放射性曲线C:BloodpoolphaseD:Delayedphase,RightkneegiantcellsarcomaA:BloodflowphaseB:Time-activecurveofROIC:Delayedphase,Colddefectinrightfemurhead,hotspotinrightfemurheadIschemicnecrosisofthefemoralhead,Jointimaging关节显像,Principlesandmethod,关节炎症、退变、骨性关节压力异常，该部位无机盐代谢增强，局部血供增加，导致关节周围骨更新旺盛Tc-MDP+蛋白,显像剂,反映炎症滑膜局部血供的显像剂：99mTc（99mTcO4）-白蛋白骨显像剂：99mTc-MDP选择性聚集于炎症病灶：111In（99mTc、Ga）-WBC（HIG）,Imagingprotocol（显像方法）,检查前口服过氯酸钾400毫克确定兴趣区three-phaseboneimaging,Indications适应症,Jointdisease骨关节病Arthritis关节炎Suspectjointdisease,withoutradiographyfinding可疑骨关节病Followupofjointdisease关节疾病的随访Followupofprosthesis人工关节的随访Reflexsympatheticdystrophysyndrome,RSDS放射性交感营养不良综合征,Normalimaging,Normalimaging,异常表现Abnormalimaging,hotspotthree-phaseboneimaging,Clinicalapplicationsandinterpretation,Rheumatoidarthritis类风湿性关节炎Osteoarthritis骨关节炎/退行性关节病Prosthesis人工关节Re