^(99m)Tc-依替菲宁注射液肝胆平面和断层显像在胆道闭锁诊断中的价值

Significance of ^(99m)Tc-Diethyl Iminodiacetic Acid Hepatobliliary Planar and Tomographic Scintigraphy in Diagnosis on Biliary Atresia

目的评价99mTc-依替菲宁注射液(EHIDA)肝胆6h平面显像、6h断层显像及24h平面显像对诊断胆道闭锁(BA)的临床价值。方法2005年1月-2007年12月本院共接受99mTc-EHIDA肝胆显像患儿70例。男32例,女38例;平均年龄48.7d(29d～4个月)。根据最后诊断分为BA组45例,非BA组25例。肝胆动态平面显像检查前至少禁食4h,仪器为荷兰Philips公司生产三探头IRIX3,低能高分辨平行孔准直器,显像剂为99mTc-EHIDA,放化纯度≥95%,使用剂量为7.4MBq/kg。分别在注射显像剂5、10、15、20、30min和1、6h进行肝胆平面显像,显像过程中如胆囊或肠道内出现放射性,则检查结束;如胆囊或肠道内未见放射性出现,则行6h断层显像,同时24h行肝胆平面显像。图像结果均由2位以上核医学医师阅片分析,并作出诊断。结果27例患儿肝胆平面显像和断层显像示胆囊和肠道未出现放射性显影,提示为BA。30例患儿肝胆平面显像和断层显像示胆囊和肠道内出现放射性,提示为非BA。肝胆6h断层显像诊断BA的阳性率明显高于6h平面显像,且2种方法比较差异有统计学意义;6h断层显像诊断BA的阳性率显著高于24h平面显像,2种方法比较差异有统计学意义。结论99mTc-EHIDA肝胆显像是一种无创、安全、有效的检查方法,对BA的诊断有较高的临床价值。且6h断层显像诊断BA的价值明显高于6h平面显像和24h平面显像。

Objective To evaluate the clinical value of 6 h ^99mTc - diethyl iminodiacetic acid （^99mTc - EHIDA） planar hepatobiliary scintigraphy （HBS） ,6 h tomographic HBS and 24 h planar HBS in diagnosis on biliary atresia（BA）. Methods Seventy cases（32 male,38 female ） with continuous jaundice received planar and tomographic HBS in Beijing Friendship Hospital from Jan. 2005 to Dec. 2007. The mean age was 48.7 d （29 d-4 months）. According to final diagnosis,all cases were divided into BA group （45 cases） and non- BA group （25 cases）. All cases fasted at least 4 hours before HBS. The equipment was 3 head IRIX from Philips company with low energy high resolution collimator. The tracer was ^99mTc - EHIDA and the radiochemistry purity was more than 95 percent. The dosage was 7.4 MBq/kg. All diagnosis demonstrated by operation pathology and clinical follow - up. All cases received HBS at 5,10,15,20,30 min and 1,6 h after tracer injection. HBS would ended if radioactivity appeared in gallbladder or intestine. These cases would received tomographic HBS and 24 h HBS if radioactivity did not appear in gallbladder or intestine at 6 h post injection. All these images were analyzed by 2 or more nuclear medicine physicians. Results There were not radioactivity appearing in gallbladder and intestine on planar and tomographic HBS of 27 cases,which suggested the BA. There were radioactivity appearing in gallbladder and intestine on planar and tomographic HBS of 30 cases, which suggested the non - BA. Positive rate of 6 h tomographic HBS was significantly higher than that of 6 h planar HBS and there was significantly difference between the 2 methods. Positive rate of 6 h tomographic HBS was significantly higher than that of 24 h planar HBS and there was significant difference between the 2 methods. Conclusions ^99mTc - EHIDA HBS is a noninvasive,safety,valuable examing method and has definitely clinical value in the diagnosis on BA. The clinical value of 6 h tomographic HBS is significantly higher than that of 6 h planar HBS and 24 h planar HBS.