(99m)Tc硫黄コロイドによる骨髄造血巣分布の研究 第二編 再生不良性貧血以外の諸種血液疾患を中心として

Detection of the distributions of active hematopoietc bone marrow with (99m)Tc sulfur colloid using a scintillation camera is effective for the prognosis and therapeutic effects on the various hematological disorders, especially in the hypoplastic anemia. Two types of (99m)Tc sulfur colloid uptake into the bone marrow can be classified in the hypoplastic anemia, i.e., the islet form and the diffuse form, as reported in the Part Ⅰ of this paper. The comparative studies of the distributions of (99m)Tc sulfur colloid in the bone marrow and hematological findings in vazious blood disorders other than hypoplastic anemia were described in this part. The examinations were performed using the same methods as described in the Part Ⅰ. Seventeen patients observed were 5 leukemia, 3 multiple myeloma, 2 liver cirrhosis, and one each of erythroleukemia, malignant lymphoma, sarcoidosis, congenital hemolytic anemia, folic acid deficiency anemia, hemochromatosis and hemophilla B. As general, clear images were determined during shorter exposure time on the sternum, thoracic and lumbar spine. This indicated that the hematopoiesis, or the distribution of reticuloendothelial cells, in these marrow was more prominent than others, when the relationship of exposure time and image density of photography per 10,000 counts were classified in 4 degrees. The most distinct images of bone marrow, i.e., active hematopoietic images in the general bone marrow including the hands and feet, were obtained from the patient with the congenital hemolytic anemia, erythroleukemia, and liver cirrhosis. Increased distributions of these acitve proliferation of erythroblasts in the patients with the congenital hemolytic anemia and with the erythroleukemia. On the other hand, the fat cells in the bone marrow of a patient with the liver cirrhosis were replaced with reticulum cells proliferating actively coinciding with the proliferation of the Kupffer's cells in the liver. Clearer and wider distributions of active hematopoietic marrow were able to be detected in a patient with the malignant lymphoma, multiple myeloma, sarcoidosis or liver cirrhosis than in a normal subject. From these evidence a good correlation of distribution is considered to be exist between the active hematopoietic marrow and the proliferation of either tumor cell, epitheloid cell or reticulum cell. Therefore, it may be concluded that (99m)Tc sulfur colloid uptake in useful for making the diagnosis as well as for appreciating the therapeutic effect on the patients with various blood dyscrasias which involve the bone marrow. The above results indicated a good correlation of a (99m)Tc-sulfur colloid uptake in the reticuloendothelial system with a (59)Fe in the erythroblastic series of myeloid cells, in almost all the patients studied. Therefore, we may conclude that this method is useful for the destribution of active hematopoiesis in the body with hypoplastic anemia, and in helpful for treating and justifying the prognosis on these patients.