[骨显像对淋巴肉芽肿病分期的诊断?]。

Strahlentherapie Pub Date : 1985-08-01
H Hundeshagen, V Diehl, H Creutzig
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引用次数: 0

摘要

骨显像对淋巴肉芽肿分期的重要性判断不一,文献中的适应症也不一致。这种方法的高灵敏度是无可争议的,但由于其特异性低,据说在排除骨骼表现方面不是很可靠。骨显像显示骨代谢紊乱;在临床检查中,必须通过x线检查,以排除非肿瘤引起的浓度升高或降低的原因。在一项前瞻性研究中,我们调查了这种联合放射学方法是否允许在分期分类中使用闪烁成像。23例I期患者中有4例出现肿瘤可疑的闪烁图,其中2例在1年半内通过x线检查证实。133例II期和III期患者中有四分之一有病理闪烁图。在36名可以随访的患者中,有34名患者后来在同一部位的x光检查中证实了这一点。36例III期患者中有15例最初的闪烁图正常,但在疾病的后期过程中转为肿瘤可疑扫描。在分期时发现的肿瘤可疑的闪烁图在我们的系列中有91%的病例后来通过x线检查得到证实。因此,闪烁图可能被认为是有价值的阶段分类。进一步观察可疑肿瘤闪烁图与骨髓活检的符合性。而在62%的M+ a患者中,闪烁成像可以显示骨骼表现,而在闪烁成像0+的患者中,只有46%的患者在骨髓中显示组织学表现。因此,骨显像不能用来证明或排除骨髓的表现。由于在骨骼表现明显的情况下,代谢会因治疗而改变,因此在这些情况下,闪烁成像也应该是一个敏感的参数,用于早期指示对细胞抑制剂治疗的反应。46名完全缓解的患者的闪烁图恢复正常;九名患者中有八名的显像结果恶化为无反应。12例闪烁图未改变的患者中有5例病情缓解。正常的闪烁图表明对治疗有反应,而恶化则表明无反应。骨显像也可以用来判断细胞抑制剂治疗的成功。
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[Bone scintigraphy for the staging of lymphogranulomatosis?].

The importance of bone scintigraphy for the classification of stages of lymphogranulomatosis is judged differently, the indications in literature are not unanimous. The high sensitivity of this method is uncontested, but it is said to be not very reliable in the exclusion of a bone manifestation because of its low specificness. Bone scintigraphy demonstrates a disturbance in bone metabolism; in clinical examination this has to be checked by X-ray view in order to exclude not tumor-induced reasons for the increased or decreased concentration. In a prospective study we have investigated if this combined radiologic approach allows to use scintigraphy in the classification of stages. Four out of 23 patients in stage I showed a tumor-suspicious scintigram which was confirmed by X-ray examination within 1 1/2 years in two patients. One quarter of 133 patients in stage II and III had a pathologic scintigram. In 34 out of 36 patients who could be followed up, this was confirmed later on by an X-ray finding in the same site. 15 out of 36 patients in stage III with initially normal scintigram showed a conversion to a tumor-suspicious scan during the later course of the disease. The tumor-suspicious scintigraphy found at the time of classification of stages has been confirmed later on by X-ray examination in 91% of our series. So, scintigraphy may be considered to be valuable for the classification of stages. Furthermore the conformity of tumor-suspicious scintigram and bone marrow biopsy was investigated. Whereas in 62% of patients with M+ a bone manifestation could be demonstrated by scintigraphy, only 46% of patients with scintigraphic 0+ showed a histologic manifestation in bone marrow. Consequently, bone scintigraphy cannot be used to demonstrate or to exclude a manifestation in bone marrow. As the metabolism is modified by therapy in case of a demonstrated bone manifestation, scintigraphy should be a sensitive parameter in these cases, too, for an early indication of response to cytostatic treatment. The scintigram became normal in 46 patients coming to a complete remission; eight out of nine patients the scintigraphic findings of whom became worse were non-responders. Five out of twelve patients with unchanged scintigram came to a remission. A normalizing scintigram indicates a response to therapy, whereas a deterioration suggests a non-response. Bone scintigraphy can also be used to judge the success of a cytostatic therapy.

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