^(99)Tc^mO_4^-异位胃黏膜显像诊断小儿梅克尔憩室并出血的价值

Value of ^(99)Tc^mO_4^- Ectopic Gastric Mucosa Imaging on Diagnosing Meckel′s Diverticulum Combined with Hemorrhage in Children

目的评价99TcmO4-异位胃黏膜显像诊断小儿梅克尔憩室的价值。方法对有便血史、临床疑诊为梅克尔憩室的43例患儿行99TcmO4-异位胃黏膜显像。显像前禁饮食4 h以上,静脉注射99TcmO4-(111~185 MBq)后立即动态及30 min、1 h、2 h静态采集图像。23例患儿行小肠造影。将99TCmO4-显像结果与小肠造影结果及临床最终诊断结果进行对比、评价、分析。结果 43例患儿中99TcmO4-异位胃黏膜显像阳性且核医学医师诊断为梅克尔憩室27例,其中术后病理证实为梅克尔憩室26例,肠重复畸形1例。阴性16例中3例为梅克尔憩室,13例非梅克尔憩室。诊断灵敏度为89.7%,特异性为92.9%,阳性预测值为96.3%。阳性病例影像多表现为动态影像上与胃同时或稍晚出现异常核素浓聚灶,多位于右腹股沟区,呈圆形或类圆形,随时间延长渐增浓;静态影像上仍可见该浓聚灶,随时间延长其位置、形态、大小变化不大。99TcmO4-异位胃黏膜显像与小肠造影比较,诊断灵敏度(χ2=3.08,P>0.05)、特异性(χ2=0.28,P>0.05)差异均无统计学意义。结论 99TcmO4-异位胃黏膜显像诊断梅克尔憩室灵敏度、特异性高,无创、安全、简便且无痛苦,应作为诊断梅克尔憩室并出血的首选影像学方法。

Objective To evaluate the value of 99TcmO4-ectopic gastric mucosa imaging in diagnosing Meckel′s diverticulum combined with hemorrhage in children.Methods 99TcmO4-ectopic gastric mucosa imaging was performed in 43 children with a history of gastrointestinal hemorrhage and clinical suspicious of having Meckel′s diverticulum.They were all forbidden to drink and eat more than 4 hours before imaging.The imaging was performed immediately and at 30 minutes,1 hour,2 hours after intravenous injecting of 99TcmO4-（111-185 MBq） respectively.Small intestinal enteroclysis was performed in 23 cases of the 43 patients.The materials of imaging were compared,evaluated and analyzed with small intestinal enteroclysis and clinical final results.Results Twenty-seven cases of the 43 patients had positive results with 99TcmO4-ectopic gastric mucosa imaging,and were diagnosed as Meckel′s diverticulum by nuclear medicine physician,in which 26 cases were confirmed as the Meckel′s diverticulum,and 1 case was confirmed as intestinal duplication by pathology.Among the 16 cases with negative image,3 cases were Meckel′s diverticulum,13 cases were not Meckel′s diverticulum.The sensitivity,specificity and positive predictive value of 99TcmO4-ectopic gastric mucosa imaging were found to be 89.7%,92.9% and 96.3%,respectively.There were no significant diffe-rences in the sensitivity and specificity between 99TcmO4-ectopic gastric mucosa imaging and small intestinal enteroclysis compared by Chi-square test（χ2=3.08,0.28,Pa0.05）.Most positive cases of 99TcmO4-ectopic gastric mucosa imaging showed abnormal radionuclide uptake lesions appeared with stomach at the same time or later in dynamic imaging.Most lesions in the right lower abdomen,round or oval.Its concentration gradually increased with time.These lesions were still visible on static imaging,and its location,shape and size had little changes with time going.Conclusions 99TcmO4-ectopic gastric mucosa imaging has high sensitivity and specificity in the diagnosis of Meckel′s diverticulum combined with hemorrhage,and is non-invasive,safe,simple,no pain.It should be the first choice of imaging in diagnosing Meckel′s diverticulum combined with hemorrhage.