- 期刊
Discordant Findings of Skeletal Metastasis between Tc(superscript 99m) MDP Bone Scans and F^18 FDG PET/CT Imaging for Advanced Breast and Lung Cancers-Two Case Reports and Literature Review
甲基雙磷酸鹽骨骼造影與氟化去氧葡萄糖正子電腦斷層造影對乳、肺癌骨轉移偵測的不一致性－病例報告與文獻回顧
摘要
傳統上鎝99m甲基雙磷酸鹽骨骼造影提供高靈敏度偵測骨轉移，尤其在乳、肺癌的診斷與追蹤。近年來，氟化去氧葡萄糖正子電腦斷層造影根據腫癌細胞葡萄糖代謝，在腫瘤學上，成為描述腫癌生長增生及轉移很重要的影像。一般而言，對乳、肺癌骨轉移，甲基雙磷酸鹽骨骼造影與氟化去氧葡萄糖正子電腦斷層造影皆有一致性結果。然而一年問連續三百名正子造影受檢者中，兩名嚴重乳、肺癌患者出現兩種造影極度不一致判讀，即甲基雙磷酸鹽骨骼造影呈現無轉移所造成之骨再生活度，但氟化去氧葡萄糖正子電腦斷層造影卻呈現瀰漫性高糖質吸收骨髓浸潤或蝕骨作用，因此診斷為第四期腫癌轉移。由於腫癌是基因變異疾病，同為乳、肺癌仍可呈現不同蛋白質體表現，本文將根據文獻回顧，討論兩種影像差異因素，然而氟化去氧葡萄糖正子電腦斷層造影在腫癌追蹤是近代非常重要的影像診斷方法。
並列摘要
Traditionally, Tc(superscript 99m) methyl diphosphate (MDP) bone scintigraphy provides high-sensitivity detection of skeletal metastasis from breast and lung cancers in regular follow-up. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), based on the glucose metabolism of malignant cells, plays a role in describing tumor growth, proliferation of neoplasm and the extent of metastasis. In general, concordant findings of skeletal metastasis are seen on both types of image, especially in cases of breast and lung cancer. However, there were extremely discordant findings of skeletal metastasis between bone scans and F^18 FDG PET/CT imaging in two cases among 300 consecutive F^18 FDG PET/CT follow-up exams of patients with malignancies, during the past year, in our center. Both cases, one of breast cancer and one of lung cancer, had negative bone scintigraphic findings, but a diffusely high grade of F^18 FDG avid marrow infiltration in the axial spine, leading to the diagnosis of stage IV disease in both cases. Owing to variant genetic aberrance of malignance, F^18 FDG PET/CT reveals direct evidence of diffuse, rapid neoplasm metabolism in the bone marrow of the spine, but not of secondary osteoblastic reactions in vivo. F^18 FDG PET/CT should always be employed in the follow-up of patients with malignancies.
延伸閱讀
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