核素显像在阴囊急症的临床应用价值

Value of radionuclide scrotal imaging for diagnosis of acute scrotal pain

目的探讨放射性核素阴囊显像在急性睾丸扭转与急性睾丸附睾炎鉴别诊断中的临床应用价值。方法对阴囊急症13例行SPECT核素阴囊显像,“弹丸”注射99mTcO-4370MBq后即刻行动态血流灌注显像,15min后行静态血池显像并进行显像结果分析。结果10例血流灌注相呈血流减低,静态血池相放射性缺损,经急诊手术证实了9例为睾丸扭转,其中3例因及时确诊及手术纠正扭转而保留患睾。3例血流灌注相呈血流增高,静态血池相放射性分布仍明显高于对侧,符合睾丸附睾炎表现,经内科保守治疗后症状消失。结论睾丸缺血的时间是影响其存活的重要因素。核素阴囊显像简便、快速、非创伤,对阴囊急症的鉴别诊断、治疗方法的选择具有重要的临床指导价值。

Objective To investigate the value of radionuclide scrotal imaging for differentiating the acute testicular torsion from the acute orchiepididymitis.Methods Thirteen patients with acute scrotal pain underwent radionuclide scrotal imaging.The scrotal scintigraphy was performed by intravenous bolus injection of 99mTc-pertechnetate with 370 MBq.Following the injection,the dynamic flow perfusion imaging was perfomed immediately while subsequent static blood pool imaging was performed at 15 minutes after the injection.Results On dynamic flow perfusion images,10 cases had decreased flow and uptake in the involved testicles while on static blood pool images these patients had defect of radionuclide distribution,of them,9 cases were testicular torsion demonstrated by emergency operation,in whom 3 cases retained the ill testicles because of obtaining timely definite diagnosis and surgical detorsion.The remaining 3 cases who had increased flow and focal uptake in affected side either on dynamic flow perfusion images or static blood pool images were corresponding to the manifestations of orchiepididymitis and then through medical conservative treatment the clinical symptoms disappeared.Conclusion The ischemic duratpion of testicle is an important factor influencing the testicular survival.Radionuclide scrotal imaging is not only a simple,quick and non-invasive means in the detection and differentiation of acute testicular torsion from inflammatory testicular disease but it has the guiding significance for selecting the appropriate therapeutic protocol in patients with acute scrotal pain.