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題名 | Tc99m Sulfur Colloid Scintigraphy for Detection of Intrathoracic Extramedullary Hematopoiesis in Patient with Beta-Thalassemia Major--A Case Report=鎝99m硫化膠體骨髓掃描對一乙型海洋性貧血病人偵測胸腔內骨髓外造血組織 |
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作者 | 陳毓雯; 許瑞昇; 邱世欣; 張泰琮; 黃英峰; 劉金昌; Chen, Yu-wen; Sheu, Reu-sheng; Chiou, Shyh-shin; Chang, Tai-tsung; Huang, Ying-fang; Liu, Gin-chung; |
期刊 | The Kaohsiung Journal of Medical Sciences |
出版日期 | 20000600 |
卷期 | 16:6 2000.06[民89.06] |
頁次 | 頁319-324 |
分類號 | 414.93 |
語文 | eng |
關鍵詞 | 鎝99m硫化膠體骨髓掃描; 乙型海洋性貧血; 胸腔; 骨髓外造血組織; Extramedullary hematopoiesis; EMH; Tc99m sulfur colloid marrow scintigraphy; Beta thalassemia major; |
中文摘要 | 骨隨外造血組織代表一代償機轉,於骨髓以外地方製造血球細胞,常 見於骨髓功能不良病人。本報告描述一罹患乙型地海洋性貧血三十四歲女性病 人,於胸部X光檢查發現多發性、邊界明顯的軟組織腫塊,分佈於右側肋膜腔 上、下方,進一步的胸腔磁振造影檢查,呈現多發性、邊界清楚不均勻等強度之 T1-及低強度之T2-訊號軟組織腫塊,分布於胸腔右上及兩側下方脊柱邊。根據 臨床病史,懷疑此胸腔內軟組織腫塊為骨髓外造血組織,因此安排核子醫學骨髓 掃描造影,進一步建立診斷,鎝-99m標幟硫化膠體可以代表體內網狀內皮系統 吞噬活性,根據過去文獻,網狀內皮系統吞噬活性與造血活性呈一正相關性,由 核醫骨髓造影證明,與胸腔磁振影像相同解剖位置上,具高強度放射活性組織吸 收,且全身造影呈現周邊骨髓增生,由於侵入性細胞檢查,須冒大量出血危險, 在此考慮下,本病例並無最後組織病理診斷。但是,根據骨髓掃描診斷,此一乙 型海洋性貧血病人的胸腔內多發腫塊,可排除其他常見鑑別診斷原因,更肯定為 一無症狀性胸腔內骨髓外造血組織,核子醫學鎝-99m標幟膠體骨髓掃描提供一 方便、非侵入性且專一性更高的影像檢查,以支持骨髓外造血組織的診斷,特別 是對肝、脾及淋巴以外的骨髓外造血組織確認,更具臨床診斷意義。 |
英文摘要 | Extramedullary hematopoiesis (EMH) refers to the production of blood cells outside the bone marrow and is a compensatory mechanism for bone marrow dysfunction. A 34 year- old female patient with beta thalassemia major was found to have multiple large, well-circumscribed radiopaque paravertibral mass lesions in chest radiography. Magnetic resonance imaging (MRI) of the thorax disclosed a right upper apical and two lower thoracic paraspinal mass lesions with heterogeneous isointensity on T1-weighted images and hypointensity on T2-weighted images. Because intrathoracic EMH is suspected in our case, which had obvious bone marrow dysfunction, radionuclide bone marrow scintigraphy is helpful in supporting the diagnosis. Tc99m sulfur colloid scintigraphy demonstrated three intense radioactive thoracic paraspinal mass lesions corresponding to the lesions seen on MRI. We believe whole body bone marrow scintigraphy with Tc99m sulfur colloid is the best convenient noninvasive method for supporting the diagnosis of EMH. |
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