| Abstract | 「緒言」 人骨髄造血巣の分布に関しては19世紀後半より人体解剖例についての検討が諸家により行なわれてきたが, 生存体における造血巣分布は研究手段のないまま放置されてきた. しかるに1953年Anger一派が52Feとgamma cameraを用いて人骨髄造血巣分布を推定して以来最近は99mTc, 198mAu, 52Fe, 113mIn, 等の核種を用い, 又scintillation scannerからscintillation cameraの改良に伴い, 生体における骨髄造血巣の分布が議論されるようになった. 本邦においても上田, 脇坂, 筧教授等によって99mTcとscintillation cameraが導入された. 私達もGamma III型scintillation cameraと99mTcを用いて血腋疾患を中心に骨髄造血巣の研究を行ったのでその方法並びに成績の概略を報告する. |
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| Abstract | [Summary] Since Anger and his collaborators reported bone marrow scanning with 52Fe and positron camera in 1953, several isotopes such as 99mTc, 52Fe, 198Au, and 113mIn have been used to study bone marrow distributions with scintillation scanner and scintillation camera. Although it is impossible to get 52Fe in Japan, 99mTc is available commercially at present. So the bone marrow figures in variousdisorders of survives are becoming to objects of our clinical investigations. The bone marrow distributions of 99mTc sulfur colloid in various hematological disorders were studied with Pho/Gamma IIIScintillation Camera in this paper. The subjects studied were five hypoplastic anemia, two acute myelocytic leukemia, three multipl emyeloma and each one case of chronic myelocytic leukemia, acute and chronic lymphocytic leukemia, erythremia, folic acid deficiency anemia, congenital hemolytic anemia, hemophilia B, hemochromatosis, Banti's syndrome, malignant lymphoma, liver cirrhosis, SM ON and a normal male subject. Three to ten mCi of 99mTc sulfur colloid were used intravenously in each case with the intensity of 485, window of 20 and exposure of fifty thousands counts on polaroid film that was considered to be the best condition to shoot the photograph with our scintillation camera. The average half disappearance time of 99mTc sulfur colloid from the blood was about fifteen minutes. In normal subjects, the bone marrow figures obtained with 99mTc sulfur colloid were relatively clear and sharp only in larger bone such as skull, pelvis, humerus, and femur. The figures of foot and hand were hardly obtained. The intensity of the figures was corresponded anatomically to red bone marrow distributions. In the patients with hypoplastic anemia the bone marrow pictures were able to be classified into two types. One is the islet form with clear and distinctive high density figure in obscure and low density background in skull, pelvis, shoulder, vertebrave, humerus and femur. This type of hypoplastic anemia was seemed to be classified as the bone marrow arrest form of our classification due to myelogram, peripheral blood pictures and our tissue culture pattern. The ferrokinetics of this group was relatively active and cumulative as compared with other types of hypoplastic anemia. The other is thediffuse type with obscure and low density pictures in skull, pelvis, femur and humerus, though the figures of foot and hand could not obtained in both types. The ferrokinetics of this type was inactive and low uptake of 59Fe into the bone marrow. These findings were well correlated to the pathoanatomical distributions of red marrow in the patients with hypoplastic anemia. The hand and foot which had reduced bone marrow functions were decreased their uptake of 99mTc sulfur colloid, so the negative figures of bone marrow were obtained with positive figures of connective tissue on account of their blood supply. The injected dosis of 99mTc sulfur colloid have no connection with this relationship of the figures between bone marrow and connective tissue. In the patients with acute myelocytic leukemia the bone marrow figures were clearly and diffusely shadowed in all bone including foot and hand. In a case of chronic myelocytic leukemia obscure and diffuse figures were obtained in skull and pelvis with dim figures in foot and hand. Few differences of figures were observed between normal subjects and acute and chronic lymphocytic leukemia. No defects of figures attributable to infiltrations of leukemic cells were obtained in any patients with leukemia. The osteoclastic areas of the bone with multiple myeloma were not figured out with 99mTc sulfur colloid. The patient with erythremia showed diffusely dick and solid figures in all bones as same as the patients with congenital hemolytic anemia and liver cirrhosis. The patients with hemochromatosis, Banti's syndrome, hemophilia B, and folic acid deficiency anemia were observed diffusely obscure pictures in skull, pelvis, vertebrae, femur, humerus, and knee joint. These findings were necessarily coincided with the data of ferrokinetics, peripheral blood pictures, myelogram, serum iron level and pathoanatomical distributions of red marrow in these disorders. In conclusions, the observations of distribution of 99mTc sulfur colloid in the bone marrow with scintillation camera were revealed to be useful in the decision of existence of red marrow in most hematological disorders. It was of great interesting especially that two types of figure were classified in the patients with hypoplastic anemia, that is the islet form and the diffuse form, with good correlation to hematopoietic functions. |
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