^(99m)Tc-RBC和^(99m)Tc-PHY阴茎动静脉动态显像对血管性阳痿的临床价值研究

Clinical value of dynamic imaging of arterial and venous of corpus cavemosum in vascular impotence via ^(99m)Tc-RBC and ^(99m)Tc-PHY

目的建立放射性核素标记的99mTc-RBC和99mTc-PHY阴茎动、静脉动态显像对血管性阳痿定量分析的评价指标体系。方法用99mTc-RBC和99mTc-PHY作阴茎海绵体动、静脉动态显像,随机选择18例正常男子(对照组)和162例临床证实的阳痿患者(阳瘘组),根据阴茎动脉系统显像指数(PIA)>0.60、阴茎静脉系统显像指数(PIV)>-0.45的诊断标准,将162例阳痿患者分为A组(非血管性阳痿组)、B组(静脉性阳痿组)、C组(动脉性阳痿组)和D组(动静脉性阳痿组)。阳痿患者在盐酸罂粟碱局部注射的负荷条件下,利用ECT动态显像连续测量阴茎海绵体内放射性药物动态变化的量化指标和实时动态系列影像。结果正常对照组99mTc-RBC放射性核素显像的阴茎动脉系统显像指数(PIA)平均为(1.45±0.74),局部注射盐酸罂粟碱后达时间-放射性曲线1/2高峰值的时间(1/2PT)为(2.09±0.35)min,99mTc-PHY放射性核素显像的阴茎静脉系统显像指数(PIV)为(-0.32±0.09)。B组PIV为(-0.70±0.12),与正常对照组比较差异有统计学意义(P<0.01);C组PIA为(0.33±0.18),与正常对照组比较差异有统计学意义(P<0.01);D组PIA为(0.42±0.14),PIV为(-0.80±0.14),与正常对照组比较差异有统计学意义(P<0.01)。结论 99mTc-RBC和99mTc-PHY阴茎动、静脉动态显像对评价血管性阳痿,特别是鉴别阳痿的动脉和静脉系统病因来源具有肯定的价值。

Objective To develop a new quantitative diagnosis method for vascular impotence. Methods The penile cavernous hemodynamic change of 18 normal volunteers and 162 impotent were studied by ^99mTc-RBC and ^99mTc-PHY. The arterial and venous penile images were evaluated with intravenous and intracevernous administration of ^99mTc and also monitored both before and after nitracavernous prostaglandin injection. The recirculation of ^99mTc-PHY were calculated by measuring the counts of liver tissue and venous blood. Results The penogram index of arterial system （PIA） of 18 volunteers was （1.45±0.74）, 1/2 peak time was （2.09±0.35）, and the penogram index of venous system （PIV） was （-0.32±0.09）. PIA〉60,PIV〉-0.45 were accepted as normal according to the normal value. 162 impotent patient were classified into 4 groups; 9 with psychogenic impotence （PIA 1.37±0.65, PIV-0.37±0.08）; 118 with venogenic impotence （PIA 1.30±0.75. PIV-0.70±0.12）, 6 with the arteriogenic impotence （PIA 0.33±0.18,PIV-0.28±0.16）, 29 with both arteriogenic and venogenic impotence （PIA 0.42±0.14, PIV-0.80±0.14）. The cavernous of ^99mTc -PHY value due to recirculation is very low, and is less than 0.01. Conclusion The radioisotope erection penogram is a safe, noninvasive and valuable screening test in the identification of vasulogenic impotence, and is effective in differentiating arteriogenic and venogenic impotence.