Japanese
Title腎性骨異栄養症の診断および治療効果判定における画像診断の有用性 - 骨シンチSPECT, X線CTおよび他検査との比較 -
Subtitle原著
Authors岡村光英*, 福田照男*, 井上祐一*, 小泉義子*, 池田穂積*, 越智宏暢*
Authors(kana)
Organization*大阪市立大学医学部放射線科
Journal核医学
Volume24
Number7
Page933-946
Year/Month1987/7
Article原著
Publisher日本核医学会
Abstract「要旨」慢性腎不全患者52例に骨シンチを施行し, その所見を4群に分類した. I群は頭蓋骨・顎骨等に強いRI集積を示すdiffuse high activity of the bone型, II群はhigh background activity型で, これはさらに骨描出が比較的明瞭で骨折を示すhot spotを有するものと, 骨のRI集積の低いものに分類した. III群はRI骨外集積を示すextraosseous accumulation型で肺・腎などの臓器に集積するものと軟部組織に集積するものとに分類した. IV群は特に異常分布を認めないパターンである. I群は副甲状腺機能亢進症, II群は骨軟化症が主体であると考えられた. さらに上記症例の内, 副甲状腺亜全摘術施行例に対し, 術前後の骨変化を種々の方法で観察した. 骨単純X線像では術後骨病変の改善を示したが, 客観的評価に乏しかった. 中手骨microdensitometry, 橈骨bone mineral analysisと比べ, X線CTによる前頭骨EMI値測定は術前後の変化を大きくとらえた. 骨シンチで術前みられた頭蓋骨, 顎骨の強いRI集積は術後減少し, この変化を定量的に観察したSPECTによるRIカウント比測定が術前後の変化を最も大きくとらえることができ, 骨変化の観察に有用であった.
Practice臨床医学：一般
KeywordsRenal osteodystrophy, Secondary hyperparathyroidism, Subtotal parathyroidectomy, Bone scintigraphy, Single photon emission computed tomography.
English
TitleUsefulness of Bone Scintigraphic Classification and Quantitative Evaluation of Bone Mineralization with X-CT and SPECT in Renal Osteodystrophy
SubtitleOriginal Articles
AuthorsTerue OKAMURA, Teruo FUKUDA, Yuuichi INOUE, Yoshiko KOIZUMI, Hozumi IKEDA, Hironobu OCHI
Authors(kana)
OrganizationDepartment of Radiology, Osaka City University Medical School
JournalThe Japanese Journal of nuclear medicine
Volume24
Number7
Page933-946
Year/Month1987/7
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary]1. Bone scintigraphy with Tc-99m-MDP was performed on 52 patients with chronic renal failure. These bone scintigrams were classified into 4 groups, each of which was correlated to laboratory data and quantitative data of bone mineralizatlon. Group I (32 patients) showed high accumulation of Tc-99m-MDP in the bone. High level of Alk-Pase and c-PTH, low BMC/BW, low EMI number and high radionuclide activity ratio (RN ratio) were observed. Group II (9 patients) demonstrated unclear bone images with high background activity. RN ratio was slightly higher than the normal. Group III (11 patients) showed extraosseous accumulation of Tc-99m-MDP in the lung, kidney or soft tissues. One patient belonged to Group I. High level of Ca×P product and slightly high RN ratio were observed. In both Group II and III, BMC/BW and EMI number were normal. Group IV (one patient) showed normal skeletal activity on bone scintigram. The mean duration of hemodialysis was the longest in Group I. Our scintigraphic classification is convenient and might contribute an understanding of pathophysiological bone changes in such patients. 2. Subtotal parathyroidectomy (S-PTX) was employed in 18 of 52 patients on chronic renal failure with secondary hyperparathyroidism. These patients were studied before and after S-PTX using 6 different procedures; conventional radiography, microdensitometry, bone mineral analysis, measurement of EMI number with X-CT (frontal bone), bone scintigraphy, and RN ratio (frontal bone/brain) with SPECT. On the bone scan, the diffuse increased activity in the calvarium became less prominent after S-PTX in all 18 patients. We devised a new method to quantify the bone changes revealed by the bone scan; the RN ratio with SPECT. The ratio decreased markedly after surgery. This method seems to be most useful for detecting dynamic bone changes sensitively and quantitatively.
PracticeClinical medicine
KeywordsRenal osteodystrophy, Secondary hyperparathyroidism, Subtotal parathyroidectomy, Bone scintigraphy, Single photon emission computed tomography.

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