摘要
目的：调查国内对全身平面骨扫描前位图像的中下颈部相对高摄取区（RHTUN）的认识情况，并通过SPECT/CT分析其形成的原因。方法：分析2000年以后出版的20本核医学专业书籍、以“骨扫描”和“颈”为条件检索2000年至今的维普中文数据库、向203位成员组成的腾讯QQ群“快乐核医学”发出调查询问，调查国内的核医学专业书籍、核医学专业论文、核医学专业人员对于RHTUN现象的了解及其形成原因的认知情况。选择在同一天行全身平面骨扫描和颈部SPECT/CT断层融合显像的病例100例为研究样本，以SPECT/CT图像为定性标准，分析RHTUN的形成原因。结果：20本书籍均提及RHTUN。关于形成原因，18本书（90%）提到可能是“甲状腺异常摄取99mTcO4-”，13本书（65%）提到还可能是“颈椎骨质增生而过多摄取放射性药物”，8本书（40%）提到还可能是“喉部软骨钙化而异常摄取放射性药物”。维普中文数据库中共检索到14篇文献，其中有关的仅4篇，所有文献均与RHTUN无直接关系。通过“快乐核医学”共收到有效答复105份，105人（100%）均知道RHTUN。关于形成首要原因，72人（68.6%）首先考虑是“甲状腺摄取99mTcO4-”，28人（26.7%）考虑是“颈椎骨质增生而过多摄取放射性药物”，5人（4.8%）考虑是“喉部软骨钙化而异常摄取放射性药物”。在100例样本中，88例出现RHTUN。其中88例（100%）在SPECT/CT图像中均出现颈椎放射性浓聚，以椎间盘附近、椎体后缘放射性水平更高；88例（100%）出现喉部软骨放射性分布，放射性水平都不超过颈椎骨本底放射性水平；88例（100%）均未出现甲状腺异常放射性分布。88例RHTUN中63例呈长条型，其中存在颈椎增生（明确41例、可疑7例、无15例）和椎间盘异常（明确27例、可疑8例、无28例）；局灶型25例，其中存在颈椎增生（明确14例、可疑4例、无7例）和椎间盘异常（明确17例、可疑5例、无3例）。2型之间在颈椎增生方面不存在显著性差异，在椎间盘异常方面存在显著性差异。结论：国内核医学界对于RHTUN的关心程度较低，且认识存在一定误区。颈椎退行性变和颈椎生理性摄取是RHTUN的主要原因。“甲状腺摄取99mTcO4-”发生概率极低，“喉部软骨摄取放射性药物”发生概率很高、但是放射性水平不高，都不是RHTUN的原因。RHTUN呈局灶型时，提示可能合并椎间盘异常。
Abstract
Objective: To investigate the reasons for domestic knowledge about neck’s relatively higher tracer uptake(RHTUN) in anterior image of 99mTc-MDP whole body scanning by SPECT/CT. Methods: After investigating the domestic nuclear medicine professional books and papers for understanding RHTUN and its reasons, analyzing 20 nuclear medicine professional books published after 2000, searching VIP Chinese database with conditions of “bone imaging” and “neck”, and sending questionnaire survey to the Tencent QQ group “happy nuclear medicine” with 203 members, 100 cases of whole body bone imaging and neck SPECT/CT in one day were enrolled in the study. SPECT/CT findings were taken as the qualitative standard to analyse the causes for RHTUN. Results: All 20 books mentioned RHTUN. On the cause of formation, 18 books(90%) referred to “abnormal thyroid uptake of 99mTcO4-”, 13 books(65%) referred to “cervical bone hyperplasia and excessive intake of radioactive drugs”, 8 books(40%) referred to “throat cartilage calcification and abnormal uptake of radioactive drugs”. Only 4 of 14 papers in VIP Chinese database were correlated but not directly related with RHTUN. A total of 105 copies of effective response were got from “happy nuclear medicine”, and 105(100%) all knew RHTUN. About the primary cause of RHTUN, 72(68.6%) supported “thyroid uptake of 99mTcO4-”, 28(26.7%) supported “cervical bone hyperplasia and excessive intake of radioactive drugs”, and 5(4.8%) supported the “throat cartilage calcification and abnormal uptake of radioactive drugs”. In the 100 cases, 88 cases showed RHTUN. 88 cases(100%) showed cervical radioactive concentration in SPECT/CT image with higher radioactive level near intervertebral disc and the posterior side of vertebral body. In 88 cases(100%) of radioactivity distribution in the laryngeal cartilage, the radioactive level was not more than the background level in the cervical vertebra. All 88 cases(100%) showed no abnormal radioactivity distribution in the thyroid. In 88 cases of RHTUN, 63 cases were along with cervical vertebra hyperplasia(clear in 41 cases, suspicious in 7 cases, none in 15 cases) and intervertebral disc anomalies(clear in 27 cases, suspicious in 8 cases, none in 28 cases), and 25 cases were focal with cervical vertebra hyperplasia(clear in 14 cases, suspicious in 4 cases, none in 7 cases) and intervertebral disc anomalies(clear in 17 cases, suspicious in 5 cases, none in 3 cases). There was no significant difference in cervical vertebral hyperplasia or in intervertebral disc anomalies between 2 types. Conclusion: Domestic nuclear medicine profession showed no big concerns or even some misunderstandings on RHTUN. Degeneration of cervical vertebra and cervical physiological uptake were the main reasons of RHTUN. Focal type of RHTUN suggested the possibility of intervertebral disc degeneration.
关键词
甲状腺 /
颈椎 /
体层摄影术 /
发射型计算机 /
单光子 /
99m锝美罗酸盐
Key words
Thyroid /
Cervical vertebrae /
Tomography /
emission-computed /
single-photon /
Technetium tc 99m medronate
李 伟;张汝森;刘 枫;卢斌贵;任志刚.
国内对99mTc-MDP骨扫描前位图像中下颈部相对高摄取现象的认识调查和原因分析[J]. 中国临床医学影像杂志. 2015, 26(3): 200-205
LI Wei;ZHANG Ru-sen;LIU Feng;LU Bin-gui;REN Zhi-gang.
Investigation and reason analysis of domestic knowledge on relatively higher tracer uptake inneck in anterior image of 99mTc-MDP bone scanning[J]. Journal of China Clinic Medical Imaging. 2015, 26(3): 200-205
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