Pathophysiologische Grundlagen und diagnostische Grenzen der konventionellen Skelettszintigraphie

Zusammenfassung

Das normale Skelettszintigramm reflektiert die physiologische regionale Knochenneubildungsrate, die auf das Remodeling und die Aufrechterhaltung der Kalziumhomöostase zurückgeht. Osteotrope Radiopharmaka können sowohl als Perfusionsmarker als auch als Marker des regionalen Knochenstoffwechsels eingesetzt werden. Eine lokale Hyperperfusion ohne gesteigerten Knochenstoffwechsel findet sich bei der Inaktivitätsatrophie und der sympathischen Reflexdystrophie, die schwierig zu unterscheiden sind, eine lokale Hypoperfusion ist Ursache für falsch negative Befunde bei Osteomyelitis. Eine regional gesteigerte Knochenneubildung ist Substrat des Positivnachweises von Frakturen, Entzündungen, Tumoren, Metastasen und anderen Läsionen. Im direkten Vergleich mit anderen bildgebenden Verfahren (MRT, Szintigraphie mit nicht osteotropen Radiopharmaka und PET, jedoch nicht CT und Multislice-CT) zeigt die planare Skelettszintigraphie unerwartete Defizite in der Sensitivität, die durch Anwendung von SPECT und noch besser PET mit ¹⁸F-Fluorid weitgehend bis ganz abgebaut werden können. Diese Techniken verbessern auch die Spezifität, die trotz verbesserter Abbildungsqualität und großem Erfahrungsschatz immer noch ein Schwachpunkt der Methode ist. Noch wünschenswerter ist daher die Einführung von SPECT/CT und PET/CT in die Skelettszintigraphie.

Abstract

Normal bone scan demonstrates the physiological regional bone formation rate, which is related to bone remodeling and maintenance of calcium homeostasis. Osteotrope radiopharmaceuticals can be used as a perfusion marker as well as a marker of regional bone formation rate. Local hyperperfusion without increased bone formation is seen in disuse atrophy and reflex sympathic dystrophy, which are difficult to discriminate, local hypoperfusion is responsible for false negative results in osteomyelitis. A local increased bone formation rate is the substrate of a positive finding in bone fracture, inflammation, tumors, metastases and other lesions. In direct comparison with other imaging modalities (MRT, scintigraphy with non-osteotrope radiopharmaceutical and PET, but not CT and multislice-CT), planar bone scintigraphy shows an unexpected deficiency in sensitivity, which can be almost or completely overcome by using SPECT or even better ¹⁸F-fluoride PET. These techniques will also improve specificity, which still is a weak point of bone scanning, despite improved imaging performance and a huge experience in this field. The introduction of SPECT/CT und PET/CT in bone scanning will be even more desirable for this reason.

Skelettszintigraphie - Perfusionsmarker - Marker der regionalen Knochenneubildungsrate - Sensitivität

bone scanning - perfusion marker - marker of regional bone formation rate - sensitivity

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