《核医学骨关节系统》PPT课件.ppt

1、Musculoskeletal system骨、关节,Musculoskeletal system骨、关节,放射性核素骨显像 Radionuclide bone imaging,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：

2、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,Static bone imaging (静态骨显像）,原理（ Principles ）,Bone,Organic substances (有机物) bone cell, collagen,Minerals: （矿物质） hydroxyapatite (HAP),Ca10(PO4)6(OH)2 （羟基磷灰石晶体）with a 3106m2 surface area,过程,Bone,Extracellular fluid (ECF),Blood flow,Radiopharmac

3、euticals (tracer),Ions exchange,i. v.,Tracer uptake increase (hot spot，热区),Tracer uptake decrease (cold defect，冷区/缺损),1.blood flow increased 2.bone turnover increased osteoblastic activity 3.new bone formation,1.blood flow decreased 2.osteonecrosis change 3.destructive process.,Blood flow Metabolic

4、change,The process of bone disease,Reaction stage Proliferate stage Stable stage 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 Imaging agents （tracer）,P-O-P: Pyrophosphate (PYP, 焦磷酸盐) P-C-P: Methylene diphosphonate (MDP,亚甲基二膦酸盐), and HMDP (亚甲基羟基二膦酸盐),剂量,99mTc-MDP is most widely used bone scan imagin

5、g agent. The usual dose of radiopharmaceutical is 20-25 mCi (740-925 MBq). For pediatric patients, the recommended dose is approximately 9.25MBq or 0.25mCi/kg,Imaging protocol （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

6、（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,Scan interpretation（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,adult child,正常图象,Pelvis SPECT imaging 骨盆的断层显像,异常图象（Abnormal imaging ）,热区 冷区,hot

7、 spot,Pagets disease,Pagets disease,特殊骨显像（Super bone scan ）,超级骨显像(super-bong scan) 闪烁（flare phenomenon) 长骨骨密质显象浓集 胸部软组织显影浓集,主要用途,Widespread metastases (广泛性骨转移，breast and prostate cancer) Hyperparathyroidism （甲状旁腺功能亢进）,Abnormal radioactive decrease: cold defect（冷区/缺损）,doughnut sign (炸面圈征),Osteonecros

8、is in thorax and lumbar spine 胸椎和腰椎的骨质破坏,Multiple bone metastasis, abnormal tracer uptake in lung and right calf muscle.,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,Clinical applications,Search bone metastasis at early stage.,Whole body metastasis of prostate cancer lung cancer metastasis

9、 肺癌骨转移 前列腺癌的全身骨转移 right femur doughnut sign, right hip joint hot spot 右股骨炸面圈征，右髋关节浓聚灶,Whole body metastasis of prostate cancer 前列腺癌 Super bone scan (超级骨显像),3 m after prostate cancer surgery,18 m after surgery,A: Multiple bone metastases B: after 89Sr therapy (8 m),2 m, 13m, 19m after prostate cancer

10、 surgery,2. Primary bone tumor,Upper side, lower side of of left femur osteogenic sarcoma （成骨肉瘤）,multiple myeloma 多发性骨髓瘤,骨折（Fracture）,To find out fracture in early stage. Occult or covert fracture （隐匿性骨折） Stress fracture（应力性骨折） Insufficiency fracture （不完全性骨折）,Calcaneus (跟骨),Left foot 4th toe,代谢性疾病,骨

11、质疏松 甲状旁腺功能亢进 骨软化症 畸形性骨炎,Vertebral fracture in lumbar spine 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,Dynamic bone imaging 骨动态显像,Principles and Method,三时相 四时相,Three、four-phase bone imaging,（three-phase bone imaging，骨三、四相） Imaging agent and dosage Imaging protocol（血流相、血池相、延迟相） Blood

12、 flow phase: 3s / frame, 60s Blood pool phase: 2-3 min after injection, 60s /frame, 5 f Delayed phase: 2-4hrs 24 hrs after injection, static imaging,Indications 适应症,Survey blood supply and metabolic situation of bone and soft tissue; Differentiate malignant tumor from benign tumor Ischemic necrosis

13、of the femoral head (aseptic necrosis of femoral head) Differentiate acute osteomyelitis from cellulitis; Evaluate viability and blood supply of bone graft,显像剂,P-O-P: Pyrophosphate (PYP, 焦磷酸盐) P-C-P: Methylene diphosphonate (MDP,亚甲基二膦酸盐), and HMDP (亚甲基羟基二膦酸盐),剂量,The usual dose of radiopharmaceutical

14、 is 20-25 mCi (740-925 MBq).,方法,3s / frame, 60s 2-3 min after injection, 40-60s /frame, 5-10 frame 2-4hrs 24 hrs after injection, static imaging,Normal imaging 正常影像,Blood flow phase Blood pool phase Delayed phase,Normal imaging 正常影像,A: Blood flow phase B: Time-active curve of ROI C: Blood pool phase

15、 感兴趣区的时间放射性曲线,Clinical applications and interpretation,Differentiate malignant tumor from benign tumor（骨肿瘤良恶性鉴别） Ischemic necrosis of the femoral head (aseptic necrosis of femoral head，股骨头缺血性坏死) Differentiate acute osteomyelitis（急性骨髓炎 ） from cellulitis（蜂窝组织炎） Evaluate viability and blood supply of b

16、one graft （移植骨存活的判断） 诊断血管疾病,Left femur osteogenic sarcoma A: Blood flow phase B: Time-active curve of ROI 时间-放射性曲线 C: Blood pool phase D: Delayed phase,Right knee giant cell sarcoma A: Blood flow phase B: Time-active curve of ROI C: Delayed phase,Cold defect in right femur head,hot spot in right fem

17、ur head Ischemic necrosis of the femoral head,Joint imaging关节显像,Principles and method,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 ）,Imaging protocol （显像方法）,检查前口服过氯酸钾400毫克 确定兴趣区 three-phase bone

18、imaging,Indications 适应症,Joint disease骨关节病 Arthritis 关节炎 Suspect joint disease, without radiography finding 可疑骨关节病 Follow up of joint disease关节疾病的随访 Follow up of prosthesis人工关节的随访 Reflex sympathetic dystrophy syndrome, RSDS 放射性交感营养不良综合征,Normal imaging,Normal imaging,异常表现Abnormal imaging,hot spot three-phase bone imaging,Clinical applications and interpretation,Rheumatoid arthritis类风湿性关节炎 Osteoarthritis骨关节炎/退行性关节病 Prosthesis人工关节 Re