骨骼系统核医学培训课件

1、骨骼系统核医学12022/10/5Learning contentTo review the anatomy and physiology of skeletal systemTo introduce nuclear medicine inspection methodTo discribe the normal and abnormal manifestation of bone scanTo master the principle and clinical application of bone scanComparation with relative imageological ex

2、amination骨骼系统核医学12022/10/3Learning cont骨骼系统核医学22022/10/5Image Characteristics of Orthopedic Nuclear MedicineReflect the change of bone metabolic more early diagnosisShow overall skeleton in one pictureProvide more anatomy information (by SPECT or image fusion of SPECT/CT)Safe, noninvasive, simple an

3、d convenientNo absolute contraindicationHigh effect-cost ratio骨骼系统核医学22022/10/3Image Charact骨骼系统核医学32022/10/5Anatomy of skeletonGeneral level Axial skeleton skull、spinal、 thorax (rib and sternum) Appendicular skeleton Limb bone、pelvic girdle、 shoulder girdle (clavicle and shoulder blade)Induction fr

4、om four levels:Axial skeletonAppendicular skeleton骨骼系统核医学32022/10/3Anatomy of sk骨骼系统核医学42022/10/5Anatomy of skeletonperiosteumHaversian system compact bonecancellous boneTissue levelCompact bone(cortical bone) Arranging by haversian systemForming the outer layer of bone (cortex)Constituting 80% of o

5、sseousContain 99% of total calcium and 90% of phosphateCancellous bone (trabecula bone)Storage of hematopoietic cell and blood cell8 times of cortical bone in update 骨骼系统核医学42022/10/3Anatomy of sk骨骼系统核医学52022/10/5Anatomy of skeletonCellular levelosteoblast成骨细胞 derived from mesenchymal tissue produci

6、ng organic constituentosteocyte骨细胞 mineralized from osteoblast producing inorganic constituentosteoclast破骨细胞 derived from hematopoietic system acting on bone resorption骨骼系统核医学52022/10/3Anatomy of sk骨骼系统核医学62022/10/5Anatomy of skeletonStructure and function of bone matrix Molecular level structure fu

7、nctionorganic matrix (35%) collagenous fiberProviding support and tension proteoglycanControlling iron transport through matrix sialoproteinPromoting calcification osteocalcinInhibition calcium and phosphate deposition,promoting bone resorption lamininStabilizing basement membrane of skeleton calmod

8、ulinCombining calcium onto skeleton albuminTransfering essential substance to matrixinorganic matrix (65%) calciumProviding hardness and stress phosphateRegulating Vitamin D, promoting mineralization process骨骼系统核医学62022/10/3Anatomy of sk骨骼系统核医学72022/10/5Function of skeletonSupport and protect for or

9、gansHematopoietic function Maintain the dynamic equilibrium of mineral substanceContinuous remodeling骨骼系统核医学72022/10/3Function of s骨骼系统核医学82022/10/5Theory and Methods Dominant mechanism of imaging agent deposit in skeleton： Combining with hydroxyapatite by chemisorption； Combining with organic matri

10、x.Imaging agent：99mTc-MDP（ Methylenediphosphonate ）7401110MBq（2030mCi）骨骼系统核医学82022/10/3Theory and Me骨骼系统核医学92022/10/5Theory and MethodsUptake of radiotracer in different part of skeleton varies based on： Region blood flow Inorganic salt metabolism Osteogenetic activity骨骼系统核医学92022/10/3Theory and Me骨

11、骼系统核医学102022/10/5Theory and Methods Static imaging and dynamic imaging Whole body imaging and regional imaging Planar imaging and bone tomographyMethods：骨骼系统核医学102022/10/3Theory and MInjection99mTc-MDPImaging by SPECT or SPECT/CTImage analysis and diagnosisWait for 34Hrs Drink warter 1500ml Static I

