Key words malignancies; osteoarthrosis secondary hypertrophic; bones; radionuclide imaging
Malignant tumor patients complained of bone pain, there are two possibilities, One bone metastases, hypertrophic osteoarthropathy, which often shows long bone, joints and fingers (toes) rod-like changes in bone, lung cancer, chronic lung disease or Pleural patients often accompanied by hypertrophic osteoarthropathy , and other malignant tumors may also be hypertrophic osteoarthropathy. Our department in recent years, 1528 cases of patients with malignant tumors of bone scintigraphy were retrospectively analyzed to understand the incidence of various malignancies hypertrophic osteoarthropathy the hypertrophic osteoarthropathy therapeutic relationship, hypertrophy of bone relationship of joint disease with metastatic lung cancer and hypertrophy of bone and joint diseases and bone metastasis identification, are reported below.
1 Materials and Methods
1.1 cases of 1528 patients with malignant tumors, male 1022, female 506 cases, aged 16 to 77 years, with an average age of 51.6 years, the final clinical diagnosis by pathology examination, biopsy, or CT confirmed.
1.2 Methods 99Tcm methylene bisphosphonate (MDP) provided by the Atomic Hi-Tech Nuclear Technology Application Co., Ltd., the instrument for the the Elscint company sp 6-type SPECT instrument, 1h before injection oral potassium perchlorate 400mg, closed the thyroid, elbow the former intravenous injection 99Tcm MDP925MBq after 3h lines anteroposterior SPECT bone scintigraphy. Hypertrophic osteoarthropathy positive criteria: (1) the long bone, especially in the lower limbs was symmetrical “two-track" sign like radioactive concentrated; ② long bone showed heterogeneous asymmetric radioactive concentration; ③ periarticular symmetry radioactive concentration .
2.1 1528 patients with various malignancies bone scintigraphy in patients with hypertrophy of bone and joint disease incidence of 407 cases of lung cancer bone scintigraphy hypertrophy of bone and joint disease incidence was 9.3% (38/407); 4.9% (4 of 81 patients with esophageal cancer / 81); 52 cases of gastric cancer was 5.7% (3/52); 21 patients with HCC was 4.7% (1/21); 330 cases of breast cancer was 3.9% (13/330); 355 cases of prostate cancer was 4.2% (15 / 355); 52 cases of rectal cancer was 3.8% (2/52); 105 patients with nasopharyngeal carcinoma was 7.6% (8/105); 40 cases of bone tumors was 5.0% (2/40); 37 cases of bladder cancer ; 48 cases of thyroid cancer is 0.
2.2 tumor after treatment efficacy and hypertrophic osteoarthropathy bone imaging follow-up (follow-up 2 to 19 months), surgery, chemotherapy, radiation therapy, and the effect of the 78 cases, 56 cases of hypertrophic osteoarthropathy performance disappeared four cases The dual lower extremity long bone radioactive still concentrated, but not “the rails" like changes.
2.3 nasopharyngeal carcinoma lung metastases and hypertrophy of bone and joint disease relationship 105 patients with nasopharyngeal carcinoma patients with hypertrophic osteoarthropathy eight cases, eight cases of hypertrophic osteoarthropathy positive in 4 cases (50%) lung metastases.
2.4 bone imaging and X-ray diagnosis of hypertrophic osteoarthropathy followed up patients with malignant tumors of 42 patients with bone scintigraphy mast osteoarthropathy positive X-ray examination prompted only four cases of hypertrophic osteoarthropathy manifested as lower extremity periosteal thickening inflammatory changes.
Many reports on lung cancer complicated by hypertrophic osteoarthropathy, Qu Wanying et al  reported 1537 cases of lung cancer with bone scintigraphy in hypertrophic osteoarthropathy 51 cases, accounting for 3.32%. United States Mayo reported that 10% of the 1879 patients with lung cancer  hypertrophic osteoarthropathy. The results of this study show that the high incidence of lung cancer patients hypertrophy osteoarthropathy, 9.3% other malignancies hypertrophic osteoarthropathy may also occur, but a low incidence of hypertrophic osteoarthropathy nasopharyngeal carcinoma lung metastases higher positive rate, to prompt bone imaging can be used to judge nasopharyngeal carcinoma with or without pulmonary metastasis. Liu et al [4,5] reported 27 cases of 407 patients with nasopharyngeal carcinoma patients with hypertrophic osteoarthropathy, accounting for 6.6%, while 27 cases were positive in 13 cases (48%) lung metastases.
Occurrence of hypertrophic osteoarthropathy in patients with malignant mechanism is unclear. Vagicer  hypertrophic osteoarthropathy is an inflammatory reaction around cell invasion and angiogenesis, the osteoid tissue change, the formation of special-shaped bone MDP bone scintigraphy showed long bones “car rail-like radioactive concentration. Some scholars believe that the factors related to tissue hypoxia, infection produces toxic substances and the amount of local blood circulation increase .
The results of this study show that bone scintigraphy found the hypertrophic osteoarthropathy positive performance as patients with malignant to treatment efficacy auxiliary indicators, malignant tumors caused by hypertrophic osteoarthropathy may produce toxins lesions caused by autonomic disorders caused by peripheral circulatory abnormalities, The new bone reaction tumor location and development. The nasopharyngeal bone scintigraphy in patients with hypertrophic osteoarthropathy performance indicators can be used as auxiliary diagnosis of lung metastases.
Effective way to identify bone metastasis and hypertrophic osteoarthropathy bone scintigraphy, have their own characteristics in bone scintigraphy Figure: the tumor through the blood transfer to the bone, mainly shifted to the red bone marrow rich bone. Axial skeleton and proximal (spine, ribs), to hypertrophic osteoarthropathy occurs mainly in the limbs, long bone lack of red bone marrow sites; the bone metastatic bone scintigraphy irregular, limitations asymmetry radioactive concentration hypertrophic osteoarthropathy was higher symmetry periosteal surface radioactive concentration and long bone radioactive; In addition, the relationship between bone metastases and tumor efficacy of hypertrophic osteoarthropathy with tumor efficacy . Can also be found in clinical cancer patients at the same time a bone metastasis and hypertrophic osteoarthropathy has been reported to account for about 19.6% . This understanding can help to improve the diagnosis of bone scintigraphy.