Japanese
Title多発性骨髄腫に対する全身タリウムシンチグラフィの臨床的意義
Subtitle原著
Authors津布久雅彦*
Authors(kana)
Organization*東邦大学医学部第一放射線医学教室
Journal核医学
Volume33
Number1
Page33-47
Year/Month1996/1
Article原著
Publisher日本核医学会
Abstract「要旨」多発性骨髄腫における全身タリウムシンチグラフィの異常集積所見の特徴とその臨床的意義について評価を行った. 診断の確定している多発性骨髄腫24例(未治療10例, 再燃例5例, 治療後経過観察例9例)を対象とした. 異常集積所見はびまん性の骨髄集積による骨格描出がめだつ骨格描出型, 限局性の異常集積が優位な限局集積型, および混合型の3型に大きく分けられた. 骨髄集積による骨格の描出は全身分布により5段階にgrade分類した. 未治療群, 再燃群では骨格描出が明瞭かつ広範囲に認められ, 経過良好例では骨格描出は認めないか, 胸骨, 仙腸関節で淡く認めるのみにとどまる傾向がみられた. Tumor mass staging, 血清β2-microglobulin値との比較では, 骨髄描出の程度との関連が認められ, 全身の腫瘍量と分布, 病勢の視覚的評価が可能と考えられた. 限局性病変の検出能の評価は, 未治療例10例を対象とし, 腫瘍の大きさ, 占拠部位との関連のほか, MRIを含めた他画像診断との比較により行った. 限局性病変は腫瘍の大きさ5cm3以上ですべて検出可能であった. 特に小病変では腫瘍の大きさのみならず, 腫瘍の体表からの距離の関与が大きく, 脊椎病変では椎体に限局する小病変の検出は困難であった. しかし, 確認しえた46病巣の限局性病変のうち32病巣(69.6%)で全身タリウムシンチグラフィでの検出が可能で, 全身単純骨X線撮影の23病巣(50.0%), 骨シンチグラフィの22病巣(47.8%)の検出に比較し優れていた. 全身タリウムシンチグラフィは多発性骨髄腫の骨病変の全身検索, 全身のtumor burdenの臨床評価に有用であり, 患者のQOLの向上に寄与するところが大きいと考えられた.
Practice臨床医学：一般
KeywordsMultiple myeloma, 201Tl-chloride, Whole body scanning, Bone marrow, Tumor burden.
English
TitleClinical Significance of Whole Body Thallium-201 Chloride Scintigraphy in Multiple Myeloma
Subtitle
AuthorsMasahiko TSUBUKU
Authors(kana)
OrganizationFirst Department of Radiology, Toho University School of Medicine
JournalThe Japanese Journal of nuclear medicine
Volume33
Number1
Page33-47
Year/Month1996/1
ArticleOriginal article
PublisherTHE JAPANESE SOCIETY OF NUCLEAR MEDICINE
Abstract[Summary]This study attempts to characterize the findings of thallium-201 chloride (201TlCl) uptake in patients with multiple myeloma and to evaluate its clinical significance. Twenty-four patients (including 10 untreated cases, 5 relapsed cases and 9 cases in stable course after initial treatment) were evaluated. Whole body 201Tl scintigraphy was performed 10 minutes after intravenous administration of 111 MBq of 201TlCl. Abnormal scintigraphic findings in whole body scanning varied from solitary focal uptake to extensive diffuse bone marrow visualization, but fell into the following 3 broad types ; 1)skeletal visualization type, 2)predominant focal uptake type and 3)mixed type. Diffuse bone marrow uptake could be classified according to the skeletal distribution into 5 gradings (grade 0-4) between normal and entire skeletal visualization. This grading was roughly related to estimated tumor mass classification by tumor mass staging system (Alexanian, 1985). Furthermore, serum β2-microglobulin level, that is widely confirmed as the reliable parameter of tumor burden and response to treatment except for patients with renal dysfunction, showed significant difference between grade 2 and grade 3 (p<0.05), grade 2 and grade 4(p<0.01). The detectability of focal myelomatous lesions was compared to those of plain radiographa and 99mTC-MDP scintigraphy in the untreated cases. Whole body 201Tl scintigraphy demonstrated 32 lesions among 46 focal lesions which included lesions revealed on either X-ray CT or MR imaging. In contrast to whole body 201Tl scintigraphy, plain radiographs and 99mTc-HMDP scintigraphy demonstrated 23 lesions and 22 lesions, respectively. All focal lesions exceeding 5cm3 in tumor size were detectable on whole body 201Tl scintigraphy. Whole body 201Tl scintigraphy additionally showed 12 focal lesions that were demonstrated on MR imagings but failed to be detected on plain radiographs. However, detection of small lesions confined within the vertebral body was difficult. In conclusion, whole body 201Tl scintigraphy is a useful non-invasive tool to investigate the patients with multiple myeloma.
PracticeClinical medicine
KeywordsMultiple myeloma, 201Tl-chloride, Whole body scanning, Bone marrow, Tumor burden.

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