12、maging procedureInjectionImaging Image analysiBlood flow phase：15 s/frame for 60 sDelayed phase：3h after injection Blood pool phase：35min after injectionBegin after injection immediatelyThree-phase bone imagingDynamic Imaging procedureBlood flow phase：15 s/frame 骨骼系统核医学132022/10/5Dynamic Imaging pro

13、cedureBlood flow phase（血流相）Reflecting large vascular perfusionBlood pool phase（血池相）Reflecting blood distribution in soft tissueDelayed phase（延迟相）Reflecting the metabolic activity of boneThree-phase bone imaging骨骼系统核医学132022/10/3Dynamic Imag骨骼系统核医学142022/10/5Three-phase bone imaging骨骼系统核医学142022/10/3

14、Three-phase 骨骼系统核医学152022/10/5Planar Imaging and Bone TomographyA patient of metastasisWhole body planar image vs lumbar tomography骨骼系统核医学152022/10/3Planar Imagi骨骼系统核医学162022/10/5Normal Manifestation of Bone ScanClear visualizationBilateral symmetryCancellous bone (e.g. flat bone and long bone metap

15、hysis) showed more clear than compact bone (e.g. long bone diaphysis)Kidney and bladder could be seen 骨骼系统核医学162022/10/3Normal Manif骨骼系统核医学172022/10/5Normal bone imaging of infant（1 .5 years old）Normal bone imaging of children（12 years old）Normal Manifestation of Childrens Bone Scan骨骼系统核医学172022/10/

16、3Normal bone 骨骼系统核医学182022/10/5Variation and ArtifactVariation: nonuniform of skull variety of sternum calcification of costicartilage calcification of thyroid cartilage stippling ribs uptake defect of spine asymmetry of humerus tuberositas deltoidea骨骼系统核医学182022/10/3Variation an骨骼系统核医学192022/10/5Ab

17、normal Manifestation of Bone Scan Increased activityThe most commonSingle focal or multiple focalRandom, multiple focal, irregular local lesions densification is the characteristic feature of malignant metastasesHigh uptake in blood flow phase and blood pool phase refer to primary malignancy or infe

18、ctious bone disease骨骼系统核医学192022/10/3Abnormal Man骨骼系统核医学202022/10/5Abnormal Manifestation of Bone Scan Deficient lesionOsteolytic lesionIschemic diseaseArtifact by body surface metal Lower uptake in blood flow phase and blood pool phase refer to ischemic necrosis or bone infarctionANTPOST骨骼系统核医学2020

19、22/10/3Abnormal Man骨骼系统核医学212022/10/5Abnormal Manifestation of Bone Scan Super scan: Increased bone uptake throughout the skeleton and the appearance of bone images is too clear with poor renal visualization, this pattern are more commonly seen in bone metastases and metabolic bone disease.骨骼系统核医学21

20、2022/10/3Abnormal Man骨骼系统核医学222022/10/5Super scan of bone Metastases骨骼系统核医学222022/10/3Super scan o骨骼系统核医学232022/10/5Super scan of Metabolic bone disease骨骼系统核医学232022/10/3Super scan o骨骼系统核医学242022/10/5Clinical ApplicationHave or notSingle or multipleStaging, pain evaluating, prognosisCure effect obse

21、rvingDetecting the dangerous part of pathological fracture1、Metastatic bone disease the first choice indication骨骼系统核医学242022/10/3Clinical App骨骼系统核医学252022/10/5Clinical ApplicationImaging findings: Random, multiple focal, irregular local lesions uptake densification Uptake deficient lesion Coexist of

22、 uptake increase and deficient Super scan Isolate increase uptake lesion Flare phenomenon 主要见于乳腺癌和前列腺癌患者，在临床治疗后6个月内， 患者临床症状改善，但骨显像阳性病灶呈加重表现。 1、Metastatic bone disease骨骼系统核医学252022/10/3Clinical App骨骼系统核医学262022/10/5Clinical Application 1、Metastatic bone diseaseThe two main advantages are： its high se

