淋巴显像诊断小肠淋巴管扩张症的腹部影像分型及价值

Diagnositic value and image classification of 19Tcm-DX lymphoscintigraphy in intestinal lymphangiec tasia

目的探讨小肠淋巴管扩张症（IL）患者99Tcm-DX淋巴显像的腹部影像分型及其诊断价值。方法选择2007年6月至2012年9月临床疑诊IL的68例患者作为研究组，通过分层随机方法选取同期年龄、性别与研究组相匹配的60例下肢淋巴水肿或乳糜腹腔积液的患者作为对照组。2组患者均行99Tcm-DX淋巴显像，对患者的腹部影像特征进行分型。以肠道显影作为IL阳性诊断标准，根据病理检查或胶囊肠镜的最终诊断评价99Tcm-DX巴显像的诊断效能。结果68例患者中有60例患者确诊为IL。99TcmDX腹部影像可分为5型：I型，肠道动态显影型；Ⅱ型，肠道延迟显影型；Ⅲ型，腹腔积液显影型；Ⅳ型，混合型；V型，腹部显影阴性型。研究组和对照组符合I、Ⅱ、Ⅲ、Ⅳ和V型表现的病例数分别为19和0、17和4、11和13、6和0以及7和43。在全部128例受试者中，”Tc“．DX淋巴显像诊断IL的灵敏度为70．0％（42／60），特异性为94．1％（64／68），阳性预测值为91．3％（42／46），阴性预测值为78．0％（64／82），准确性为82．8％（106／128）。结论99Tcm-DX显像可以作为临床诊断IL的首要手段．肠道显影是其首要的诊断依椐．

Objective To investigate the image classification and diagnostic value of 99Tcm-DX lymphoscintigraphy in intestinal lymphangiectasia （IL）. Methods A total of 68 patients （the study group） with clinical suspicion of IL from June 2007 to September 2012 were retrospectively analyzed. Using a strati fied sampling method, 60 patients with lower limb lymphedema or chylous ascites （the control group） were selected by age- and gender-matched with the study group. All patients underwent 99Tcm-DX lymphoscintig- raphy. The lymphoscintigraphic findings were classified according to the imaging characteristics in abdomen. The intestinal tract could be shown on the images of 99Tcm-DX lymphoscintigraphy was the diagnostic stand- ard of IL. Results According to the histopathology resuhs, 60 cases of the study group were finally diag- nosed as IL and 8 cases were excluded. Five patterns of 99Tcm-DX images in abdomen were classified as fol lowing： pattern I, consecutive visualization of intestine; pattern , delayed visualization of intestine; pattern accumulation in ascites ; pattern IV, hybrid ; pattern V, negative results. The cases of IVandVin the study group and control group were 19 vs 0, 17 vs 4, 11 vs 13, 6 vs 0 and 7 vs 43, re spectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 99 Tcm_DX lymphoscintigraphy in diagnosing IL were 70.0% （ 42/60 ）, 94.1% （ 64/68 ）, 82.8 % （ 106/128 ）, 91.3% （42/46） and 78.0% （64/82）, respectively. Conclusions 99Tcm-DX lymphoscintigraphy may be an important diagnostic method for IL, and the visualization of intestine is an important evidence for the diagno sis of IL.