23、nsitivity in detecting early disease the ease of surveying the entire skeleton骨骼系统核医学262022/10/3Clinical App骨骼系统核医学272022/10/5Clinical ApplicationPrimary malignancy which are mostliable to metastast to bone：Prostate cancerBreast cancerLung cancer1、Metastatic bone disease骨骼系统核医学272022/10/3Clinical Ap

24、p骨骼系统核医学282022/10/5Clinical ApplicationProstate cancerosseous metastasisOsteoblastic metastasis骨骼系统核医学282022/10/3Clinical App骨骼系统核医学292022/10/5Clinical ApplicationFemale, 51, after modified radical mastectomy of breast cancer 14 years, axillary lymph nodes excision. lymph gland 5/21.Chemotherapy for

25、 2 courses after operation. Bone pain for half a year.Breast cancer osseous metastasis骨骼系统核医学292022/10/3Clinical App骨骼系统核医学302022/10/5Clinical ApplicationLung cancer osseous metastasis breast cancer and Lung cancer often show mixed metastasis骨骼系统核医学302022/10/3Clinical App骨骼系统核医学312022/10/5Clinical A

26、pplication A patient after right renal carcinectomyRenal carcinoma osseous metastasis骨骼系统核医学312022/10/3Clinical App骨骼系统核医学322022/10/5Differential Diagnosis Between Benign Disease and MalignancyInvolve entirety of bone, uniform, “Black skull”Involve axial skeleton mainly, multiple, nonuniform骨骼系统核医学3

27、22022/10/3Differential骨骼系统核医学332022/10/5Clinical Application Application Value:Osteosarcoma Wheather multiple Wheather metastasis Therapeutic evaluation Prognosis judgment2、Primary bone tumour骨骼系统核医学332022/10/3Clinical App骨骼系统核医学342022/10/5Clinical ApplicationDevelop of imageology and improvement in

28、 diagnosis and treatment of osteosarcomaX-rayNuclear medicine(SPECT、PET)Confirm range of tumourDetect metastasisMonitor recurrenceCure effect evaluationCT、MRI骨骼系统核医学342022/10/3Clinical App骨骼系统核医学352022/10/5Multicenter Osteosarcoma骨骼系统核医学352022/10/3Multicenter 骨骼系统核医学362022/10/5Pulmonary Metastasis o

29、f Osteosarcoma骨骼系统核医学362022/10/3Pulmonary Me骨骼系统核医学372022/10/5Male，21，OS of right fibula, metastasis to left lung Pulmonary Metastasis of Osteosarcoma骨骼系统核医学372022/10/3Male，21，OS o骨骼系统核医学382022/10/5FDG-PET Metabolic ImagingOS of right tibia, necrosis in center骨骼系统核医学382022/10/3FDG-PET Meta骨骼系统核医学392

30、022/10/5Clinical ApplicationMale，15 years old，multiple bone mass for 8 yearsMultiple hereditary osteochondroma多发性遗传性骨软骨瘤（骨干续连症）2、Primary bone tumour骨骼系统核医学392022/10/3Clinical App骨骼系统核医学402022/10/52、Primary bone tumourMale，15 years old，tenderness of right tibia for 34 yearsClinical Application骨骼系统核医学

31、402022/10/32、Primary bo骨骼系统核医学412022/10/5Chondroblastoma 软骨母细胞瘤骨骼系统核医学412022/10/3Chondroblast骨骼系统核医学422022/10/5Chondrosarcoma软骨肉瘤Male, 20 years old, pain of left pars iliaca for 5 months骨骼系统核医学422022/10/3Chondrosarco骨骼系统核医学432022/10/5Follow-up after Operation9 months after operation, showed tumour r

32、ecurred and confirmed by puncture骨骼系统核医学432022/10/3Follow-up af骨骼系统核医学442022/10/53、OsteomyelitisClinical ApplicationAcute Osteomyelitis:Female，28 years old，severe pneumoniafever , pain and swelling in right lower extremity骨骼系统核医学442022/10/33、Osteomyeli骨骼系统核医学452022/10/5Clinical Application3、Osteomye

33、litisChronic Osteomyelitis:Fracture of bilateral femur, radioactive increased in left femur骨骼系统核医学452022/10/3Clinical App骨骼系统核医学462022/10/5Clinical Application4、Avascular NecrosisDoughnut sign骨骼系统核医学462022/10/3Clinical App骨骼系统核医学472022/10/5Clinical ApplicationDiagnose of fracture:1.Multiple fracture

34、d ribs2.Compression fracture (Differentiate fresh or old fracture)3.Stress fracture5、Traumatic Disorders骨骼系统核医学472022/10/3Clinical App骨骼系统核医学482022/10/5Clinical ApplicationCompression fracture of lumbar : uniform strip uptake increase 骨骼系统核医学482022/10/3Clinical App骨骼系统核医学492022/10/5Clinical Applicat

35、ionFemale，15 years old，pain in bilateral lower shank Stress fracture 应力性骨折 骨骼系统核医学492022/10/3Clinical App骨骼系统核医学502022/10/5Imaging Modalities For Stress FracturesTestAdvantagesDisadvantagesPlain radiographyLow cost, little radiation, wide availability Limited differential detail, poor initial sensit

36、ivityBone scinitigraphyLow cost, high sensitivitySome radiation exposure, limited differential detail, may be falsely positive if focal infection or tumor is presentMagnetic resonance imagingBest differential detail, no radiation, equal or slightly better sensitivity than scintigraphy and higher spe

37、cificityHighest costUltrasonographyNo radiation, low costLittle differential detail, limited data on use in diagnosing stress fractures骨骼系统核医学502022/10/3Imaging Moda骨骼系统核医学512022/10/5Stress FracturesX-ray shows sclerosis and periostealchanges in the fibula. Bone scan confirms focal uptake in the rig

38、ht fibula consistent with a stress fracture. 骨骼系统核医学512022/10/3Stress Fract骨骼系统核医学522022/10/5Clinical Application6、Metabolic bone disease6.1 Hyperparathyroidism Characteristics： 1 Symmetrical increased uptake in whole body bone； 2“Black skull”； 3Beading rib； 4Tie sign sternum；5Kidney shadow light； 6

39、Heterotopia calcification in lung or stomach；7Pseudo-fracture；8、brown tumour(osteitis fibrosa)骨骼系统核医学522022/10/3Clinical App骨骼系统核医学532022/10/5Clinical Application6、Metabolic bone disease6.2 Paget病（畸形性骨炎）骨骼系统核医学532022/10/3Clinical App骨骼系统核医学542022/10/5 Male，72，fever and cough, sputum with blood strea

40、ks 2 months, pain in knees and scelalgia X-ray: shadow in hilum of left lung double-track sign6.3 Hypertrophic Pulmonary Osteoarthropathy 肥大性肺性骨关节病Clinical Application6、Metabolic bone diseaseA type of painful periostitisoften because of lesion in chest accompany with malformation of fingers and toes

41、, hydrosis and skin thichening骨骼系统核医学542022/10/3 Male，72，fe骨骼系统核医学552022/10/5Clinical ApplicationInfection of joint after THA（left）7、Identify of prosthetic loosening or infectious骨骼系统核医学552022/10/3Clinical App骨骼系统核医学562022/10/5Clinical ApplicationProsthetic loosening after THA（right）7、Identify of pr

42、osthetic loosening or infectious骨骼系统核医学562022/10/3Clinical App骨骼系统核医学572022/10/5Clinical ApplicationMale，81，history of thyroid and colon cancer hepatic and pulmonary metastases8、Arthritis and osteoarthrosis骨骼系统核医学572022/10/3Clinical App骨骼系统核医学582022/10/5Clinical Application骨骼系统核医学582022/10/3Clinical App骨骼系统核医学592022/10/5Limitation The major limitation of bone imaging is its nonspecificity. In the majority of cases, the diagnostic significance of scintigraphic findings should aris